Breast Reduction

What is breast reduction (reduction mammaplasty)?

Women with large breasts can have neck, shoulder, back and breast pain. Additionally, women may also suffer from bra strap grooving or rashes under the breasts due to large breasts. Breast reduction is a surgical procedure that removes excess skin, fat, and gland from the breasts to reduce the size of the breasts and alleviate these symptoms.

Who is a suitable candidate for a breast reduction surgery?

The ideal candidate for breast reduction surgery is in good physical health and has a stable weight. A candidate’s typical concerns would symptoms including neck, shoulder, back and breast pain. Additionally, the patient may also suffer from bra strap grooving or rashes under the breasts due to large breasts.

The aims are to achieve a breast size that is more proportional to your body frame and alleviate the symptoms and discomfort associated with oversized breasts. All women have natural asymmetries in their breasts, and these will be discussed with you. Where possible the differences in the breasts may be reduced, though perfect symmetry is never guaranteed. An added benefit of breast reduction is to raise a fallen nipple to a more youthful position on the front of the breast.

Breast reduction places permanent scars on the breasts, and the amount and location of the scars depends on the type of breast reduction and the volume of reduction.

What is done during surgery?

Several breast reduction techniques exist, and your surgeon will discuss which would best achieve your goals given your breast size, shape, and the extent of ptosis present. Breast reduction may be combined with liposuction to achieve a more desirable contour and shape of the breasts and chest wall.

In the preoperative area, surgical markings are drawn on the breasts to plan the operation. Two major approaches exist, based on different scar patterns. A variable portion of the skin is removed, allowing the nipple and areola to be repositioned. The procedure also involves removal of breast tissue to decrease the weight of the breasts and help relieve symptoms. Surgical drains may or may not be necessary after breast reduction. A dressing is applied to the surgical site and a bra is usually worn for several weeks after surgery.

Where is the surgery performed?

All surgeries are performed at Women’s College Hospital as day surgery by the plastic surgery senior resident under the supervision of a faculty plastic surgeon.

What to expect in the recovery? How long will I be off work? When can I resume exercise?

The procedure itself can take from 1 to 3 hours depending on how much work is required. Breast reduction is performed as day surgery. Specialized skin tape and/or a bra will be applied at the end of your surgery. After the operation you will be brought to the recovery room, and medications will be given to help relieve any pain or prevent nausea. You will be discharged home with a prescription for pain medication, postoperative instructions and a follow-up appointment. For the best results, you should plan on resting and taking it easy after surgery. For the first few days after surgery, most patients experience some discomfort at the surgical site. Pain should generally subside after one week, and it is normal to experience some minor oozing around the incisions. After which you will starting feeling better and returning to your normal self. Recovery from the surgery varies between individuals and the specific procedure performed.  Swelling and bruising in the area of the surgery will be present and generally begins to improve about 1 week after surgery.  You should plan on being off work for 1 week. During your recovery, you should refrain from strenuous physical activity including lifting and pulling for 6 weeks following surgery.

Where are the scars?

As plastic surgeons, we realize the importance of the cosmetic outcome.  We will make every effort to optimize the scar size and conceal it in the least visible area of the breasts. In many cases, it is possible to perform breast reduction and improve the appearance with very little scarring. Breast reduction scars vary depending on which technique is performed. The most common patterns are:

  • Vertical – around the areola with a vertical portion extending to the breast crease. This is also referred to as a “lollipop” scar
  • Inverted-T – around the areola with a vertical line to the breast crease, and extending horizontally in the breast crease

It is important to realize that scar formation varies between individuals and is highly dependent on a person’s genetic predisposition.  Scars typically fade over time but their final dimensions and colour are difficult to predict.  At the consultation, the plastic surgeon will talk to you about this.

What are some common complications of surgery?

Complications of breast reduction surgery, like those of other cosmetic procedures, are uncommon but may include unfavorable scarring, asymmetries, bleeding, infection, swelling and numbness. Specific to breast reduction surgery, risks including recurrence of the size or sagginess and the rare possibility of loss of feeling or skin loss or nipple loss can occur. In some cases, patients do not experience relief of their symptoms following breast reduction surgery. Your plastic surgeon will speak to you in greater detail about expected outcomes including potential complications.

When will I see the final results of the surgery?

An improvement from breast reduction surgery should be apparent immediately after surgery; symptoms improve soon after surgery. The appearance of the breasts will continue to improve over 3 to 6 months as incisions heal and swelling resolves. Scars mature over time, and will become fainter and lighter up to one year after your operation.

What does breast reduction cost?

A referral from you family physician is required for a consultation for breast reduction. Breast reduction surgery is covered by OHIP but requires application and preapproval by OHIP before surgery. Some techniques for breast reduction require liposuction and this is not an uninsured service; liposuction is not covered by OHIP. In this case, the patient is responsible for the associated costs.