Many women consult with plastic surgeons because of overly large or sagging breasts, a condition resulting in neck and shoulder pain, deep grooves in the shoulders from brassiere straps, skin rashes, and increased menstrual discomfort. In addition, these patients often experience emotional distress when friends (and even total strangers) thoughtlessly comment on the size of their breasts. Other women are bothered by sagging breasts, and while the size of their breasts may be acceptable, the undesirable shape makes them feel unattractive.



Enlarged breasts are often the result of hereditary factors or weight gain. Hormones also play a part in some cases where the breast tissue is actually more sensitive than normal to certain female hormones. Sagging breasts result from poor skin tone, stretching of ligaments during pregnancy and breast-feeding, weight changes, heredity, and the aging process. Either of these conditions can be corrected with the same basic operative procedure, and thousands of women each year undergo successful surgical alteration of their breasts.

During your initial consultation, you will be encouraged to discuss your desires, fears, expectations, and goals. In addition to reducing breast size, your plastic surgeon will strive to create a more aesthetically pleasing breast by improving shape and balance and creating breasts which are proportional to your chest and shoulders. No woman has breasts which are perfectly symmetrical in volume, shape, or position. Your surgeon will aim for improved breast symmetry in addition to a more youthful appearance (firm breasts with proper uplift).

A more shapely breast (lifted and reduced in size) is created by elevating the nipple (which normally remains connected to its nerve and blood supply) to a more acceptable position. If the nipple is enlarged, its size is reduced. The breast and torso are measured to determine the amount of reduction required, and a pattern is drawn on the breast. If necessary, the internal breast tissue is reduced and molded into a normal size and shape. Sometimes, during uplift operations, a small implant may be placed to add extra support and shape to the breast. Your plastic surgeon will discuss this with you before surgery.

New techniques in plastic surgery aim to reduce the length of incisions and scars in performing breast lifts and reductions. In traditional techniques the final incision lines are made around the areola (dark circle around the nipple), down the bottom center and horizontally under the breast and resulting in an "anchor scar." More modern methods have limited the incisions to either just around the areola (small circular scar) or around the areola and down the center of the breast resulting in a "lollipop scar." In particular cases, a significant breast reduction can be achieved by sculpting the breast using liposuction ( liposculpture ). All incisions are closed in multiple layers in order to minimize widening of the scars.

A comfortable bandage is fitted after surgery and worn for 48 hours. We recommend continued support of the breasts with a well-fitted, comfortable bra after reduction to prevent sagging. A small drain may be used to collect fluid for a day or two after the procedure to help decrease swelling and discomfort.

For the first two days after surgery, you will spend most of your time at home. You are encouraged to walk around your home, but will want to take a break from your daily routines. You may experience less discomfort than you expected, but will probably want a mild pain medication such as Tylenol. Stronger medication will be available if you need it.

By the third day you will be up and walking around. When you get up out of bed, try rolling on your side toward the edge of the bed and bring your knees up to your waist. Move your legs over the side of the bed and gently help yourself up by pushing up with your elbows. The idea is to let your legs do most of the work so your arms can rest. When you shower, gently wash your stitch line with mild soap, then apply a thin layer of a mild antibiotic ointment such as Bacitracin or Polysporin.

Most patients are driving by the fifth to seventh day, and return to work or school in one to two weeks, depending on the level of activity required and the rate of recovery. Half of the swelling is resolved in two weeks, three-quarters by one month, and the remainder in one to three months. Any change in sensation following surgery may be temporary; resolution can occur over several weeks to several months. Although breast-feeding is desirable for infants, it can have an effect on the operated breast, sometimes resulting in size reduction, and discomfort. This should be considered before a decision is made about breast surgery and subsequent pregnancy and nursing.