Definition and Overview
Also known as breast reduction surgery, reduction mammoplasty is a cosmetic procedure that involves the removal of excess glandular tissue, skin, and fat to make breasts smaller. Although more common among women, it can also be performed on men with gynecomastia.
Before puberty, both males and females have a small buildup of breast tissue. As they enter adolescence, breast changes occur in women due to the increased production of female hormones like estrogen. The lobes begin to branch out more as the breasts are prepared for potential pregnancy and childbirth. Also, as females gain weight, fats can accumulate in these subcutaneous adipocytes, causing the breasts to become larger and heavier.
Hormone changes and increased fat buildup may lead to disproportionately large breasts that can lead to different health and cosmetic problems. One of the possible solutions to such a problem is a breast reduction procedure.
Who should undergo and expected results
Reduction mammoplasty may be performed to:
- Reduce discomfort caused by large breasts – Significantly large and heavy breasts can cause chest and back pain. Some studies also link having big breasts with breathing difficulty, headaches, and severe migraines.
- To boost self-confidence as big breasts can be a source of embarrassment for some men and women.
- To participate in physical activities – Large breasts may reduce a person's endurance, flexibility, and motion.
As a cosmetic procedure, breast reduction surgery is often elective and not covered by insurance. According to the American Society of Plastic Surgeons, the ideal candidates for this procedure are non-smokers, individuals who are of good weight, and physically healthy. It may not be advisable for women with underlying conditions like hypertension and diabetes.
How the procedure works
Prior to the actual breast reduction surgery, the patient meets with the surgeon for a consultation where the following are discussed:
- Expectations – It is important for the surgeon to ensure that the patient's expectations are realistic
- Risks and complications
- Actual surgical procedure and technique to be used
- Cost and financing options
- Follow-up care
- Family and personal medical history including history of previous surgeries and breast cancer
- Medications and supplements being taken
The surgeon will look into the patient's medical records and may request certain tests including psychological exam to ascertain that the patient is in rational mind while making the decision. The surgeon will also assess the breasts and take photographs and scanned images to help him devise the best reduction mammoplasty plan for the patient. A mammogram is also taken before and after the procedure to monitor any changes in the breasts. If the patient is a smoker, she will be advised to stop as soon as possible to increase the chances of quick and uncomplicated recovery. Certain medications may also have to be stopped.
The surgery may be outpatient or inpatient. However, in most cases, patients only stay in the hospital or clinic overnight.
During the actual procedure:
- The surgeon will place markings on the breasts to serve as a guide when making incisions.
- The patient is made to lie down topless on the operating table
- The patient is connected to a machine that monitors the vital signs such as blood pressure and heart rate.
- Anesthesia is delivered usually through an IV line.
- The surgeon applies antiseptic on the breasts before making an incision. The type of incision that will be made depends on factors like the shape of the breasts, the position of the areola and nipple, and the amount of fat and/or skin tissue that needs to be removed. The incision could be circular or around the areola, a keyhole that runs around the areola and into the breast crease, or an inverted T, which includes a circular incision on the areola, then a vertical incision to the breast crease, and another incision underneath the breast crease.
- With the nipple still attached to its nerves and blood supply, the surgeon begins to excise excess fat through cauterization and the use of a scalpel. If necessary, the skin around the areola may also be removed.
- The breasts are then reshaped and the remaining skin tightened to make them appear more youthful.
- The nipples and areolas are moved to a higher position.
- The incisions are closed with sutures before the breasts are bandaged. A compression garment may also have to be worn during recovery.
Normally, a breast reduction surgery takes around two to three hours with one or more surgeons working on the patient. As much as four pounds of tissue may be removed during the surgery.
Possible risks and complications
A breast reduction surgery does not guarantee that the breasts will not return to their normal since it does not deal with underlying causes such as hormonal imbalance or fat buildup.
Also, the surgery can result in visible scarring. The patient is also vulnerable to breast asymmetry, the decreased or complete loss of sensation on the areola and nipples, infection on the wound or incision site, and allergic reaction to anesthesia. Some studies also found that the procedure can affect breast milk production.
- Fisher J, Higdon KK. Reduction mammoplasty. In: Neligan PC, ed. Plastic Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 8.1.