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BREAST
REDUCTION (REDUCTION MAMMAPLASTY)
 If you are considering breast reduction surgery, we recommend being as close to your ideal body weight for your height as possible. That way, we can make a more accurate estimate of the amount of breast tissue to be removed which will result in a breast size that is proportional to the rest of your body. Moderate or substantial weight loss following breast reduction surgery may ultimately lead to breasts that are smaller than you planned. Another reason for achieving a certain goal weight prior to breast reduction is related to insurance coverage. One of the criteria used by insurance companies when you go through the process of precertification for breast reduction surgery is a requirement that you are within 10% of your ideal body weight.
 Although we usually perform the surgery under general anesthesia, breast reduction can also be performed under local anesthesia with intravenous sedation. Most often, the incisions for breast reduction are similar to those used for breast lift techniques. Breast reduction surgery is a trade-off between the extent of the scars and the extent of the reshaping and size reduction possible.
The most common technique for reducing the breasts involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Incisions outline the area of skin, breast tissue, and fat to be removed and also outline the new position for the nipple. In most cases, the nipples remain attached to their blood vessels and nerves. Excess glandular tissue, fat, and skin are removed, and the nipple and areola are moved into their new position. We then bring the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. If the breasts are very large or pendulous, the nipples and areola may have to be completely removed and grafted into a higher position. We then remove excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. Skin that was formerly located above the nipple is brought down and joined to reshape the breast. Sutures are used to close the incisions, giving the breast its new contour. Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. The resulting scars around the areola, below it, and in the crease under the breast are permanent. In general, the more skin that is removed, the better shape you can expect.
After surgery, you will need to wear a support or compression bra for one to two weeks day and night to keep swelling to a minimum and allow the scars to heal without a pull-down effect of the suture line. Most of our patients can return to vigorous activity within three weeks. It is quite common to lose weight after surgery, as women are frequently able to increase their athletic activity. You may feel sore and stiff, until the swelling resolves over the first several weeks, but there is usually very little pain. In fact, breast augmentation surgery is often substantially more painful than breast reduction due to manipulation of the underlying pectoralis major muscle. Breast reduction surgery is performed predominantly on the breast mound, which produces very little discomfort.
Breastfeeding after breast reduction or lift surgery depends upon the technique used by the individual surgeon. Unless the breasts are extremely large requiring an extensive reduction, 50% of patients can go on to breastfeed. It is rare but possible that the nipple and areola may lose their blood supply and the tissue may develop scabbing and have to be treated while it heals. Breast reduction scars can be extensive and permanent. They often remain lumpy and red for months, and then gradually fade to thin lines. Another potential complication of large breast reductions that is more common with free nipple graft methods, is the loss of pigment around the areola. This can be improved if necessary with medical tattooing. The procedure can also leave slightly mismatched breasts or unevenly positioned nipples.
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 During breast reduction surgery, the size of the areola, the colored portion around the nipple, is often reduced. The size of the areolar may be disproportionately large for the breast and give the breast a more matronly or aging appearance. This occurs following breastfeeding in many patients and is present in almost all very large breasts. During breast lifting or breast reduction, the areola is reduced to a balanced size which makes the breast appear more youthful as well. As a standalone procedure the reduction of the areola is uncommon. It is usually performed in association with other breast surgery. Some men who develop gynecomastia (overgrown breast tissue) will also have a large areola. Because this is a feminized feature men sometimes present for reduction in the size of the areola in order to look balanced or normal. In this case, areolar reduction is performed as a stand alone procedure.
Nipple reduction on the other hand can be performed in a separate procedure or in combination with other breast surgery. Many women will develop large, projecting nipples that in some cases droop following breastfeeding. The nipple itself can be telescoped back into the breast and in this way appear more youthful and balanced for the breast.
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