Breast Reduction

A breast reduction, or reduction mammoplasty, is a surgical procedure designed to reshape and reduce the size of the female breast, usually by surgically removing excess tissue, lifting the surrounding skin, and repositioning the nipple-areola complex.

A breast reduction mainly involves the removal of excess skin and tissue through one or more incisions. There are a number of techniques available to help achieve the desired result, and your surgeon will choose a technique based on the volume of tissue to be removed and the severity of ptosis. Breast reduction is similar in many ways to mastopexy (breast lift). One of the most common breast reduction techniques involves the use of an anchor-shaped incision pattern: one incision around the areola, a vertical incision to the breast fold (or inframammary fold), and one along the inframammary fold. This incision pattern allows the operating surgeon the most control over the amount of tissue removed and the repositioning of the nipple and areola, but it is slightly more invasive and can leave visible scarring. It is often used for breasts that are severely enlarged or saggy.

A variation of the anchor pattern involves the use of a “lollipop” pattern that includes a periareolar incision around the areolar border and a vertical incision to the inframammary fold, omitting the horizontal inframammary incision used for the anchor technique. This technique is best suited for removing smaller areas of breast tissue in less severe cases of enlarged breasts. Another variation features only a horizontal incision at the inframammary fold and at the border of the areola. This technique is best suited to women whose breasts are too large to benefit from the lollipop technique. This technique eliminates the vertical scarring of the other techniques but may lead to thicker scarring at the inframammary fold. In each of these cases, the nipple-areola complex (NAC) is transposed higher on the breast, but remains attached to a mound of tissue known as a “pedicle,” thereby retaining its sensitivity and lactating function.

A less popular method of breast reduction is referred to as the free nipple-graft technique, wherein the nipple-areola complex is completely incised from its blood supply and repositioned higher on the breast. This technique is useful for cases when a large amount of breast tissue must be removed, but has the disadvantages of producing a nipple-areola complex that lacks sensitivity and lactating capability. However, some women have found that they regained nipple sensitivity and some lactating capacity after undergoing a breast reduction using the free nipple-graft technique. Nonetheless, this technique is only used in severe and specialized cases, such as in diabetic women and smokers.

When only a medium volume of internal tissue needs to be removed, a liposuction-only method is available. This method is appropriate for women who require only a slight reduction and who don’t need to have any excess skin removed. In such cases, general anaesthesia may not be required, incision scars will be minimal, and recovery times may be considerably shortened.

Breast reduction carries the same risks of any surgical procedure, including scarring, bleeding, infection, and complications with anaesthesia. Patients are advised that while scars should fade over time and are easily hidden by a bra or bathing suit, they may always be visible. Other risks include the potential for lost sensitivity and lactation capability, although your surgeon is highly qualified and will take every precaution in order to prevent this from occurring. Some women with reduced sensitivity following a breast reduction find that they may regain sensitivity after a few months. You may also end up with unevenly positioned nipples, or breasts that are asymmetrical. While every measure is taken to avoid this outcome, every woman heals differently, and corrective surgery may be required in such cases. Patients are also advised that a breast reduction may not be permanent: changes in hormone levels (e.g. during pregnancy) or weight gain may cause future increases in breast size.