Plastic surgeons have long known that women who undergo breast reduction surgery tend to be very satisfied with their results, despite scarring potential and other risks associated with any surgery. For women with excessive breast tissue who suffer neck, shoulder, back pain or if they have a major disproportion affecting their body image, breast reduction surgery can bring wonderful relief. Several large studies over the last 10 years have confirmed surgeon’s impressions of patient satisfaction through outcome assessments including multiple self-esteem measurements. 

Women with large breasts can experience deep grooving in their shoulders from bra straps, an uncomfortable pulling sensation on the chest, inability to wear many clothing styles, inability to exercise comfortably, and rashes under the breasts. 

Breast reduction, one of the most common plastic surgery procedures, is a safe out-patient procedure. After consulting with a plastic surgeon and deciding to proceed, the patient is seen preoperatively for photographs, followed by detailed planning of the surgery to achieve the ideal outcome. Utilizing preplanned markings to assure the desired result, the skin and excess breast tissue is surgically reduced, mostly from the lower portion of the breast so that the resized breasts can be positioned upward and remain more elevated. The nipple and areola are carefully preserved to maintain good blood flow and sensation, and then positioned upward on the newly shaped breast. The breast is carefully shaped to create a more youthful and lifted appearance. Incisions are typically located around the nipple, from the areola down to the fold beneath the breast, and sometimes within the fold beneath the breast.

To optimize symmetry, the tissue removed from each breast is weighed during surgery, which along with pre-surgical photographs and skin markings helps to ensure the closest match of the two breasts. No two breasts are exactly equal before or after surgery. The tissue is typically sent for examination to be sure no abnormalities are present.

Post-surgery, a soft support bra is worn for 2-3 weeks.  Occasionally, a small plastic drainage tube is used to lessen accumulation of fluid, and removed 1-2 days after surgery. 

As with any surgery, there are risks to be discussed fully prior to surgery. The patient should ask all questions to achieve as complete an understanding as possible prior to proceeding. Scarring is inevitable but all efforts are made to minimize the scars. While some permanent decrease in nipple sensation is possible, sensation usually returns but may take up to two years.

Patients are encouraged to breast feed and can usually do so successfully after breast reduction, although, the ability to nurse may be lost.  

Most patients report minimal pain after breast reduction, but typically experience tightness or fullness for several days, gradually improving over the first 1-2 weeks. The usual schedule of recovery is: Bruising and swelling, 2-3 weeks; return to work & social activity, 7-10 days; aerobic or strenuous activity, 3-4 weeks. 

Women of any age from 16-60+ can undergo breast reduction. In the December 2011 issue of the Plastic and Reconstructive Surgery Journal, a large review of women who underwent breast reduction at the Johns Hopkins Medical Institutions found that women over 50 experienced a greater rate of complications, specifically infections. The authors speculated that hormonal deficiencies in this age group may have some effect. They raised the question of hormone replacement therapy as a risk-reducing consideration specifically regarding infection and wound healing.  

Happily, the great majority of women who undergo breast reduction are extremely satisfied, often with immediate reduction in physical discomfort and achievement of a better proportioned figure. Broader wardrobe choices follow, and women can often participate in activities and sports that were previously off limits.

David J. Levens, MD, PA, FACS, has been in practice in Coral Springs for 22 years and is a graduate of MIT and Columbia University-College of Physicians and Surgeons. He is certified by the American Board of Plastic Surgery and has been named a Top Doctor in Castle Connolly’s national ratings for 2010 and 2011. 954.752.1020 / www.DrLevens.com.