What is Breast Reduction Surgery?
Breast reduction is a surgery that removes unwanted breast tissue and skin. This is a surgery of the breasts for women who wish to get rid of large, heavy, sagging, or uneven breasts. It will reduce breast volume and elevate drooping nipples and stretched areolas (the darker area surrounding the nipples), creating a smaller, more youthful shape and lift to your breasts. Breast reduction can also alleviate neck and back pain associated with heavy breasts, grooves in the shoulders from bra straps, and skin irritation under the breasts from skin on skin contact and moisture.
When to Consider a Breast Reduction
- You are physically healthy
- You have realistic expectations
- You don’t smoke
- You are bothered by feeling that your breasts are too large
- You have breasts that limit your physical activity
- You experience back, neck and shoulder pain caused by the weight of your breasts
- You have shoulder indentations from bra straps
- You have skin irritation beneath the breast crease
Considerations for Breast Reduction
- You will have smaller and improved breast shape
- Your breasts may have a more youthful appearance.
- You may feel better with less weight of the breasts
- You may feel more confident about the size of your breasts
- The effects of a breast reduction might slowly diminish over time because of weight gain, gravity and aging.
- A breast reduction leaves scars that will be hidden in a bra or swimsuit.
- You may lose sensation to the nipple
- Subsequent pregnancy may compromise your surgical results.
Are You a Candidate for a Breast Reduction?
If you’ve become increasingly unhappy about the large size and weight and sagging of your breasts, you may wonder what surgery can do. If you are in good health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
The following are some common reasons why you may want to consider a breast reduction:
- Breasts that are heavy, large and pendulous.
- Breasts that sag or or lack firmness.
- Nipples and areolas that point downward, especially if they are positioned below the breast crease.
- Breasts that appear different from each other; one breast may appear firm and well positioned while the other does not.
- Breasts that are not equal in size.
- Breasts that are large and heavy can be reduced and lifted at the same time.
- You are finished with childbearing and breast-feeding. If you plan to have children, you may want to postpone cosmetic breast surgery. Pregnancy may stretch the breasts and reduce their volume, compromising surgery benefits.
How is a Breast Reduction Procedure Performed?
A breast reduction is performed under general anesthesia or intravenous sedation in the outpatient surgery center. Different techniques for removing breast skin and reshaping the breast determine the location of the incisions and resulting scars. Dr. Gruber will select a technique based on your breast size and shape, areola size and position, degree of breast sagging, skin quality and elasticity and how much extra skin you have.
Dr. Gruber will remove excess breast tissue, skin and shift the nipple and areola to a higher position.
If your areola has become stretched, it can now be reduced in size.
Skin that was formerly located above the areola is brought down and together, beneath the breast, to reshape the breast.
Dr. Gruber will remove excess skin and close your incisions, tightening the skin, sewing the breast back together and placing sutures deep in the breast tissue to support the new breast position for a longer period of time.
Scars are usually hidden under the breasts, although some light scarring may be seen around the areola.
The nipples and areolas remain attached to underlying mounds of tissue, and this usually allows for the preservation of sensation and the ability to breast-feed.
Options for Breast Reduction
Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.
In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.
The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice. Here are descriptions of the different incision patterns and techniques that Dr. Gruber may choose from:
- The “lollipop” incision, also known as a “keyhole” incision, made around the perimeter of the areola and vertically down from the areola to the breast crease, is suitable for most women. Dr. Gruber will use this incision in most cases. An extension of the incision along the bra line toward the armpit is used in larger cases.
- The “anchor” incision, made around the perimeter of the areola, vertically down from the areola to the breast crease and horizontally along the breast crease, produces the most scarring. It is for women with a severe degree of sagging who will not be helped sufficiently by less invasive techniques. Dr. Gruber rarely uses the incision that is directed toward the center of the chest.
- The “donut” incision, also known as the “Benelli lift” or “periareolar incision,” made around the perimeter of the areola only, is suitable for women with a mild-to-moderate degree of sagging. Dr. Gruber uses this incision infrequently.
Incisions and Scars from Breast Reduction
These vary according to the type of incision you have.
A common method of reduction the breasts involves three incisions:
- Around the areolas
- Extending downward from the areolas to the breast creases
- Horizontally along the breast crease toward the armpit
Although incision lines are permanent, in most cases they will fade and significantly improve over time. Dr. Gruber makes every effort to place scars in hidden areas and minimize them, with the goal of achieving the desired results with the shortest possible scar. Special tissue handling and suture techniques further minimize scars.
Your initial consultation appointment
During your initial consultation, you will have the opportunity to discuss what you want to achieve. Dr. Gruber will evaluate you as a breast reduction candidate and clarify what procedures may benefit you most. It is important to be completely honest during the consultation.
Dr. Gruber will examine, measure and photograph your breasts for your medical record. We will consider:
- The current size and shape of your breasts.
- The breast size and shape that you desire.
- The quality and quantity of your breast tissue.
- The quality of your skin.
- The placement of your nipples and areolas.
You should come to the consultation prepared to discuss your complete medical history. This will include information about:
- Previous surgeries, including breast biopsies.
- Past and Present medical conditions.
- Allergies and current medications.
- Medical treatments you have received.
- Family history of breast cancer.
- Current mammogram results.
If you are planning to lose a significant amount of weight, be sure to tell us. We may recommend that you stabilize your weight before undergoing surgery.
If you think that you may want to become pregnant in the future, discuss this with us. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results.
Breast Reduction Treatment Plan
Based on your goals, physical characteristics Dr. Gruber will share recommendations and information with you, including:
- An approach to your surgery, including the type of procedure or combination of procedures.
- The outcomes that you can anticipate.
- Your financial investment for the procedure.
- Associated risks and complications.
- Options for anesthesia and surgery location.
- What you need to do to prepare for the surgery.
- What you can expect to experience after surgery.
- Show before-and-after photos of cases similar to yours and answer any questions.
How do I prepare for a breast reduction procedure?
We will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery.
If Dr. Gruber recommends weight benchmarks or lifestyle changes, do your best to achieve them to ensure the best results and minimize the chance of complications.
In advance of your procedure, you may be asked to:
- Stop smoking at least six weeks before undergoing surgery to promote better healing.
- Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
- Keep alcohol consumption at less than two to three drinks per week.
- Breast reduction is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.
What can I expect on the day of my procedure?
Your breast reduction surgery will be performed in the outpatient surgery center in Tampa, FL. We will give you an estimate of how long your surgery will last based on the details of your surgical plan.
Medications are administered for your comfort during the surgical procedure.
General anesthesia is commonly used during your breast reduction procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
Following the surgery a surgical bra is placed. Drainage tubes may be used.
You will be taken into a recovery area where you will continue to be closely monitored.
Before leaving for home, you (or someone looking after you) should feel capable of emptying and resetting the drains.
You will be permitted to go home after a short observation period.
Aftercare and Recovery
Dr. Gruber will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
- Drains, if they have been placed
- Normal symptoms you will experience
- Potential signs of complications
Generally, you can expect to be bandaged, wearing compression garments and you may have some surgical drains.
When the anesthesia wears off, you may have some pain. You will also have some redness and swelling after the surgery. Other common recovery side effects include bruising, numbness, or changes in nipple sensitivity, itching around incision sites and increased firmness or fullness in the breast tissue. These side effects should subside over the next few weeks, with some residual effects lasting up to three months following the surgery.
Recovery time frame after breast reduction surgery
It is important that you follow all patient care instructions provided. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed and the level and type of activity that is safe. Dr. Gruber will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
The first week
The day after surgery, you will be encouraged to get out of bed for short periods of time.
After several days, you should be able to move about more comfortably.
Avoid straining, bending and lifting since these activities might cause increased swelling or even bleeding.
You will probably be instructed to sleep on your back to avoid pressure on your breasts.
Any surgical drains will be removed within a few days of surgery, at which time your dressings may also be changed or removed.
For two to five days, your chest region may feel stiff and sore.
Two weeks to six weeks
After breast reduction surgery, it is often possible to return to work within a week or so, depending on your job.
You should avoid excessive physical activity for at least the first two weeks following surgery. After that, be extremely gentle with your breasts for at least the next month.
Avoid sexual activity for a minimum of one or two weeks. After that, take care to be extremely gentle with your breasts for at least the next couple of weeks.
You may be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminish.
You may notice that you feel less sensation in the nipple and areola areas. This is usually temporary; however, it may take weeks, months or even more than a year before sensation returns to normal.
Your breasts may require some time to assume a more natural shape.
Incisions will initially be red or pink. They will remain this way for many months following surgery.
In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks.
You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. If you have severe pain, call us immediately.
How Long Will the Results Last?
Your breasts should will not return to their presurgery size, assuming you don’t have significant weight fluctuations or go through pregnancy. Some settling may occur, but the new nipple position should remain intact.
Breast Reduction Costs
The cost of a breast reduction varies from doctor to doctor and from one geographic area to another. The national average surgeons fee for breast reduction is about $6000. This only reflects the physician/surgeon fees and does not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to breast reduction. Additional fees usually add $2-3000. Dr. Gruber’s prices are similar to prices charged by other experienced and skilled surgeons. Prices could be slightly higher than national averages depending on size and complexity of individual cases.
Limitations and Risks
Fortunately, significant complications from breast reduction are infrequent. Your specific risks for breast reduction will be discussed during your consultation.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
- Blood clots in the legs or lungs