Breast reduction, medically known as reduction mammoplasty, is a surgical procedure that lifts and reduces the size of the breasts.

Breast reduction surgery aims at balancing the figure, especially if a woman has a small frame and large breasts. This surgery involves reducing the volume and weight of the breasts and, in some cases, moving the nipple to a new location.

Breast reduction is performed on women and should not be confused with gynecomastia, the breast reduction procedure for men.

Reflecting on global trends, breast reduction was the sixth most popular cosmetic surgical procedure in Australia in 2009, with around 4,500 operations performed. Its popularity is increasing, and in 2010 breast reduction moved up the ladder to the fifth most popular cosmetic surgical procedure in the American market. The number of breast reductions in the US increased by over 20% between 2009 and 2010.

Reasons for choosing to have a
breast reduction

Women with very large breasts often suffer physical discomfort in the form of back and neck pain. Bra straps supporting large breasts can dig into the shoulders causing bruising and an indentation. Physical issues aside, large-breasted women often feel extremely self-conscious.

Women who have experienced abnormally excessive and rapid growth of the breasts may have a rare condition called breast hypertrophy. Hypertrophy usually affects both breasts and occurs around puberty. Talk to your doctor if you think you may have this condition.

Women opt for breast reduction surgery for both medical and aesthetic reasons.

You are a good candidate for a breast reduction if you have any of these issues:

• Very large breasts that cause physical problems, including pain in the shoulders, back and neck.
• Pendulous heavy breasts with nipples pointing downwards.
• Breasts that interfere with routine activities and restrict your lifestyle.
• One breast has grown larger than the other.
• Your shoulders show indents from bra straps.
• The weight of your breasts disrupts your sleep.
• The skin in the crease of your breasts is constantly irritated.
• You are self conscious and embarrassed about your breasts and have difficulty buying bras or clothing that fits.
• You want your breasts to harmonise with the rest of your body.
• Your breasts have increased in size after menopause, causing you to feel awkward and unbalanced.

Many women have a breast reduction after pregnancy if they find their breasts have grown. Some women have the procedure before having children; others wait until that phase of their lives has passed. Discuss your plans with your surgeon, who can advise you on breast-feeding after this surgery.

Things to consider once you’ve decided to have a breast reduction

You need to discuss the following options with your surgeon prior to surgery:

• Size and shape of the breasts  Before surgery, you need to convey to your surgeon the exact size and shape you want your breasts to be after surgery.
• Repositioning of the nipples and areola  Depending on the size of your breasts, the extent of the reduction and how far the nipples need to be moved, it may be possible to keep them connected to blood vessels and nerves. If not, areolas and nipples may need to be removed fully and grafted onto a new location. This step may result in the loss of nipple and areola sensation. If you want your areola to be reduced, the surgeon can remove some of the dark pigment when making the areolar incision.
• Incision location  There are several methods of performing breast reduction surgery. The most common technique uses three incisions: one around the areola, another running from the areola to the crease under the breast and the third along that crease. The longer the incisions, the more scarring there will be.

What to expect

Depending on how much work is involved, a breast reduction takes 2-3 hours, performed under a general anaesthetic. Patients usually stay in hospital either overnight or for 2 nights following surgery.

After incisions have been made, excess skin, tissue and fat from the breasts is removed, the nipples repositioned and the skin re-draped and stitched together.

Small tubes may be inserted into the wounds to allow accumulated fluids to drain. These will be removed after a few days. You will also have gauze dressings on your breasts, usually covered with a surgical bra or elastic bandage.

For the first few days after surgery, your breasts will be bruised and swollen. Your surgeon may ask you to wear a compression garment for up to a week to keep swelling to a minimum and support your breasts as they heal. Sometimes mild swelling can last up to four months.

Initially, incisions will be red or pink in colour. Over time and with correct scar management treatment, these scars will fade.

You may also have slightly less sensation in your nipples and areolas than you did before. This is normal and usually temporary. Sometimes it can take weeks, months or even a year before normal sensations return.

Although walking as soon as you are able helps avoid blood clots, strenuous activities such as exercise and heavy lifting should be avoided for at least a month.

You may feel some level of discomfort from time to time. This is normal. If you have severe pain, contact your surgeon. Your surgeon may recommend wearing a sports bra for extra support for six weeks following surgery.

Before and after surgery

There are several things you can do leading up to any kind of surgery.

Advise your surgeon if you have lost weight recently or plan to lose weight in the future. Your surgeon may recommend that you stabilise your weight before having breast reduction surgery.

For women of 35 and over, a mammogram is often recommended before breast reduction surgery, followed by another mammogram about a year later. These two scans give the radiologist a baseline for comparison with other scans in the future.

There are also a number of things you can do following any type of surgery.

In addition to following general post-surgical instructions, there are important things you can do to ensure successful healing following your breast reduction:

• Pillows under the head and upper back can help to make you sleep more comfortably. A pillow under your knees will keep you from rolling over.
• Ask your surgeon when you can bathe or shower again. Because dressings need to be kept dry until the incisions close, you may have to make do with sponge baths for a few days. You won’t be able to raise your hands above your head for a week or so, and you may need help washing your hair.

Possible risks and complications

As with any surgical procedure, there are risks involved in breast reduction surgery. You should be fully aware of these before you elect to have the procedure. Make sure you familiarise yourself with the list of complications that could arise as a result of any surgery.

Specific complications that may occur after a breast reduction include:

• Asymmetry of breasts – After breast reduction surgery you may discover that the breasts are not the same size or shape, or that the nipples are not the same size or are at different heights. If any of these things happen, revision surgery may be required.
• Losing breast or nipple sensation – This could be permanent or temporary, depending on the extent of nerve damage. In most cases surgeons try to leave the nipple and areola attached to their nerves and blood vessels to ensure they remain sensitive after surgery. If you have very large breasts, the nipples may have to be moved and grafted. Permanent loss of sensation is possible.
• Permanent scarring on the breasts – Usually scars around the areolas are not obvious, but the vertical and horizontal scars will remain. Internal bleeding or heavy bruising during surgery or internal bleeding may increase the size of the scars.
• Loss of the ability to breast-feed – There is some risk that you may not be able to breast feed after this surgery. If you expect to have children, discuss this possibility with your surgeon.

The best way to reduce risk in any surgery is to find a fully qualified surgeon with formal training in breast reduction surgery, who has performed the procedure many times. And just as you would discuss potential benefits before surgery, ask your surgeon to address the potential risks as they apply to you. 

What does a Breast Reduction cost?

The cost of a breast reduction will vary depending on the surgeon you choose and the facilities used. Your surgeon will help you estimate potential costs after an initial consultation.

Expect surgeon’s fees for a breast reduction to cost between $6000 and $8000 (AUD). You’ll need to add the assistant surgeon’s fees, anaesthetist’s fee, hospital facilities and the cost of follow up visits to this figure.

Some Australian private health insurers may help pay for the hospital bed and theatre fees. Getting a doctor’s referral may enable you to make a claim on these costs.

You should expect the costs to be higher if you are having combined procedures at the same time.

This information is correct as of 2019.