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Breast Reduction (Reduction Mammoplasty)

What Is It?

Breast reduction is an operation that reduces the size of the breasts, and usually incorporates an uplift procedure that tightens the skin envelope and reduces the size of the areola (the pigmented skin around the nipple). Women with large breasts frequently experience neck and shoulder discomfort and indents from the heavy pulling through the bra straps. Because they are usually self-conscious about their large breasts, these patients often have poor posture, walk with a slouch and have secondary back pain.

Some large-breasted women also experience pain in their breasts when jogging, in spite of the use of sport bras. Others develop heat rashes beneath their breasts. They find it difficult to buy clothes that fit, and many feel they do not look attractive. These are all reasons to consider a breast reduction.

It is recommended that young women wait until they have reached full breast development (usually by age 15 to 16) before considering breast surgery.

With the newer breast reduction surgery techniques, about 75% of women will have normal nipple sensation, and the capacity to breastfeed. However, this cannot be guaranteed. If normal nipple sensation and the ability to breastfeed are important to a woman, she should give further thought before going ahead with surgery.

Mammary hypertrophy (large pendulous breasts) is frequently considered a medical problem, and all or part of the surgery may be covered under OHIP.

Patient Examples

Click on any photo for larger version and more views of that patient.

Before Surgery Consultation

Dr. Neu will carefully review the patient’s general health, and discuss the specific symptoms experienced as a result of having large breasts. The breast cup size, body weight and height are all assessed in interpreting the proportions that would best suit the patient. It is important to realize that being overweight can contribute to large breasts, and it is advisable that patients be within 15 to 20 lbs. of their stable, if not ideal, weight. If a patient loses more than 20 lbs. after a breast reduction, they may find that their breasts will also become smaller.

Once it is determined that a patient is a good candidate for surgery, Dr. Neu will review the advantages and disadvantages of the standard breast reduction, and the more recently popularized vertical breast reduction. In both operations, there is a scar around the areola, and a vertical scar between the areola and the crease beneath the breast. With a standard breast reduction, there is also a scar from side to side in the fold beneath the breasts. Many women nowadays prefer not having the scar beneath the breasts because it stretches substantially more than the other breast scars.

A vertical breast reduction also tends to give more of an uplift, and leaves more fullness in the cleavage area. Disadvantages of the vertical breast uplift are that the degree of reduction is slightly less than with a standard breast reduction, the surgery usually requires contouring with liposuctioning (not covered by OHIP), and there can be tether points and skin irregularities that take longer to even out than with a standard breast reduction. Also, some women with very loose saggy breasts are better suited to a standard breast reduction, where there is more skin removal. Today, more women choose to have the vertical breast reduction than a standard breast reduction.

For some women, the issue is not the size of the breasts, but rather that they look large and shapeless because they are stretched out and droopy. These women are better served with a breast uplift (mastopexy) than an actual reduction procedure.
(Please see section on Breast Uplift).

It is important to realize that there is a body proportion between the breasts and the abdomen (tummy). If the breasts are made smaller, the tummy may look proportionately larger. It is not uncommon for women who have a breast reduction to also consider having a tummy tuck.

The Surgery

Breast reduction is typically done by Dr. Neu as a day surgery procedure under general anesthesia. Careful markings are made on the breasts prior to surgery. Once the patient is asleep, the breasts are infiltrated with a long-acting anesthetic, which minimizes discomfort when the patient wakes up. (Medical reports now confirm that patients who wake up with little pain have much less total pain from surgery, and therefore have a much lower requirement for pain pills.)

During surgery, every effort is made to make the breasts as proportionate and natural looking as possible, keeping in mind the size of breasts that were requested preoperatively. However, blood supply to the tissue determines how much breast tissue can be removed. There is a limit to how much a breast can safely be reduced. The breast tissue removed is weighed and sent off for biopsy analysis. The breasts are made as symmetrical as possible, but it is important to note that breasts normally have some asymmetry. Liposuction will be used when it improves the shape and size of the breasts, and can also be used to remove excess fat from the sides beneath the armpits.

All incisions are closed with invisible mending sutures underneath the skin to give the best possible scars. No staples are ever used.

Resumption of Activity

Most patients after a breast reduction resume sedentary work within two weeks of surgery and sports within three weeks of surgery.