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Published by Bupa's health information team, July 2009.
This factsheet is for women considering having breast reduction surgery. Breast reduction surgery involves reshaping and reducing the size of a woman's breasts.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
About breast reduction
Breast reduction (or reduction mammaplasty) is an operation to remove excess tissue and skin from your breasts. Your breasts are then reshaped to make them smaller, and your nipples repositioned. Breast reduction can also be used to even up the size of your breasts if one is much larger than the other.
Breast reduction surgery can relieve the discomfort you may have if you have large breasts, such as:
- back, neck and shoulder pain
- grooves in the shoulders from bra straps
- excessive sweating, rashes and skin infections under the breasts
Many women find it easier to participate in sport and feel happier and less self-conscious about the way they look after the operation.
The structures of the breast
Getting advice about breast reduction
It's important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a reputable surgeon or advise you about choosing which hospital to be treated in.
Before you opt for breast reduction, you should consider the result you hope to achieve, and think about what will fit with your body shape. Some women initially want a radical reduction in size, but this can affect the final shape and appearance of the breasts, so a more moderate reduction may be a better option.
Because breast size alters with body weight, you will be more suitable for surgery if your weight is stable. Your breasts won't grow back after surgery, but they may increase in size if you put on weight or become pregnant.
Preparing for your breast reduction
Your surgeon will give you advice on how to prepare for your operation. For example, if you smoke you may be asked to quit as smoking increases your risk of getting chest and wound infections, and can slow the healing of your wounds, which can leave you with worse scarring.
Breast reductions are usually done under a general anaesthetic. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
Bring in a soft, supportive bra to wear after your operation. Your surgeon will advise you about the most suitable type of bra beforehand.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine. Your surgeon or another healthcare professional will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
Your surgeon will mark your breasts with a pen to show the planned size and shape of the incisions for your operation. With your permission, the surgeon may also photograph your breasts for confidential 'before and after' images.
Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs (this is called deep vein thrombosis).
About the operation
There are various ways to do this operation. Your surgeon will discuss which is the most appropriate for you and explain how your breasts are likely to look afterwards. The operation usually takes two to four hours.
Typically, excess breast tissue will be removed through cuts on the lower part of your breasts and your nipples moved to suit the new shape.
Your skin will be re-shaped and the cuts closed with stitches (which may be dissolvable). Your breasts will be wrapped in a special supportive dressing or support bra.
Fine plastic tubes may be left in each breast for up to 48 hours afterwards. These allow blood and fluids from your breast to drain into a bag.
How breast reduction surgery is carried out
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What to expect afterwards
You will usually need to stay in hospital for two to four days after the operation.
You will be given painkilling tablets or injections to help relieve any discomfort as the general anaesthetic wears off. Your anaesthetist may also prescribe painkillers and antibiotics for the first few days after the operation.
Before you go home, your nurse will advise you about caring for the healing wounds and arrange a date for a follow-up visit. You may have several follow-ups to check on your progress.
If your surgeon has fitted you with a special supportive dressing, this will be removed about a week after surgery. Otherwise you should wear your support bra day and night, as this helps prevent the weight of your breasts pulling on the wound and slowing the healing process.
Your stitches will be taken out after seven to 14 days. If you have had dissolvable stitches, the amount of time they will take to disappear depends on the type you have. They usually disappear in around two to three weeks, but it can sometimes take longer.
Recovering from breast reduction surgery
If you need them, continue taking painkillers as advised by your surgeon.
At your follow-up appointment, your surgeon will give advice about when you can resume your usual activities and return to work. You may need two to four weeks off work, depending on what you do, and you should not do any heavy lifting or exercise for six weeks afterwards.
There is a chance you will be left with small folds of skin at the end of the scar, both between and at the sides of the breasts. You may need to have a second operation to remove these.
What are the risks?
Breast reduction surgery is a commonly performed and generally safe operation. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
These are the unwanted but mostly temporary effects you may get after having the procedure.
After surgery, your breasts will be sore, possibly for some weeks or months. You will have scars, which will be red and slightly raised to start with, but should fade over the following months.
Your nipples may be less sensitive than before. This is more likely if the position of your nipples has been moved during surgery. Depending on the type of breast reduction surgery you have, you may be unable to breastfeed after the operation.
This is when problems occur during or after the operation. Most women are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis).
Specific complications of breast reduction include those listed below.
- Infection - this may need to be treated with antibiotics and sometimes further surgery.
- Haematoma - this is when bleeding occurs inside your breast causing it to swell and become painful. This may require further surgery to stop the bleeding.
- Your wound can be slow to heal. The skin may form a scab that can fall off, leaving a wide scar.
- Rarely, alterations in the blood supply to your breast may result in the loss of part, or even all, of a nipple.
- It's possible that your breasts may not be exactly the same shape and size as each other or that your nipples may not be level after surgery.
The exact risks differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
Breast reduction Q&As
See our answers to common questions about breast reduction, including:
- British Association of Plastic Reconstructive and Aesthetic Surgeons
020 7831 5161
- Reduction mammaplasty. British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 19 February 2009
- Breast reduction. British Association Plastic Reconstructive and Aesthetic Surgeons. www.bapras.org.uk, accessed 19 February 2009
- Breast reduction: inferior pedicle. eMedicine. www.emedicine.medscape.com, accessed 19 February 2009
- Breast reduction (female). Department of Health. www.dh.gov.uk, accessed 19 February 2009
- Smoking and anaesthesia. British Association for Day Surgery. www.daysurgeryuk.org, accessed 18 February 2009
- Venous thromboembolism: Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. National Institute for Health and Clinical Excellence (NICE), www.nice.org.uk, April 2007
- Tejirian T, Difronzo LA, Haigh PI. Antibiotic prophylaxis for preventing wound infection after breast surgery: a systematic review and meta-analysis. J Am Coll Surg 2006; 203(5):729-34
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: July 2009