Having very large breasts can lead to a number of health problems, both physical and psychological. For some, they cause chronic neck and shoulder pain, as well as headaches. For others, very large breasts may lead to poor posture, and ongoing back pain; some women may refrain from participating in sports or exercise because it is uncomfortable. And for some women, the issue may lead to mental health challenges such as depression, anxiety, or low self-esteem.

Breast reduction surgery (what medical professionals call “reduction mammoplasty”) may be an option. The procedure reduces the size and weight of the breasts, thereby relieving pain and other symptoms. In 2018, around 101,000 breast reduction procedures were performed in the United States. 

Outcomes are usually excellent with women reporting greater comfort, improved body image, and better quality of life.  “Our breast reduction patients tend to be our happiest and most satisfied population,” says Paris Butler, MD, MPH. “For many of us plastic surgeons, we view the operation as both reconstructive and cosmetic. We are alleviating the symptoms of back/neck/shoulder pain and rashes under the breast, while simultaneously making the breasts shapelier and placed at a more aesthetically ideal location on the chest."

Breast reduction surgery, reduction mammoplasty, or simply mammoplasty are all names for a surgical procedure to reduce the size and weight of the breasts. During the procedure, a surgeon removes excess breast tissue, fat, and skin to make the breasts smaller. The surgeon also reshapes the breast and relocates the nipple and areola (the dark area around the nipple)—what doctors call the nipple-areola complex (NAC)—so that it is better positioned on the now-smaller breast.

Breast reduction surgery is often used to treat women who have symptomatic macromastia or gigantomastia, conditions in which the breasts are abnormally large relative to body size. 

In order to be deemed “symptomatic,” there must be evidence that the weight and size of the breasts are causing chronic neck, back, and/or shoulder pain, bra notching, skin irritation under the breasts, or a number of other problems.

In general, breast reduction surgery is used to treat women with large breasts who experience any of the following:

• Neck, shoulder, breast, and/or back pain
• Frequent headaches
• Poor posture
• Nerve problems that can cause numbness or tingling in the hands and/or arms
• Rash and/or skin infections under the breasts
• Interference with daily activities and exercise
• Anxiety and/or poor self-esteem
• Difficulty breathing when lying down
• Grooves/notches in skin from bra straps
• Difficulty in finding clothes that fit properly

With these symptoms, as well as documentation, many women can have their breast reduction surgery covered by their medical insurance provider. (Insurance companies may require that patients first try to treat their symptoms with physical therapy, a weight loss program, or other therapies.) 

Women who do not have a medical need for breast reduction surgery (or who are denied coverage by their insurance provider) can still choose to have breast reduction surgery, but would need to pay for it themselves.

Before undergoing breast reduction surgery, it is important to discuss the goals and risks of the procedure with the surgeon. Prior to having surgery, patients should talk to their doctor about their desired breast size. Women who plan to have children should discuss this with their surgeon, since breast reduction surgery may impair their ability to breastfeed.

Women with a family history of breast cancer, a palpable lump in the breast, or other breast cancer risk factors may need to undergo a breast cancer screening mammogram prior to breast reduction surgery. It may be necessary to stop taking certain medications, such as blood thinners, in the days or weeks leading up to the surgery. Because smoking can increase the risk for complications from breast reduction surgery, women who smoke should stop smoking 6-8 weeks before and after surgery.

During breast reduction surgery, patients are given general anesthesia, meaning they will be unconscious and will not feel any pain during the procedure.

Several surgical techniques are used for breast reduction. The surgeon will determine which technique is most appropriate for a given patient. For the most commonly used technique, the surgeon makes an incision around the areola and down the front of breast to the underside of it. The surgeon then removes excess tissue, fat, and skin from the breast, and may cut away some of the areola to reduce its size. The nipple and areola will then be repositioned. Finally, the surgeon uses stitches to close the incisions and reshape the breast.

Liposuction is sometimes also used to remove excess fat from—and to help reshape—the breast. There are several liposuction techniques, but in general, during liposuction a surgeon makes a small incision into which he or she inserts a tube. A special vacuum device is used to suction fat out of the body. In rare cases, breast reduction surgery may involve only liposuction.

Breast reduction surgery carries certain risks. These include complications that may occur with any surgical procedure, such as risk of infection of the surgical wound, blood clots, and bleeding.

Other potential complications specific to breast reduction surgery include:

• Breasts may end up differing in size and shape
• Visible scars
• Inability or reduced ability to breastfeed
• Accumulation of fluid under skin—known as a seroma
• Reduced or loss of nipple sensation—usually temporary, but may be permanent
• Loss of blood flow to the nipple and areola (dark area around nipple), which may lead to tissue loss
• A skin infection (cellulitis)
• Hematoma—buildup of blood in tissue due to a break in a blood vessel wall
• Pain in breasts or arms.   

Serious complications from breast reduction surgery are rare.

Typically, women who have breast reduction surgery can go home the day of the procedure. Sometimes, though, patients need to stay overnight in the hospital.

After surgery, the surgical wounds will be covered with bandages. In some cases, drainage tubes will be connected to the breasts. These drain excess fluid from the breasts and are usually removed within 1 to 5 days. Women may need to wear a surgical bra that fastens in the front or a sports bra 24 hours a day for several weeks while the breasts heal.  

Swelling and bruising around the breasts are common after the procedure and may last for a few weeks. Pain may be managed with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Sometimes, prescription-strength medications are used to control pain.

Stitches will be removed and bandages changed during follow-up appointments. Scars from surgical incisions will be visible, but they will fade over time.

Women who undergo breast reduction surgery usually need to limit physical activity for several weeks. In most cases, women are able to return to work within 2 to 3 weeks after surgery.

Outcomes after breast reduction surgery are usually very good. Studies have found that women who undergo the procedure typically report reduced back, neck, and shoulder pain, fewer headache symptoms, alleviation of skin rashes, and improved posture. They are usually able to exercise more comfortably and can more easily and economically purchase bras. Lastly, after surgery women frequently report improved self-esteem, enhanced body image, and better quality of life.

“Yale Plastic Surgery has some of the most well-trained plastic surgeons in the region, if not the country, who are all board-certified or board-eligible,” says Dr. Butler. “Yale’s Plastic Surgery team will work on your behalf to request coverage of the procedure by your medical insurance provider. We have several surgeons with extensive experience with breast reduction surgery, pre- and post-operative photos will be shown during a consultation, and all questions will be answered.”

To make an appointment, please call us at 203-785-2571.