Breast reduction
Introduction
Female breast reduction, also known as reduction mammoplasty, is a surgical operation to reduce the weight and volume of the breasts. During the procedure, fat, glandular tissue and skin are removed from the breasts, which are then reshaped and the nipples repositioned.
Breast size is determined by genes, hormones, body frame and weight. For most women, breast size is proportionate to the body, but for some, the breasts are particularly large.
Large breasts can cause physical symptoms such as:
- discomfort
- backache
- neck pain
- skin irritations
Large breasts can also cause psychological distress. Common complaints from women with large breasts include not being able to wear fashionable clothes and finding it difficult to take part in active sports.
Breasts are particularly sensitive to the hormone oestrogen. They can grow particularly large during adolescence or later in life following the menopause or because of the use of hormone replacement therapy (HRT). Some women also develop a noticeable asymmetry (difference in size or shape) between their breasts.
Breast reduction surgery can help women who are unhappy with the shape, weight or droop of their breasts by making them smaller and more lifted. However, breast size alters with body weight, so even after surgery, your breasts may increase in size if you put on weight or become pregnant.
Availability on the NHS
Because breast reduction is usually done to improve appearance rather than health, it is not normally available on the NHS.
The NHS will not pay for surgery for cosmetic reasons alone. To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have to have a consultation with a plastic surgeon and possibly an assessment by a psychiatrist or psychologist. They will then consider whether there is enough social, psychological or physical benefit to justify surgery, for example if your breasts are causing you significant pain or mental health problems.
The final decision is usually made at a meeting by a panel run by your Health Board. The panel will take into account the information from your assessments and review your individual case.
For information on Male breast reduction see Why should it be done
Find out more about Cosmetic surgery
^^ Back to top
Why should it be done?
You may consider having a breast reduction operation if you have physical discomfort or psychological distress due to having large breasts.
Physical problems may include:
- backache
- neck pain
- shoulder ache
- skin irritation
- poor posture
- excessive sweating, rashes and skin infections under the breasts
- weals or grooves in shoulders from bra straps
- an inability to exercise or take part in sports
Psychological distress can be
- unwanted attention or harassment
- self-consciousness
- difficulty finding clothes that fit
- depression
For both women and men, breasts can become large due to fatty deposits within them. Losing weight by eating a healthy diet and doing regular exercise may help reduce the size of your breasts without the need for surgery.
Male breast reduction
Causes of male breast enlargement
Enlargement of male breasts is known as gynecomastia. Large breasts in men are often believed to be a result of obesity, but this is not the only cause. Men, like women, can have an abnormal growth of glandular breast tissue, usually due to a hormone imbalance.
Other causes of enlarged male breasts include:
-
excessive alcohol intake
-
use of certain drugs, particularly anabolic steroids
-
certain diseases, such as liver failure and cancer
-
congenital abnormality (a problem from birth)
-
dramatic weight loss, which can cause the skin to sag
For men who feel self-conscious about their appearance, breast reduction surgery may be considered to flatten the breast area.
Before surgery
When breast enlargement is due to obesity, poor health or excessive alcohol intake, breast size may be reduced through healthy eating and regular exercise. Consult your doctor and consider all your options before choosing to have breast reduction surgery.
Procedure
Male breast reduction surgery usually takes an average of one hour. The surgeon will make an incision around the areola and liposuction may be used to suck out excess fatty tissue. If there is a lot of tissue to remove, cuts may extend down the chest from the areola and the nipples may need to be repositioned.
You will be required to stay in hospital overnight, take a few days off work to rest and avoid lifting or strenuous physical exercise for one month after the operation. An elastic garment also needs to be worn for one to four weeks after the operation to encourage smooth results.
Results
Male breast reductions are usually required to reduce the size of the breast area and give a flattened shape.
Results are permanent but weight gain, hormonal imbalances and the use of certain drugs can cause the breast area to enlarge again.
Risks
Surgery can leave red and lumpy scars. These may last for several months but should eventually fade to your natural skin colour. Other risks include uneven results and loss of sensation in the nipples.
^^ Back to top
Considerations
Things to consider
Breast reduction should only be considered by women who have taken medical advice from a qualified cosmetic, plastic or breast surgeon.
Many patients gain a better quality of life following a breast reduction as symptoms, such as back pain, are often dramatically reduced. However, any kind of surgery, including breast reduction, should not be undertaken lightly. You may feel it will improve your appearance and quality of life but it can be expensive and time consuming and, as with any form of surgery, there are a number of risks.
The decision to have a breast reduction should only be taken after a lot of careful thought and questioning.
Do your research
If you feel that you will benefit from a breast reduction, it is important that you are as well informed as possible.
Talk to your GP to get information and general advice on the procedure, and look into the surgeons, hospitals and clinics that perform breast reductions.
Your GP should refer you to an appropriate surgeon who can discuss your problems, examine you and advise you about the options available, along with their advantages and disadvantages.
Do not be nervous about asking for information from your GP or a surgeon. You will need to ask questions that can help you get all the details you need to make an informed decision on whether surgery is right for you.
Choosing a surgeon
Surgeons who are trained in general surgery should have FRCS (Fellow of the Royal College of Surgeons) after their name. Surgeons trained in plastic surgery in the UK will usually have FRCS(Plast) after their name.
Doctors who are also considered to be suitably trained are listed on the specialist register kept by the General Medical Council (GMC). You can find out if a doctor is on the specialist register by calling the GMC on 0845 357 0022. The register does not tell you what the doctor is a specialist in.
Before choosing a surgeon, find out about their experience of doing breast reductions and make sure you meet them before committing to surgery.
When you find a surgeon, be honest and clear about your expectations of the procedure and find out if a breast reduction can really give you the results you want. A surgeon should provide full details of the procedure before you decide to go ahead with it. Expect the consultation to take half an hour or longer.
Expected results
It is important to discuss the results you expect from surgery with your surgeon. Sometimes, a very radical reduction will alter the shape and look of the breasts. There will be scarring and sometimes also a loss of nipple function and sensitivity.
For women with very large breasts, the benefits of a reduction may outweigh any potential imperfections. For women with only moderately large breasts, the benefits may not be worth the potential risks and side effects.
Your breasts can still change in size and shape after surgery. They should not regrow, unless the operation is done at an age when your breasts are still growing, but they can increase in size if you put on weight or become pregnant. They can also decrease in size if you lose weight. Normal breasts also have a tendency to droop over time.
Arranging for surgery outside the NHS
You will be asked to sign an agreement form before having your breast reduction procedure. Make sure you understand and are happy with the agreement before you sign.
The agreement should include details of cost. Make sure you understand what this covers, especially in terms of aftercare and any revision surgery (surgery to treat any complications or problems) that may be needed. There may also be financial penalties if you decide to cancel the agreement.
Your records
The provider of your procedure, a private clinic or hospital, will keep a record of your treatment that may contain before and after photographs of you. Think about whether you would mind the provider showing these to other potential patients. The provider should ask for your consent before showing any part of your records to other patients.
Surgery abroad
Cosmetic surgery, such as breast reduction, may be cheaper abroad than it is in the UK. However, this needs to be weighed up against the cost of travel and accommodation and any follow-up or revision surgery that may be needed.
The Care Standards Inspectorate Wales, which inspects organisation providing private healthcare in Wales, does not cover procedures abroad and will not be able to help if you experience any problems. If you are not confident that the procedure you are having is safe, it could end up being more costly in terms of risk, pain, revision surgery and aftercare.
The cosmetic surgery checklist
1. Think about the CHANGE you want to see. Find out about the treatment you want and be precise as to the change you hope to see and why.
2. CHECK OUT potential surgeons. Make sure you find a surgeon with the right qualifications who is on the specialist register with the GMC and has experience of doing the procedure you want. Make sure you meet them before committing to surgery.
3. Have a thorough CONSULTATION. Your surgeon should discuss your treatment options with you and then plan your treatment. Make sure you know the risks involved with the procedure and the likely results.
4. COOL OFF before you commit. You need to be confident in your decision to have cosmetic surgery. After an initial consultation with a surgeon, take some time to think about whether the procedure is right for you and if you are happy with the surgeon who will be treating you.
5. CARE about your aftercare. Aftercare can be just as important as your actual surgery, so make sure you know how you will be looked after, especially if there are any complications following surgery.
Further detail on "The Five Cs" cosmetic surgery checklist can be found on the BAPRAS website.
^^ Back to top
How is it performed?
Before the operation
You will be asked to undergo some general health tests before your operation to check that you are fit to have surgery.
If you smoke, you may be asked to quit in the weeks before your operation. This is because smoking increases your risk of chest and wound infections and can slow the healing of your wounds, leaving you with worse scarring. Being overweight can also slow the healing process, so if you are overweight you will be encouraged to lose weight before your operation.
If you take the oral contraceptive pill or hormone replacement therapy (HRT) your surgeon may advise you to stop taking it a few weeks before the operation because they can increase the risk of developing deep vein thrombosis ( a blood clot in a leg vein). Also avoid aspirin and anti-inflammatory drugs.
Before your operation, you will be asked to sign a consent form. This is to confirm that you understand the risks, benefits and possible alternatives to the operation.
The operation
Breast reduction surgery is usually done under general anaesthetic (when you are asleep). You will be asked to follow fasting instructions before your operation. Typically, you cannot eat or drink for six hours before having the anaesthetic.
Surgery takes between one-and-a-half and three hours. You are usually required to stay in hospital for one or two nights. The aim of surgery is to create a natural shape and retain as much function and sensation in the nipples as possible.
The surgeon will use a pen to mark areas of the skin where the incisions (surgical cuts) will be made. With your permission, the surgeon may also photograph your breasts for confidential before and after images for your records.
Most breast reduction surgery begins with the nipple, which is moved to its new position, usually while still attached to the blood supply. If you have extremely large breasts, the nipples may be removed and repositioned as a skin graft. They will develop their own blood supply.
Excess skin and breast tissue are then removed. The remaining breast tissue is reshaped to create smaller and more elevated breasts.
Breast reduction techniques
There are various different ways to do a breast reduction. Your surgeon will decide which is most appropriate for you depending on the size of your breasts and the desired outcome. Techniques include:
- Anchor type or inverted T reduction: the most common type of breast reduction, this results in an anchor-shaped scar starting around the nipple, travelling vertically down and then horizontally across the breast crease.
- Vertical pattern breast reduction: this results in a circular scar around the areola, the brownish or pink ring of tissue surrounding the nipple, and a vertical scar passing downwards. This technique has the advantage of leaving no scarring under the breast but is not as effective and reliable when dealing with large breasts and may take longer to heal.
- Circumareolar reduction: this only results in a circular scar around the areola. This technique is only suitable when removing a small amount of tissue.
^^ Back to top
Recovery
After surgery
When you wake up after having breast reduction surgery, your breasts will be bandaged and plastic tubes may be attached to your breasts to drain blood away. Some patients bleed a lot and, in rare cases, a blood transfusion may be required to replace lost blood.
After one to two days the tubes will be removed and you should be able to go home. You may experience some pain for a few days, which can be relieved with painkillers.
Getting back to normal
Once you have returned home, depending on your age and general fitness, you will need to rest for two to six weeks. The length of time you need to keep the dressings on will depend on how quickly your wounds heal. After one to two weeks, your stitches will either dissolve or will be removed at the outpatient clinic.
At your follow-up appointment, your surgeon will advise you when you can resume your normal activities and return to work. You may need to take two to four weeks off, depending on what your work involves.
Avoid stretching, strenuous exercise and heaving lifting for up to six weeks after your operation. You also need to keep your breasts supported by wearing a well-fitting, wireless sports bra.
Results
It is likely that your breasts will be swollen and feel tender and lumpy after surgery. The final appearance of your breasts may not be obvious for several weeks.
Scars are usually quite red for the first six weeks after surgery. They then change to a purple colour over the next three months before fading to white. Most scars heal well but occasionally patients are left with red and lumpy scars that do not improve in appearance.
^^ Back to top
Risks
Risks associated with breast reduction
The possible complications of any operation include an unexpected reaction to anaesthetic, excessive bleeding or developing a blood clot. Complications specific to breast reduction surgery are described below.
Scarring
The main disadvantage of having a breast reduction surgery is that you will be left with permanent scarring. The operation, when done using the anchor technique, leaves three scars:
- one around the nipple (areola)
- one from the nipple to the crease below the breast (this is the worst scar as it takes the most tension)
- one from the breast bone to the armpit along the crease below the breast
The severity of scarring largely depends on the individual. Some women are left with red and raised scars but most scars fade over time and should be invisible under normal clothing and most bras or bikini tops.
Uneven shape
Your breasts will change shape after reduction surgery. There is a chance that they may end up slightly lopsided, lumpy or with uneven nipples.
Wound healing problems
Wound healing problems after breast reduction surgery are common, particularly after the anchor scar procedure where the vertical and horizontal scars meet.
Most wound problems are minor and can be simply managed and treated. More severe wound complications, such as infection, skin loss, wound separation and delayed healing, can be harder to manage.
Occasionally, some fat in the breasts dies off, leaving them red and lumpy. This can take some time to settle and lead to a lot of discomfort. There can also be some excess skin left around the scars and, if this does not drop off after a few months, it will need to be surgically removed.
If you smoke or have diabetes, you may have poor circulation which will affect how quickly your wounds heal.
Loss of nipple sensation
Some women lose sensation in their nipples after a breast reduction, including their ability to become erect. This is because the nerve supply can be damaged during surgery.
Very rarely, a disrupted blood supply may cause your nipple to die and fall off. This is more likely if you are a heavy smoker or have poor circulation.
Depending on the type of breast reduction you have, if your nipples have been separated from the milk ducts during the operation, you may be unable to breastfeed after the operation.
Infection
Any kind of surgical procedure carries a potential risk of infection. In the case of breast reduction surgery, there is a chance of infection from germs in the ducts of the breasts. This can be treated with antibiotics and sometimes further surgery. If you do get an infection after your surgery, this will delay the healing process.
Haematoma
If the tubes attached to your breasts do not remove all of the blood after the operation, it blood may begin to collect under your breasts, causing them to become very painful. This is called a haematoma. If this happens, you may need to have another operation to drain the blood and stop the bleeding.
^^ Back to top