Dr. Jessica Cho practiced medicine with a single mission: Help patients attain wellness and create a life full of joy, vitality and balance.
Jessica Cho, M.D. Integrative Medicine Updated: Jan 26, 2024, 10:50am Have a question we may not have answered?Ask our editors here
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There are several reasons people would consider breast reduction surgery. For some, it may be for a change in appearance—a lighter, firmer breast that is more proportionate to their body. Others may undergo the procedure to eliminate the physical discomfort caused by heavy breast tissue.
If you are considering a breast reduction, here is what to expect before, during and after surgery.
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Breast reduction surgery—also known as reduction mammoplasty—is a surgical procedure designed to reduce breast size and weight to achieve a desired smaller shape. The process typically includes surgical incisions made to remove excess tissue, skin and fat. The procedure may also include liposuction, particularly if excess skin is not a factor.
Breast reduction may be recommended for the following problems caused by heavy breasts:
Some people who are unhappy with their appearance may also consider breast reduction, due to feelings of self-consciousness or embarrassment.
People assigned male at birth may want a breast reduction surgery to remove the glandular tissue and create a flatter chest contour, adds Adam Rubinstein, M.D., a board certified plastic surgeon based in Miami. This is in response to gynecomastia, a condition that causes enlargement of one or both breasts in people assigned male at birth (due to excess breast or fatty tissue).
An ideal candidate for breast reduction surgery is reasonably healthy, with conditions like diabetes or hypertension under control before the procedure. They should not smoke, and if they do, plan to stop smoking several weeks before the surgery. Anyone seeking a breast reduction should have no uncontrolled cancers, and women over age 40 or with a history of breast cancer should consider a mammogram to screen for abnormalities before the procedure. Patients with a history of scarring, keloid scars or skin discoloration should exercise caution when considering major surgery.
Breast reduction surgery is performed under general anesthesia—medications that make you sleep (lose consciousness) and keep you from feeling pain during the procedure. It is important to have someone that will drive you to and from the surgery because general anesthesia can affect your memory and concentration.
During the procedure, your surgeon removes excess fat or tissue from your breast, repositions the nipple and areola and reshapes the remaining breast tissue and skin to achieve the desired shape.
Different surgical techniques are used during breast reduction surgery. You and your surgeon will discuss the best method for you depending on your health, breast composition, the extent of reduction and desired breast shape. Below are the common techniques performed during this procedure:
“The anchor reduction, or the inferior pedicle technique, allows the most consistent, safest and best cosmetic and functional results because of the ability to remove tissue in three separate areas, as well as giving the patient a significant lift,” says Ronald F. Rosso, M.D., medical director at Peninsula Plastic Surgery in Torrance, California.
It’s named the anchor technique because the shape of the scars resembles an anchor. There is a scar line around the areola, a vertical line down from the areola, and a horizontal line in the fold under the breast, explains Dr. Rubinstein. This is the most common technique used for breast reduction. It gives the surgeon the most control in shaping the breast, particularly with very large breasts, he adds.
“The lollipop technique is also named for the shape of the scars,” says Dr. Rubinstein. “This technique uses a scar around the areola and a vertical line down, a shape that looks like a lollipop.” By eliminating the incisions underneath the breast folds, there are fewer scars, he explains. Dr. Rubinstein also notes that this technique is best for patients that don’t have very large breasts.
“When breasts are large and dense but don’t have much sagging, liposuction can be used to reduce the size of the breasts,” says Dr. Rubinstein. “Liposuction may be used in combination with other techniques as well.”
Liposuction allows for a less invasive surgery with reduced scarring. It is best for people who need only minimal reduction, and for those whose breasts are mainly composed of fat and not excess skin. If your breasts sag, are asymmetrical or a lot of tissue needs to be removed, liposuction would not be the best choice.
It’s important to note that in each of these procedures, the nipple is not removed—it’s just placed in a higher position on the chest. However, people who breastfeed may experience a decrease in milk production and nipple sensitivity for about five years after the surgery.
Like any other major surgery, breast reduction surgery may present with certain risks including:
“The surgery, depending on breast size, lasts from three to four hours and is usually performed on an outpatient basis (the patient goes home on the same day),” says Dr. Rosso.
Showers are okay on the first day after surgery if there are no drains involved in recovery. Otherwise, wait until the drains are removed (after one to five days). Drains are tubes inserted to help remove blood or pus during recovery to prevent fluid accumulation following surgery.
The first few days will include pain and soreness, and your surgeon will recommend pain medications for relief.
The recovery timeline varies for everyone. Your surgeon will give you an idea of how long it’ll take to get back to normal. However, it typically takes between three to six weeks to return to your usual activities, but you’ll feel yourself gradually getting better each day.
It is recommended to sleep on your back in the two or three weeks after surgery. Limit your activities and only do as much as you’re able to do in the first few weeks of recovery—for instance, you shouldn’t drive until you can comfortably wear a seatbelt, you may need help with chores (such as cleaning, shopping, childcare) and can only return to work when cleared by your surgeon (a week or more depending on the nature of your job).
Your surgeon may schedule a follow-up visit one or two weeks after surgery to check your healing and recovery. Arm movement may still be limited depending on how much pain you feel, so you may need help with basic functions like dressing until you’re comfortable. Avoid heavy lifting for four weeks, as well as contact sports or other intense exercises for 12 weeks following your surgery.
It may take about six months to heal fully from surgery. It is recommended to wear a support bra day and night for two months after the procedure to maximize tissue recoil—tissue retracting to fit the desired shape—after surgery. Scars are present as healing progresses and can be managed as recommended by your surgeon.
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Breast reduction surgery is only covered by insurance when it is deemed medically necessary. “If the procedure is a lift only, it may be considered cosmetic and cost ranges from $7,000 to $12,000,” says Dr. Rosso.
Insurance coverage will require proof of treatment history (between six and 12 months) from experts such as physical therapists, chiropractors, dermatologists and orthopedic doctors.
“To gain pre-approval, a combination of pre-operative surgical photos and verification from a primary care physician of the long-term harmful effects of massive breast tissue, which can include severe neck and back pain, tissue breakdown from use of anti-fungal cream and overall harmful documented effects on daily living may be required,” says Dr. Rosso.
Dr. Rubinstein explains that if a breast reduction is covered by insurance, a minimum amount of tissue will need to be removed. “Most insurance companies utilize a formula that requires, on average, 500 grams of breast tissue to be removed from each breast,” adds Dr. Rosso.
It’s best to check with your insurance provider for all the details, as coverage terms will vary.
To find a credible plastic surgeon for your breast reduction procedure, start with a search on the directory of the American Society of Plastic Surgeons, or ask your health care provider for a referral. Find a surgeon who is board certified in plastic surgery and a member of the American Society of Plastic Surgeons. This is important, because the U.S. government does not require that a surgeon have training in the area they want to perform services. In other words, a plastic surgeon who is certified by your state’s medical board may not have training or experience in cosmetic surgery. That’s why it is crucial to ensure that whoever you select is board certified in plastic surgery specifically, and that they have extensive experience performing breast reductions.
Check that the surgeon is highly skilled in breast reduction by asking questions about their qualifications, such as:
If you’ve decided to undergo breast reduction surgery, it’s natural to have concerns, because this is a major surgery. It is advisable to talk to your surgeon about your fears prior to the surgery—discuss the different methods available to you, possible risks and management and recovery measures. This individualized consultation with your surgeon will reassure you and help you have peace of mind prior to the surgery.
