Introduction

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.

But if it's done to improve appearance rather than for health reasons, it's not normally available on the NHS. Instead, you'll need to pay for the procedure privately.

Information about breast reduction for cosmetic reasons is provided elsewhere – read about cosmetic breast reduction for women and male breast reduction.

This page focuses on when breast reduction might be available on the NHS.

Eligibility criteria for NHS breast reduction

The availability of breast reduction surgery on the NHS varies, depending on the eligibility criteria decided by your local Health Board.

Some Health Boards do not fund breast reduction surgery at all and others fund it selectively if you fulfil certain criteria.

Generally speaking, you might be considered for breast reduction on the NHS if you have problems caused by having very large breasts, such as:

  • backache
  • shoulder or neck pain
  • skin irritation
  • rashes and skin infections under the breasts
  • grooves on the shoulders from bra straps
  • psychological distress, such as low self-esteem or depression
  • an inability to exercise or take part in sports

Health Boards also tend to have additional criteria that may include the size of your breasts, your weight, your age, whether you smoke, and whether other options – such as wearing professionally fitted bras – have been tried, but haven't helped.

You can find out what the eligibility criteria are in your area from your GP or by contacting your local Health Board.

The referral process

See your GP if you think you might be eligible for breast reduction surgery on the NHS.

They can check whether you meet the criteria of your local Health Board, and if you do, can refer you to a breast or plastic surgeon for an assessment.

This may involve:

  • asking about the problems you're experiencing
  • checking your weight and general health
  • an assessment by a psychiatrist or psychologist
  • information about the risks and results of surgery

The assessment will help determine whether you're suitable for surgery and whether there's a strong enough reason for this to be done on the NHS.

The final decision is usually made by a panel of representatives from your local Health Board, which will take into account the information from your assessments and review your individual case.

Things to consider before you go ahead

t's important to discuss your problems and options with your GP and an appropriately qualified surgeon before having a breast reduction.

This will help you get a clear idea of what changes you can expect to see and ensure you're aware of any risks involved.

Be aware that:

  • a significant reduction can alter the shape and look of your breasts
  • there will be scarring and possibly lost or altered nipple sensation
  • your breasts can change in size and shape after surgery – for example, they may increase or decrease in size if you put on or lose weight
  • breasts have a tendency to droop over time
  • your breasts can get bigger during pregnancy and you may not be able to breastfeed after surgery – so you may need to wait until you're sure you don't want to have any more children

For women with very large breasts, the benefits of a reduction may outweigh any potential problems. But for women with only moderately large breasts, the benefits may not be worth the risks.

Alternatives to breast reduction surgery

It's sometimes possible to reduce problems caused by having large breasts without the need for surgery.

The following measures may help:

  • if you're overweight, losing weight can sometimes help reduce the amount of fatty tissue in your breasts
  • a professional bra-fitting service – for many women with problems due to large breasts, getting a professional to fit a correctly-sized bra can reduce discomfort
  • physiotherapy – exercises from a physiotherapist can sometimes help with aches and pains caused by large breasts
  • psychological support and treatment – this can help if your large breasts are causing emotional or mental health issues

Breast reduction surgery will usually only be available on the NHS if alternative measures such as these have been tried first.
 

Male breast reduction on the NHS

Male breast reduction isn't normally available on the NHS.

This is because enlarged breasts in men are usually a result of being overweight, and losing weight will often help to reduce their size. You'll normally need to pay privately for breast reduction surgery in these cases.

However, breast reduction on the NHS may sometimes be considered if it's caused by an underlying condition, or losing weight hasn't helped.

Your GP can advise you about whether you might be suitable for surgery on the NHS.

 

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Female breast reduction

Breast reduction surgery is an option for women who wish to make their breasts smaller, less heavy and more lifted.

If you're feeling very distressed over the size of your breasts or they're causing physical symptoms such as backache, you may be able to have a breast reduction on the NHS (see above).

But if you're considering a breast reduction operation to change your appearance, rather than for health reasons, you'll need to pay for it privately.

Before you go ahead, you may want to read Is cosmetic surgery right for me?.

How much does it cost?

In the UK, breast reduction surgery costs around £6,500, plus the cost of any consultations or follow-up care that may not be included in the price.

Where do I go?

In Wales, Healthcare Inspectorate Wales are responsible for inspecting independent healthcare organisations in Wales, including those providing cosmetic surgery.

If you're looking in England, you may wish to check the Care Quality Commission (CQC) website for providers that can perform breast reductions.

All independent clinics and hospitals that provide cosmetic surgery in England must be registered with the CQC.

Also, research the plastic surgeon or breast surgeon who is going to carry out the operation. All doctors must be registered with the General Medical Council (GMC). Check the register to see the doctor's fitness to practise history.

You may also want to find out:

What does it involve?

Breast reduction surgery is carried out under general anaesthetic.

There are several techniques the surgeon could use, but generally the operation involves:

  • moving your nipple to its new position – usually while it's still attached to the blood supply
  • removing excess fat, glandular tissue and skin from your breasts
  • reshaping the remaining breast tissue

Most women are left with a scar around the nipple. With some surgical techniques, the scar will also run down vertically and horizontally across the breast crease (anchor-shaped), or just run down vertically to the breast crease.

The operation takes between 90 minutes and 4 hours, depending on the extent of the breast reduction.

You usually need to stay in hospital for one or two nights.

Afterwards

When you wake up after surgery, you will have dressings on your breasts and plastic tubes may be attached to them to drain blood away.

After one to two days, any tubes would be removed and you will usually be able to go home. Some women experience pain for a few days, which can be relieved with painkillers.

It's likely your breasts will be swollen and feel tender and lumpy after surgery.

Recovery

It can take two to six weeks to fully recover from breast reduction surgery. You may need to take a week or two off work and shouldn't drive for at least a week.

The final appearance of your breasts may not be obvious for several weeks or months after the operation.

Some surgeons recommend wearing a sports bra 24 hours a day for up to three months after breast surgery.

The length of time you need to keep the dressings on depends on how quickly your wounds healed. Stitches are removed after a week or two, unless they are dissolvable.

You should avoid stretching, strenuous exercise and heavy lifting for up to six weeks after the operation. You can drive again when it's no longer painful to wear a seatbelt, which may be several weeks.

Side effects to expect

It's typical after breast reduction surgery to have:

  • sore breasts for a few weeks
  • up to three scars – one around the nipple, and sometimes another one vertically from the nipple to the crease below the breast, and sometimes a third scar along the crease below the breast

Scars are usually quite red for the first six weeks, but most fade over time and should be invisible under normal clothing, bras and bikini tops.

What could go wrong

Breast reduction surgery can occasionally result in problems, including:

  • thick, obvious scarring
  • unevenly shaped breasts or nipples
  • wound healing problems
  • loss of nipple sensation
  • being permanently unable to breastfeed
  • red or lumpy breasts if the fat dies (fat necrosis)
  • excess skin left around the scars, which may need to be surgically removed
  • bleeding inside the breast tissue (haematoma) – this generally occurs within the first 24 hours after the operation

Also, any type of operation carries a small risk of:

  • excessive bleeding
  • infection
  • an allergic reaction to the anaesthetic
  • a blood clot forming in the deep veins

The surgeon should explain how likely these risks and complications are, and how they would be treated if they occurred.

Occasionally, people find the desired effect wasn't achieved and feel they need another operation.

What to do if you have problems

Cosmetic surgery can sometimes go wrong and the results may not be what you expected.

You should contact the clinic where the operation was carried out as soon as possible if you have severe pain or any unexpected symptoms, such as redness of your breast skin, a burning sensation or unusual swelling.

If you have breast reduction surgery and are not happy with the results or think the procedure wasn't carried out properly, you should take up the matter with your surgeon through the hospital or clinic where you were treated.

If you have concerns about your care, you can contact Health Inspectorate Wales. If necessary, you can make a complaint about a doctor to the General Medical Council (GMC).

If you're planning to have children

If you plan to have breast reduction surgery before having children, or more children, bear in mind that breasts can get larger again during pregnancy and this may affect the results of the operation.

Also, there's a chance you wouldn't be able to breastfeed after the operation.

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Male breast reduction

Some men find that one or both breasts may be abnormally large.

Known as gynaecomastia, this condition can result from a hormone imbalance or from being very overweight, which can increase levels of oestrogen and cause breast tissue to grow.

Breast reduction surgery is an option for men with this condition. It may also be used to tighten the breast area after dramatic weight loss that has caused the skin to sag.

However, it is not suitable for men whose large breasts are simply excess fat from being overweight.

Normally, you'll need to pay for breast reduction surgery privately. But the NHS may provide this for you if you've had gynecomastia for a long time, it has not responded to other treatments, and it's causing you a lot of distress or pain.

Read on to find out:

How much does it cost to have privately?

In the UK, breast reduction surgery for men costs £3,500-£5,500, plus the cost of any consultations or follow-up care that may not be included in the price.

Where do I go?

In Wales, Healthcare Inspectorate Wales are responsible for inspecting independent healthcare organisations in Wales, including those providing cosmetic surgery.

If you're looking in England, check the Care Quality Commission (CQC) website for providers that can perform breast reductions for men.

All independent clinics and hospitals that provide cosmetic surgery in England must be registered with the CQC. The CQC publishes inspection reports and performance ratings to help people choose care.

Also, research the plastic surgeon or breast surgeon who is going to carry out the operation. All doctors must be registered with the General Medical Council (GMC). Check the register to see the doctor's fitness to practise history.

You may also want to find out:

What does it involve?

Breast reduction surgery is usually carried out under general anaesthetic.

There are several techniques the surgeon could use, but generally the operation involves:

  • making a cut (incision) around the nipple
  • using liposuction to suck out excess fatty tissue
  • extending the cuts and repositioning the nipples if there is a lot of tissue to remove

The operation takes about 90 minutes. You usually need to stay in hospital overnight.

Recovery

It can take a few weeks to fully recover from breast reduction surgery. You may need to take a few days off work. It can take up to six months to see the full results.

You will need to wear an elastic garment day and night for a few weeks after the operation.

The length of time you need to keep the dressings on depends on how quickly your wounds heal. After one or two weeks, your stitches will either dissolve or be removed at an outpatient clinic.

You should avoid stretching, strenuous exercise and heavy lifting for up to six weeks after the operation. You can drive again when it's no longer painful to wear a seatbelt, which may be several weeks.

Side effects to expect

It's typical after breast reduction surgery to have:

  • sore breasts for a few weeks
  • scars – these may take several months to fade

Most men are just left with a scar around the nipple. But a large breast reduction operation may also result in a scar that runs down vertically and horizontally across the breast crease.

What could go wrong

Breast reduction surgery can occasionally result in problems, including:

  • thick, obvious scarring
  • unevenly shaped breasts or nipples
  • wound healing problems
  • loss of nipple sensation
  • bleeding inside the breast tissue (haematoma) – this generally occurs within the first 24 hours after the operation
  • developing lumps, bruising or swelling

Also, any type of operation carries a small risk of:

  • excessive bleeding
  • infection
  • an allergic reaction to the anaesthetic
  • a blood clot forming in the deep veins

The surgeon should explain how likely these risks and complications are, and how they would be treated if they occurred.

What to do if you have problems

Cosmetic surgery can sometimes go wrong, and the results may not be what you expected.

You should contact the clinic where the operation was carried out as soon as possible if you have severe pain or any unexpected symptoms, such as redness of your breast skin, a burning sensation or unusual swelling.

If you have breast reduction surgery and are not happy with the results or think the procedure wasn't carried out properly, you should take up the matter with your surgeon through the hospital or clinic where you were treated.

If you have concerns about your care, you can contact Health Inspectorate Wales. If necessary, you can make a complaint about a doctor to the General Medical Council (GMC).

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 04/07/2018 14:47:26