What is breast reduction surgery?

Breast reduction surgery (reduction mammoplasty) removes some of the tissue and skin from the breasts to reshape and reduce the size of the breasts. It can also make the area of dark skin surrounding the nipple (areola) smaller.

Sometimes liposuction is used along with surgery. If most of the breast is fatty tissue and if excess skin isn't a problem, liposuction alone may be enough for breast reduction.

Breast reduction surgery is done in a hospital or surgical center, typically with general anesthesia. The surgery usually takes 3 to 5 hours. An overnight stay is not usually required. For smaller reductions, the surgery may be done with local anesthesia.

Depending on the type of work you do, you should be able to go back to work or your normal routine in 2 to 3 weeks. The incisions leave scars that usually fade with time.

A breast lift (mastopexy) is similar to a breast reduction, except that in some cases only skin is removed. A breast lift can raise sagging or drooping breasts, which is a common problem with large, heavy breasts or sometimes after breastfeeding. It can also raise the nipple and areola.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• For about 2 to 3 weeks after surgery, or until your doctor says it's okay, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child. Do not lift anything over your head for 2 to 3 weeks.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.
• You can take your first shower the day after your drain or bandage is removed. This is usually within about 1 week. Sometimes doctors say it is okay to shower the day after surgery. Do not take a bath or soak in a hot tub for about 4 weeks.
• You will probably be able to go back to work or your normal routine in 2 to 3 weeks. This depends on the type of work you do and any further treatment.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. Take a fiber supplement. If you have not had a bowel movement after a couple of days, take a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. Your doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If you were given medicine for nausea, take it as directed.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If your doctor gave you specific instructions on how to care for your incision, follow those instructions.
• You may be wearing a special bra that holds your bandages in place after the surgery. Your doctor will tell you when you can stop wearing the bra. Your doctor may want you to wear the bra at night as well as during the day for several weeks. Do not wear an underwire bra for 1 month or until your doctor says it's okay to do so.
• If you have strips of tape on your incision, leave the tape on for a week or until it falls off. Or follow your doctor's instructions for removing the tape.
• Wash the area daily with warm water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing.
• You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day. Consider having someone help you with this.

Exercise

• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Your doctor will tell you when to begin stretching exercises and normal activities.

Other instructions

• You may have one or more drains near your incisions. Your doctor will tell you how to take care of them. Drains are usually removed in the first week after surgery.

People who have breast reduction surgery are often extremely satisfied. It can make the breasts smaller, firmer, lighter, and more evenly proportioned. It usually relieves the physical discomfort and pain caused by large breasts.

The results of breast reduction surgery are considered permanent. But the breasts may become larger or their shape may change as a result of pregnancy, weight gain, or weight loss.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Don't smoke. Smoking can delay recovery. Stop smoking for at least a month before surgery. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The most common risks of breast reduction surgery include:

• Scars. Breast reduction surgery always leaves visible scars on the breasts. But how bad the scars are varies from person to person and by the type of incision. Although red and swollen at first, scars typically fade over time. But scars may remain very noticeable in some people long after surgery. Fortunately, the incisions usually can be limited to areas of the breast that can be covered by a bra.
• Unevenly positioned nipples, or breasts that are not the same size or shape.
• Loss of feeling in the nipples or breasts. This is often temporary, lasting a few months. But in some cases, it lasts much longer or becomes permanent. Because some people with large breasts don't have a lot of feeling in their breasts before surgery, this may not be a concern.
• Not being able to breastfeed after surgery. Some people may still be able to breastfeed, depending on what type of reduction was done.

Less often, damage to the breast's blood supply may occur during surgery. This may delay the skin's healing process. Loss of part or all of the nipple and areola can also occur, but this isn't common.

Other risks of surgery include:

• Excessive bleeding during surgery.
• Infection.
• Reaction to the anesthesia.
• Blood clots in large veins traveling up to the heart and lungs (pulmonary embolism). This isn't common.

These risks can be serious or even life-threatening, but they rarely occur.

Right after surgery, gauze is placed over the incisions. The breasts are wrapped in an elastic bandage or supported with a special surgical bra. In some cases, there may be a small tube in each breast to help drain blood and fluid for the first couple of days.

If your doctor closed your incisions with removable stitches, the stitches will be removed in 7 to 14 days.

Most people have some breast pain for the first few days after surgery and then milder discomfort for a week or longer. Medicine can help relieve the pain. Swelling and bruising may last for several weeks. Wearing a surgical bra 24 hours a day can help reduce swelling and support the breasts while they heal.

You will likely resume your normal work and social activities within a couple of weeks, unless those activities involve heavy lifting or strenuous exercise. You may need to avoid more vigorous exercise and activities for 3 to 4 weeks or more. It's important to wear a bra that supports the breasts well, such as a sports or athletic bra.

You will have visible scars on your breasts after the surgery. These are almost always in areas that can be covered by a bra or swimsuit. Scars may fade over time, but they won't disappear.

Breast reduction surgery removes some of the breast tissue and skin from the breasts. This reshapes and lifts the breasts and reduces their size. It can also make the dark area around the nipple smaller. After surgery, you will probably feel weak. You may feel sore for 2 to 3 weeks. You also may feel pulling or stretching in your breast area. Although you may need pain medicine for a week or two, you can expect to feel better and stronger each day.

For several weeks, you may get tired easily or have less energy than usual. You also may have the feeling that fluid is moving in your breasts. This feeling is normal and will go away over time.

If your doctor closed your incisions with removable stitches, the stitches will be taken out in 7 to 14 days.

Your breasts may feel firmer and look rounder. Breast reduction may change the normal feeling in your breast. But in time, some feeling may return.

Keep in mind that it may take time to get used to your breasts after your surgery. You will have swelling at first. But the breasts will soften and develop better shape over time.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• Your doctor will use a marker to draw lines on your breasts. He or she will use these lines during surgery to reshape your breasts.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 2 to 4 hours.
• You may have drain tubes in your breasts.

To reduce the breast size, the doctor first makes one or more cuts (incisions) in the breast. Then the doctor removes extra breast tissue, reshapes the remaining breast tissue, and repositions the nipple and areola. Finally, the incisions in the skin are closed.

Breast reduction surgery is usually done in a hospital or outpatient surgery center. An overnight stay in the hospital isn't needed unless there are problems during surgery. You will probably be asleep during surgery.

Breast reduction surgery is done to change the size, weight, firmness, and shape of the breasts. You may decide to have breast reduction surgery to:

• Feel more comfortable. Large, heavy breasts can cause back and neck pain, skin irritation, and posture problems. The constant pull of heavy breasts may make bra straps leave painful indentations in your shoulders. Breast reduction surgery can eliminate these problems in most cases.
• Reduce the limits that large, heavy breasts place on taking part in sports or other activities. Some physical activities may be painful or awkward if you have large breasts.
• Alter your appearance. Large breasts, especially when they are out of proportion to your height and weight, can be embarrassing. Teens and young adults with large breasts may especially feel self-conscious wearing swimsuits and other types of clothing due to unwelcome attention to large breasts. It also may be hard to find clothes that fit well.