Breast reduction surgery, also known as reduction mammoplasty, is a procedure to reduce overall breast volume, maintain nipple-areola viability, and achieve a shape that is aesthetically pleasing. Before deciding if a patient is a candidate for this type of procedure, a detailed medical history, including the age of breast development, previous or anticipated pregnancies or breastfeeding, weight change, smoking history, and overall medical status should be obtained. The family history of breast cancer is important as well. Symptoms relating to breast weight such as the neck, back, and shoulder pain are documented. Thorough preoperative assessment is essential, including a physical examination of size, shape, elasticity, looseness, striae, rashes, bra strap grooving, any asymmetry, masses, and consistency. The position of the nipple-areola complex relative to the inframammary fold is assessed. Measurements are done from the sternal notch to the nipple and nipple to the inframammary fold to assess the degree of vertical correction. It is not uncommon for a patient with severe breast ptosis to present requesting reduction when they require a mastopexy or breast lift. Although reduction mammoplasty and mastopexy are fundamentally different, both operations require similar techniques.

Breast reduction is by no means an easy procedure, and even though several techniques have been developed to perform this procedure, each has its own risks and complications. All patients need to be educated about the procedure and potential complications. The downtime can be long and avoiding scars may not always be possible. Recently liposuction has been utilized to elevate the nipple-areolar complex, but since the tissue is being removed without being histologically analyzed, the safety of this procedure is being questioned. There is a small risk that a malignancy may be missed with liposuction. Mesh has also been advocated to support the breast parenchyma, but there is a potential risk of infection and distortion of tissue planes. While minimally invasive procedures offer small scars and rapid recovery, patients should always be informed about the pros and cons of these surgeries.

Women inquire about breast reduction for both physical and psychological reasons. The most common indication for breast reduction is the relief of physical pain and discomfort associated with heavy, pendulous breasts. Patients will complain of chronic back and neck pain, headaches, shoulder pain, deep bra-strap grooves, and rashes beneath both breasts. The breast can become chronically painful as well. Upper extremity neuropathy and postural changes, along with intertrigo, maceration, irritation, rashes, and other dermatologic manifestations are common. Excessively large breasts can affect daily functioning. This can include difficulty with many forms of exercise and the inability to find properly fitting clothes. The psychological impact of hypermastia is significant, and many patients are embarrassed and self-conscious about their size. Reduction mammaplasty can eliminate or decrease these problems in most instances. Breast reduction may also be indicated to correct asymmetry caused by unilateral hyperplasia or to achieve symmetry after unilateral breast reconstruction.

Complications are common after reduction mammoplasty, but most are minor and do not require additional surgeries. BMI over 30 and smoking are risk factors that increase the risk of complications. As the quantity of breast resection increases, so does the chance of complications. Minor complications that can be seen in the early postoperative period include hematoma, seroma, cellulitis, wound infection, delayed wound healing, and minor wound dehiscence. Major complications that often require surgical intervention are major wound dehiscence, flap necrosis, and nipple-areolar necrosis. Once all wounds are well healed, complications involving cosmetic appearance are asymmetry, lack of proper shape, dog ears, under resection, over resection, and unsightly scars.

Summary

• Breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body.
• This operation may be covered by health insurance if it is performed to relieve medical symptoms.
• The results of this procedure should be permanent. However, over time, your breasts can change due to ageing, weight fluctuations, hormonal factors and gravity.
• Talk with your surgeon about the risks and benefits of breast reduction surgery and what results you can expect.

Breast reduction surgery

Breast reduction surgery removes excess breast fat, glandular tissue and skin. Breast reduction aims to achieve a breast size in proportion with your body. The surgery may be performed to relieve the discomfort associated with overly large breasts. This procedure is also called reduction mammoplasty.

Overly large breasts can cause some women both health and emotional problems. The physical discomfort may include back, neck and shoulder pain, and skin irritation beneath the breast crease. The weight of excess breast tissue can restrict a woman’s ability to lead an active life. Some women also feel very self-conscious about having large breasts.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives. Talking to a counsellor or psychologist may help you overcome your concerns about your appearance.

Changes to laws that affect cosmetic surgery

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal for:

• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health and Human Services
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health and Human Services Private hospitals page and expand the ‘contact details for private hospitals’ link
• call the Department’s Private Hospitals Unit on (03) 9096 2164
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding liposuction, cosmetic surgery or anaesthesia in Victoria.

Things to consider before breast reduction surgery

Some important issues to consider include:

• The procedure is best done when breasts are fully developed.
• Breast and nipple piercings can cause an infection.
• Breast reduction surgery can interfere with some diagnostic procedures.
• Your ability to breastfeed after breast reduction surgery may be limited. Talk to your medical practitioner if you are planning to breastfeed a baby in the future.
• Changes in the breasts during pregnancy or significant weight loss or gain can alter the outcomes of previous breast reduction surgery.
• Think about the financial cost. Breast reduction is commonly considered a reconstructive surgical procedure (although there is a cosmetic component to it), so the surgery may be covered by health insurance if it is performed to relieve medical symptoms. For more information:
• Ask your medical practitioner about any out-of-pocket costs you can expect, and if you will be eligible for a rebate.
• Visit PrivateHealth.gov.au for more information on private health insurance.
• Smokers are at increased risk of complications. To decrease the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible, before deciding to have breast reduction surgery.

Finding a qualified medical practitioner

Ask your GP for advice on a reputable medical practitioner or hospital where breast reductions are performed.

At your first consultation, ask the medical practitioner about their training and experience.

This procedure should be done by a medical practitioner who is specially trained to perform breast reductions and has a lot of experience in carrying out this type of surgery. Ask to see the medical practitioner’s certificates that show them to be qualified to perform this specialised surgery.

All doctors practising in Victoria must be registered with the Medical Board of Australia (the Board). Find out if your medical practitioner is registered with the Board by searching on the AHPRA website.

Your current medical status and breast reduction surgery

If you are considering having breast reduction surgery, you need to discuss your current medical status with your medical practitioner. This includes discussing:

• your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate
• your mental health – any mental illnesses or issues and their treatments
• medications you are currently on, including vitamins and supplements
• past reactions to medications
• any allergies you have.

As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Breast reduction surgery – what happens during surgery

All surgery, including breast reduction surgery, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

Breast reduction surgery is usually performed under general anaesthetic. In some cases, when the reduction is only small, the medical practitioner may opt for local anaesthetic with sedation.

Generally speaking, breast reduction surgery involves:

• The medical practitioner makes an incision (cut) around the nipple. The incision is continued in a straight vertical line to the breast crease. Sometimes, a further cut is made in the crease beneath the breast.
• In most cases, the nipple remains attached to its blood and nerve supply at all times. Sometimes, however, an extremely heavy breast may need a ‘free nipple graft’. The nipple is removed and reattached at a higher point on the breast.
• Excess skin, fat and glandular tissue is removed. Sometimes, the medical practitioner will use liposuction to help remove excess fat. (Occasionally, the medical practitioner can reduce the size of breasts by liposuction alone.)
• The medical practitioner puts stitches deep inside the breast tissue to add support.
• Skin incisions are brought together and closed.

Immediately after breast reduction surgery

After breast reduction surgery, you may expect:

• a drainage tube in the wound to help prevent fluid build-up
• bruising and swelling
• possible numbness
• pain and discomfort
• dressings or bandages
• the results of the breast reduction surgery to be immediately visible.

Potential complications with breast reduction surgery

All surgery carries some degree of risk. Some of the possible complications of breast reduction include:

• surgical risks such as bleeding or infection
• fluid accumulation around the implant after surgery
• allergic reaction to suture materials, tape adhesive or other medical materials and lotions
• changes in breast and nipple sensation
• temporary or permanent areas of numbness
• wrinkling of the skin over the implant
• keloid, or lumpy scar tissue, which is raised and irregularly shaped. These scars may be inflamed and itchy
• capsular contracture, where firm scar tissue forms around the implant causes it to lose shape and softness
• inappropriate implant size
• implant rupture or deflation
• asymmetry (unevenness) of the breasts
• calcium deposits in the scar capsule around the implant
• granulomas, or lumps, in local lymph node tissue formed by leaking silicone
• breastfeeding difficulties, including reduced milk supply
• reduced effectiveness of breast cancer screening, as an implant may hide breast tissue (and tumours) during a mammogram
• movement of the implants from their original position
• further surgery to treat complications
• risks of anaesthesia including allergic reaction or potentially fatal cardiovascular complications such as heart attack
• a blood clot in the deep veins of the legs (deep vein thrombosis), which can move to the lungs (pulmonary embolus) or to the brain, and may be life threatening

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your surgeon for more information.

Self-care after breast reduction surgery

Your medical practitioner will provide you with post-operative care instructions, such as:

• how to care for your surgical site(s) following surgery
• medications to apply or take orally to aid healing and reduce the risk of infection
• specific concerns to look for at the surgical site(s) or in your general health
• when to follow-up with your medical practitioner.

Long-term outlook after breast reduction surgery

Over time, swelling from the surgery will reduce. It may take about 18 months for the scarring to fade into faint lines. Satisfaction with your new image should continue to grow as you recover. Your new breast size should help relieve the pain and physical limitations experienced prior to breast reduction, and you may find that a better proportioned figure will boost your self-confidence.

The results of this procedure should be permanent. However, over time, your breasts can change due to ageing, weight fluctuations, hormonal factors and gravity.

Alternatives to breast reduction surgery

Alternatives to breast reduction can include:

• significant weight loss, if you are overweight
• professionally fitted bras
• liposuction
• talking to a counsellor or psychologist – this may help you overcome your concerns about your appearance.