Breast reduction surgery applies the arts of plastic surgery to remove breast tissue and excess skin thereby reducing an enlarged or over-sized breast to a more comfortable breast size and shape.

Breast reduction surgery is indicated for women with extremely large breasts who suffer from the following symptoms:  upper back and shoulder pain, shoulder grooving from bra straps, neck strain with associated tension headaches, and rashes or fungal infections beneath the breast.  The surgery is also appropriate in cases of profound psychological discomfort associated with large breast size, especially in younger women and teenagers.  Women who need surgery for breast cancer sometimes undergo a breast reduction on the unaffected breast to attain symmetry.

The surgery usually takes up to three hours (1.5 hours per side) and is done using general anesthesia.  It typically involves a one-night stay in the hospital, but more and more women now elect to undergo the surgery and be discharged to go home the same day (outpatient surgery).  You can discuss this issue with Dr. Pautler at the time of your consultation, as the choice depends on the age of the patient, the amount of tissue to be removed and issues of comfort at home versus the hospital setting.

Before performing the reduction, Dr. Pautler draws a pattern on the breast with the patient in the upright position.  During the surgery, breast gland and skin are removed according to this pattern, and the nipple areola complex is repositioned higher on what ends up being a smaller breast mound.  Prior to closing all the incisions, Dr. Pautler sits each patient up vertically to allow the breasts to drop and to make sure the breasts are as symmetric as possible.  A small drain is inserted into each side, the wounds are sutured closed, and a compressive surgical bra is placed before awakening the patient from anesthesia.

After the surgery, discomfort is controlled with either oral (pills) or intravenous medication.  The drains are most often removed the day after surgery, either in the hospital or in Dr. Pautler’s office.  The compressive bra is worn for about 4-6 weeks, and afterwards most patients can return to normal activities.

It is the goal of plastic surgery to minimize scarring or make scarring as discrete as possible. In the case of breast reduction surgery, Dr. Pautler will use one of the following breast reduction methods to reduce scarring:

• Vertical breast reduction – scars from the plastic surgery are limited to around the areola and an up-and-down scar from the areola to the crease beneath the breast. This is also known as the “Lejour or Hall-Findlay mammaplasty”.
• Wise-pattern breast reduction – this plastic surgery incorporates the scar around the areola, up-and-down from the areola, and underneath in the crease beneath the breast.

Women may need breast reduction surgery due to:

• Chronic pain – women with extremely large breasts often suffer from upper back and shoulder pain, neck strain with associated tension headaches and the pain of shoulder grooving from bra straps due to the weight of the enlarged breasts.
• Infections – women with large breasts can be prone to rashes or fungal and yeast infections in the area beneath the breast known as the “inframammary fold”.
• Embarrassment – women, particularly young women, with large breasts can feel psychologically uncomfortable or awkward about extremely large breast size.
• Asymmetry – a breast reconstruction patient or a breast lift patient may choose to have breast reduction surgery in one breast to create a more even or balanced appearance to both breasts.

The benefits to breast reduction surgery are:

• Comfort – with breast reduction surgery, women can ease their pain, both physical and psychological, control painful and irritating rashes and infections and achieve the benefits of cosmetic surgery with a smaller but more attractive breast size and shape.

View our Glossary of Breast Surgery key terms Here.

Notes Regarding Breast Reduction Surgery

The following notes detail various issues relating to breast reduction surgery:

• Breast cancer: Studies show that a breast reduction can reduce cancer risk by 40% but it cannot eliminate the risk. It has been documented in the literature that on RARE occasions, a cancer has been detected in the breast during breast reduction surgery. A mammogram is obtained prior to the breast reduction surgery to see if there are any breast areas that should be studied prior to breast reduction surgery, but an occasional lump can be missed. Should this unusual circumstance arise during breast reduction surgery, it is possible that breast conservation surgery may not be possible and that eventually a mastectomy may need to be performed
• Breastfeeding after breast reduction surgery: Many women are able to nurse successfully after breast reduction surgery; however, it cannot be guaranteed. If breastfeeding is something you absolutely wish to do, you may want to consider holding off on the breast reduction surgery until finished with childbearing.
• Stop smoking: If you are a smoker, Dr. Pautler will strongly urge you to cease as soon as possible.  It is important for you to stop smoking at least 8 weeks prior to and 6 weeks after your planned surgery.  Cigarettes contain nicotine, a powerful substance that decreases blood circulation especially in the areas that need it the most:  surgical wounds.  Wound healing is slowed, infections risk is increased, and recovery from surgery may be prolonged.

Dr. Pautler will discuss all of these options for breast reduction surgery at the initial consultation. For more information or to make an appointment for your initial breast reduction consultation, contact Dr. Pautler’s plastic surgery practice near Pittsburgh.