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Breast Reduction

Patients with large heavy breasts often have many complaints.  It may be poor aesthetics both in and out of clothing or back pain, neck pain, difficulty exercising, or rashing between the breasts that has you wondering what are your options.  This procedure makes the breast smaller and significantly perkier by removing skin as well as excess breast tissue weight.

Scars for the surgery are placed no higher than the nipple areola area, generally including at the very least a vertical incision or lollipop scar heading down to the inframammary fold and frequently needs an incision across the inframammary fold which leads to the anchor pattern scar.

While the scars may be extensive they are hidden within a normal bra or bathing suit and therefore in generally all but the skimpiest clothing.

Patients may lose sensation to the nipple area and they may lose the ability to breast-feed.

Surgery/Recovery

Surgery is performed outpatient but under full anesthesia.

Drains are rarely utilized for patients.  Surgical bra is worn continuously for the first week followed by a good supportive bra for the next 3 to 4 weeks including nighttime wearing.

7 to 10 days out of work is the norm, though some will be out over 2 weeks.  Light activity at 3 weeks can begin, with full exercise between 4 and 5 weeks post surgery.

Patients are very pleased with the surgery and has very high rates of patient satisfaction as well as improvement in quality of life, especially for the larger reductions.

Technique/scars

Liposuction: In rare cases there is just simply breast hypertrophy with good skin quality and appropriate nipple position.  These patients may be a candidate for liposuction alone to reduce the size of the breast without making it ptotic or exhibit skin laxity.

Circumareolar: Resection of tissue is undertaken either directly or with liposuction followed by a scar placed only around the nipple areola to allow for some tightening and elevation of the nipple areola.  Similar to liposuction alone very few patients are ideal candidates

Vertical/Lollipop: In this procedure open resection is undertaken.  The nipple areola is moved superiorly/upward to the appropriate position.  The scar then circles the nipple areola making it smaller and extends vertically down to the inframammary fold.  A minority of patients find this technique ideal, for many there is inadequate skin resection across the bottom of the breast which can lead to an effect of “pseudoptosis.”   This means that while the nipple position is appropriate, the distance from the nipple to the fold beneath is too long.  This can result in the breast still looking “saggy” and women may experience their nipple coming out of the top of their bras/bathing suits.

Wise Pattern/Anchor: This is a most commonly employed and most powerful option.  It removes tissue well as well as skin in both directions both transversely and vertically.  This allows for the most tightening of the breast and for many the most optimal long-term outcome.  The added scar in the inframammary fold is obviously significant; however, for most it hides well along that area.  When standing upright the breast usually folds over just enough to cover it.

Long-term results

The size of the reduction and elevation do last a lifetime, however the breast do eventually begin to lose some of their volume and sag as they naturally would.  However since they are starting from such a better position even after many years of aging the breast still often appear much better than pre-surgery.

Patient satisfaction is the highest of generally all plastic surgery procedures.  The most commonly heard regret is waiting so long to actually have the surgery.  Most wished they had done it sooner!

All normal breast cancer screening is undertaken following the procedure.  Mammograms are done as per usual along with self breast exams.  Since this is a very common procedure there is extensive experience amongst OB/GYNs, Family practice/internal medicine physicians, and breast surgeons to evaluate the breast clinically and the radiologists the mammograms, ultrasounds and MRIs.

Risks

Scarring, which is extensive and may be poor quality

Loss of nipple sensation

Loss of ability to breast feed

Hard areas from “fat necrosis”

Asymmetry of breasts

Recurrent sagging, which to some degree in inevitable

Nipple loss/necrosis – rare – about 1%, requires additional surgery/healing to simulate a nipple that remains non-functional

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