Breast reduction is a commonly sought-after procedure which can drastically improve one’s quality of life. It is designed for women who feel that their breasts are too large for their frame and that the size of their breasts is negatively affecting their lifestyle or creating uncomfortable symptoms.
Like other plastic surgery procedures, breast reduction has evolved over the years. The most recent innovations have focused on decreasing scarring and other side effects. Breast reduction is now a procedure which many women describe as “life-changing”.
A good surgeon will listen to your vision for your body and discuss which breast reduction procedure will give a final result that suits your needs.
Dr. Ginger Xu uses her technical education and understanding of aesthetics to make sure each person’s appearance aligns with their unique identity. Dr. Xu is a Board-certified plastic surgeon with specialty training in aesthetic plastic surgery at Harvard and is now based in the San Francisco Bay area.
A breast reduction (also known as bilateral reduction mammaplasty):
- Removes excess fat, skin and breast tissue
- Raises the nipple and areola to a higher position on the breast – the areola and nipple can also be decreased in size
- Reshapes the breasts – a breast reduction also incorporates a breast lift to improve breast fullness and contour
Women might want a breast reduction for aesthetic reasons, to decrease the size of their breasts, areola, and nipples and to improve the shape of their breasts. For women with large breasts, a reduction can also relieve symptoms and inconvenience related to excessive breast size and weight. These symptoms include:
- Breast pain
- Neck, shoulder and back pain
- Poor posture
- Shoulder grooving from excessive weight on the bra straps
- Rashes under the breasts
- Difficulty with physical activities and sports
Women can also feel self-conscious or embarrassed about their large breasts and have difficulty finding bras and clothing that fit.
Breast reduction is one of the most successful of all plastic surgery procedures, with very high patient satisfaction ratings. It can achieve:
- Immediate relief of symptoms
- Improved posture
- Relief of back, shoulder and neck pain – this occurs in many cases but is not guaranteed
- Ability to participate in sports and physical activity with more comfort
- Improvement of the condition of the skin around the breasts – including a reduction in skin irritation, itchiness, and rashes
- Improvement of shoulder grooving
- Smaller, more shapely and younger-looking breasts
- More self-confidence and self-esteem
- The ability to find bras and clothing that fits
Women who are potential candidates for a breast reduction:
- Have stable body weight
- Are close to a healthy body weight
- Have excessively large breasts and want relief from painful and inconvenient symptoms
- Have excessively large breasts and want to decrease the size and improve the appearance of their breasts
- Have fully developed breasts – this a preference because younger women’s breasts will continue to grow until maturity (approximately 18 years of age)
- Preferably don’t anticipate future weight changes or breast size changes such as those associated with pregnancy and breastfeeding
Cup size is not always an accurate measure or perfectly correlated with how women feel about their breast size. Some women with large cup sizes (eg. a DD cup) might seek out a breast reduction. But for the more petite woman, a more modest C or D cup size can still feel out of proportion with her body and frame and cause symptoms related to overly large breasts.
The best way to find out how breast reduction might help you achieve your goals is to schedule a consultation with Dr. Xu in her San Francisco office.
Different techniques are available for breast reductions, with larger breasts requiring more extensive surgery. While surgical options for larger breasts cause a little more scarring, many women find that the benefit of smaller, more shapely breasts outweighs the inconvenience of scarring.
During a consultation, Dr. Xu will examine your breasts, skin, and nipples and will ask you about your vision and goals before recommending the best technique for you.
The vertical breast reduction can be used for women who need a mild to moderate amount of breast tissue removed. The surgery involves two final scars that look like a lollipop in shape, hence it is also known as the “lollipop reduction”. One scar is around the areola and the second extends vertically from the areola to the crease under the breast. The skin is tightened, the areola is reduced, and the nipple and areola are raised to a higher position on the breast.
This technique gives the surgeon good access to reshape the tissue and improve the projection and contours of the breast. The results of this surgery are stable over time, but it does create a vertical scar that will fade.
The advantage of this approach over the anchor reduction (see below) is that there is less scar burden for the patient. However, it is less powerful in terms of the ability to remove a significant amount of skin. This limits how much a surgeon is able to reshape the lower breasts and lift the nipple position in women with very large and ptotic breasts.
A Wise-Pattern breast reduction is a common technique for women:
- With larger breasts
- With a significant amount of sagging
- Who want a significant reduction in breast size
This approach allows the surgeon better access to remove more skin, fat, and tissue and can give a significant lift for women with larger breasts.
The surgery involves three incisions that create an anchor or inverted-T shape – one around the areola, one extending vertically down to the breast crease, and one extending horizontally along the breast crease. During the surgery, the skin will be tightened, the areola will be reduced, and the nipple and areola will be raised higher on the breast.
This technique creates additional scarring under the breast compared with the vertical reduction technique but has the advantage of giving the surgeon maximum access to remove skin and tissue and reshape the breast. It is important to know that depending on your individual breast shape and size, the length of this additional scar under the breast fold may vary and can be very short and hardly noticeable.
Women with extremely large breasts who require a significant lift in the nipple position may require a free nipple graft in order to reconstruct the nipple during breast reduction. This involves a very small minority of women.
This technique may also be used as a salvage procedure in extremely rare occurrences when there is questionable blood flow to the nipple during surgery.
The free nipple graft technique involves removing the nipple and areola and replacing it in the desired new position on the breast. Women usually lose sensation and function of the nipple. The new nipple may look flatter and a little different than before the surgery, but it does retain the original tissue.
It is very important for you to think about your goal size, and be ready to discuss this with Dr. Xu. There are anatomical limits to how much breast tissue can be removed and Dr. Xu will review these concepts with you so you can arrive at a realistic goal together. It is also important to know that there is no guarantee of the final bra cup size. Bra cup sizes will vary depending on the company, brand, or country of manufacture, and so these terms are used in a general way to give an overall idea of breast size.
You and your surgeon must communicate and work together so you have a good understanding of the recommended process. The goal of a good surgeon should be to arm you with the knowledge to understand the factors affecting your breast reduction.
Dr. Xu can discuss how your age, breast size, breast shape, and skin affects the choice of surgical technique and the results you can achieve. If a large amount of skin, fat and breast tissue needs to be removed, you will need larger incisions.
It is important you have a realistic understanding of:
- How your breasts will look after surgery
- Where your nipples will be positioned
- The limitations of the surgery
- Any short- and long-term effects such as scarring
- Any possible complications
- The potential need for more breast surgery
The breasts are a very sensitive part of the female anatomy and women have different levels of scarring they can tolerate. Dr. Xu can explain which technique she would recommend for your situation and the level of scarring you can expect.
Techniques causing more scarring might have the advantage of giving you a breast shape closer to your goals. Dr. Xu can give you the information you need to weigh up the benefit of more aesthetic breast shape and the level of scarring.
Dr. Xu encourages open and honest communication about your body, your lifestyle and what you want for the future. Photos of your desired look can help her understand your needs. Your medical history is also important, including any information about pregnancies, breastfeeding, weight loss, breast cancer or other medical conditions.
Things to also discuss with Dr. Xu include:
- Any symptoms you experience because of your heavy breasts
- Why you want the surgery
- Your future lifestyle goals
- What appearance you hope to achieve
- What sort of breast shape or form you would like
- Personal or family history of breast cancer
- Anticipated weight fluctuations
- Family planning goals
Most women have some degree of breast asymmetry. But for some women, the difference in size, shape or position of their breasts is significant, causing low self-esteem and other difficulties.
Breast reduction can help improve breast symmetry. In an initial consultation with Dr. Xu, discuss your concerns and she can examine all aspects of your breasts and recommend a plan of action.
Dr. Xu can also advise women whose previous reduction with another surgeon has resulted in some form of breast asymmetry over time.
Yes. A breast lift is always a part of breast reduction surgery. During a breast reduction, breast tissue is removed to decrease breast size. At the same time, breast skin is also removed to reshape the contours of the breast to give a fuller and more pleasing appearance. This results also in lifting the position of both the nipple and the breast.
Some women with large breasts also feel their areolas or nipples are too large or project too far forward. Areolas can stretch as breast size increases, for example after weight gain and loss, pregnancy or breastfeeding.
Areola reductions decrease the diameter and area of pigmented skin. Nipple reductions decrease the projection and width of the nipple while keeping the nerves and milk ducts intact.
In fact, areola reduction is almost always performed as a part of breast reduction. The usual range of desired areola size is from 38–45mm, which is achieved using sterile sizers in the operating room.
Be sure to discuss your specific goals with Dr. Xu prior to surgery so that she can help you achieve your desired appearance.
Symptom relief and cosmetic improvements are both valid reasons for thinking about a breast reduction.
Many women with large breasts have pain, discomfort, and inconvenience related to excessive breast size and weight. A breast reduction gives instant relief from these problems while also improving the appearance of the breasts.
Other women with large breasts might not experience pain or discomfort but still feel inconvenienced and embarrassed about the size and appearance of their breasts. A breast reduction for cosmetic reasons can improve the quality of life.
This is a complex question. While some women with larger breast sizes are more likely to experience painful symptoms, others do not. Size, pain, and discomfort are related to the:
- The skin covering your breasts and chest
- Placement of the breasts on the chest
- Distribution of the weight of the breasts on the chest
- Pull of your breasts on the rest of your frame
Breast size and the likelihood of symptoms is also a question of proportions. While a C or D cup size might be considered a good size for a larger woman, it can cause symptoms and inconvenience for a petite woman because her breasts are out of proportion with her smaller frame.
A breast reduction can be appropriate at any age, as long as you are healthy.
As age increases, women need to think about a number of factors that might impact their breast reduction including that:
- Sagging or drooping of the breasts increases with age so a more extensive surgery might be needed to correct this
- More extensive surgery creates more scarring
- Wound healing changes with age
- The skin may be thinner or weaker
- The body takes longer to recover
Younger women need to think about their future before committing to a breast reduction. Dr. Xu prefers to perform breast reductions for women who have reached physical maturity (approximately 18 years or older). If surgery is done before that time, the breasts may continue to grow and this will affect the long-term results of the surgery.
Younger women might also want to consider the function of the breast after surgery – especially breastfeeding and nipple sensation. During the reduction and lift, the surgeon will shape the breast tissue while aiming to maintain the structures of the breast such as milk ducts, blood vessels, and nerves. The amount of function retained after surgery depends on the technique used for the surgery as well as variations in individual anatomy, and so no guarantees can be made regarding nipple sensation and function after surgery.
If nipple sensation is decreased, most women slowly regain sensation in their nipples with time. It can take up to a year for full sensation to return. In rare cases, women permanently lose sensation in their nipples.
If younger women think they might want a family in the future, they should take into account that their breast size will change with pregnancy, breastfeeding, weight gain or weight loss. Younger women might want to consider delaying breast reduction and waiting until the skin has settled down after pregnancy, breastfeeding or weight loss.
Both pregnancy and weight loss affect the abdominal area as well as the breasts and can leave women with excess sagging skin and stretch marks on the abdomen.
After pregnancy or significant weight loss, women might want a breast reduction and surgery to their abdominal area (tummy tuck). These two surgical procedures are the foundation of surgery for women after pregnancy (mommy makeover) but can also be suitable for women who have had significant weight loss.
A breast reduction can be performed at the same time as a tummy tuck. There can be competing forces due to the pull of the torso skin in different directions, and this must be considered during this type of surgery. When combining surgeries, it is important to find a surgeon with experience in complex techniques of cosmetic plastic surgery. Dr. Xu is a Board-certified plastic surgeon who has trained extensively, including completing an Aesthetic Plastic Surgery Fellowship at Harvard.
In addition to breast reduction, some women would like to improve their overall look with additional body contouring around the chest and torso. Dr. Xu will examine your entire body with an artistic eye and let you know if liposuction can enhance your results.
Areas that can be shaped and contoured with liposuction during a breast reduction include the:
- Outer region of the breast – liposuction on “bra side rolls” can improve the contour of the whole breast and chest area
- Armpit – liposuction of armpit fat (also known as an axillary roll)
- Back – liposuction of fat from back rolls
- Abdomen – liposuction in this area can be done alone or as part of a tummy tuck or mommy makeover
Women who have breast reduction surgery are among the people who are most satisfied with their plastic surgery.
But there can be complications, especially if a poor surgical technique is used. A good surgeon must carefully consider all factors affecting the choice of surgery and then create the ideal surgical plan and enact the plan with precision.
Common pitfalls for breast reduction surgery include:
- The nipple is positioned too high on the breast and points upwards (pseudoptosis)
- The wound opens along the incision and the scar thickens – this can be caused by increased tension on the wound when insufficient skin remains to cover the reshaped breast
- “Dog ears” or skin bulges at the corners of the incisions
- Boxy or non-aesthetically pleasing breast shape
Dr. Xu believes in focusing on understanding each person’s goals and respecting their personal history, anatomy, and vision for the future. Her combination of surgical expertise and sense of artistry can optimize your results by:
- Recommending the correct surgery – Dr. Xu will take into account your anatomy and the condition of your skin and breasts and let you know what type of breast reduction surgery will give the desired results
- Decreasing the risk of scars spreading or thickening – Dr. Xu will make sure that the wound closure is not too tight or too loose and that there is a good balance of skin to breast volume
- Taking steps to minimize anesthesia time during surgery as well as swelling, pain, and scarring after surgery
If you would like to know more, contact our San Francisco office to schedule a breast reduction consultation.
Dr. Xu understands the responsibility of transforming a woman’s appearance to better reflect their identity and build self-esteem. Her top priority is understanding your vision and needs.
Once Dr. Xu has examined your body, breasts, and chest, she will use her artistic sense and technical expertise to recommend an approach to your surgery that will best suit your goals.
During a consultation, Dr. Xu will explain:
- The different types of breast reduction techniques
- Which breast reduction options will best suit your needs
- Why your exact final breast size cannot be guaranteed
- What types of incisions will be needed
- How much scarring you can expect
- How other surgeries (eg. tummy tuck, mommy makeover) can fulfill your vision for your future body
- Any potential need for further breast surgery
- Potential complications or side effects – nipple sensation and ability to breastfeed may be affected
- What to do during the recovery period
Once you and Dr. Xu have agreed on an approach to your surgery, she will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least 6 weeks prior to surgery.
You may need to get a blood test or undergo additional workup depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare include:
- Making sure you get enough sleep and rest
- Eating a healthy diet with adequate protein and nutrition
- Exercising or engaging in physical activity to strengthen your body
- Maintaining a positive state of mind
Prioritizing your well-being and reducing stress levels
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.
After your breast reduction surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on a number of factors such as:
- The type of breast reduction surgery used
- Whether you have had other surgeries completed at the same time (eg. tummy tuck)
- Your age
- Your health before the surgery
Prescription pain medications might be needed for the first few days. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
Recovery typically takes approximately two weeks. During this time, you should avoid lifting any heavy weights. Once bruising and tenderness have gone, you can return to normal activities. Most women can return to work after a week, but strenuous exercise should be avoided for four to six weeks. Ask Dr. Xu when you can return to the full range of activities.
If you have had a combination of surgeries, such as a tummy tuck and breast reduction, Dr. Xu can advise you of any additional recovery needs.
Before you commit to breast reduction surgery, a good surgeon will make sure you understand and accept all the implications of the surgery. This includes the potential for scarring. Dr. Xu will explain what will affect the amount of scarring you will experience including:
- The type of breast reduction surgery
- The condition of your skin – thin or stretched skin or a lot of excess skin can affect surgical technique
- Your skin type – some people are born with skin that scars more easily
Dr. Xu uses surgical techniques to decrease the risk of scars spreading or thickening. Scars never disappear but they will fade and become less obvious with time.
Dr. Xu typically does not recommend this procedure. Its use is limited and highly dependent on anatomy, breast density, and the amount of excess skin.
While the technique will remove fat, it will not lift the breasts and so women with sagging or drooping breasts will not see any improvement in the appearance of their breasts.
If only a modest reduction is requested with no need for a lift (no skin excess), and the breast is mostly fatty tissue (rather than glandular), this technique could be considered.
When women wake up from breast reduction surgery, they usually feel immediate relief of symptoms related to their formerly heavy breasts.
Breast swelling from the surgery takes from weeks to months to settle. Some minor changes will be ongoing until your final shape becomes obvious after a year or more. Over time, the lower part of the breast will relax and the skin will expand to create a more natural tear-drop shape. During this settling in period you can expect the scars to fade.
Once the shape of your breasts has settled, your breasts should be stable for many years. Women thinking about a breast reduction should keep in mind that gaining weight will increase the breast size and stretch the skin. Pregnancy and/or breastfeeding will also cause breast changes that can affect long-term results.
With time, your skin will continue to age normally and your breasts will continue to change naturally. Many women consider this an acceptable part of aging and do not wish for more surgery. Dr Xu will follow-up with you to make sure your breasts are in good shape and if you are thinking about more surgery, she can give you appropriate advice.
After breast reduction surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on the type of surgery you had, your age and your overall health. Prescription pain medications might be needed for the first few days. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
Most breast reduction techniques leave women able to breastfeed, but you may not produce as much milk. Women who have free nipple reduction will not be able to breastfeed. If you can’t produce enough or any milk, you will have to use formula to feed your baby. If you are concerned, you might want to wait and have a breast reduction after you have finished breastfeeding.
Most modern breast reduction techniques are less likely to impact nipple sensation. If sensation is decreased after a breast reduction, most women slowly regain sensation in their nipples with time. It can take up to a year for full sensation to return, although in rare cases, women permanently lose sensation in their nipples. Women who have free nipple reduction usually lose all sensation in the nipple.
Even with the scars, the benefits of a breast reduction mean many women describe the surgery as a “life-changing” experience.
The position of scars depends on the type of breast reduction surgery you choose. A scar around the areola will be camouflaged in the darker skin of the areola, the vertical scar will fade and the scar under the breast is hidden or partially hidden. A bra or swimsuit will hide any scars.
Scars will appear red or pink and slightly raised until they begin to heal and become less noticeable over time. Scars will heal at different rates (up to 18 months) depending on your age, skin type, skin tone and exposure to the sun.
After the standard recovery time of four to six weeks, a swimsuit with a bikini top may irritate if you have scars under the breast. Underwires can irritate healing scars and should be avoided until your scar is not tender to the touch. Sun and water exposure should also be avoided while your scar is healing. Ask your surgeon when you can safely wear a swimsuit and enter the water.