- Breast Reduction Candidates
- Short Scar Breast Reduction
- Inverted-T Breast Reduction
- Liposuction Breast Reduction
- Breast Reduction with Implants
- Free Nipple Graft Reduction
- Preparing for Breast Reduction
- Breast Reduction Procedure
- Breast Reduction Recovery
- Risks & Complications
- Breast Reduction Results
- Additional Breast Reduction FAQs
Breast Reduction, or reduction mammoplasty, is a surgical procedure that reduces the size and shape of the breasts by removing excess skin and underlying breast tissue. It also reduces the size of the nipple-areolar complexes, which frequently become enlarged as a result of breast development. The surgery creates breasts that are lifted, smaller, and shapelier.
With large breasts, a variety of medical conditions can result:
- “Shoulder grooving” due to excessive weight on bra straps
- Back and neck pain
- Slumped shoulders and other postural changes
- Difficulty with physical activities
- Irritation to the skin in the crease underneath the breasts
- Feelings of self-consciousness
Reduces the size of the breasts
2 weeks, no strenuous exercise for 6 weeks
Short Scar Breast Reduction
Reduces and reshapes breast using shorter incisions
1-2 weeks, avoid strenuous exercise for 3-4 weeks
*Results may vary.
Who Is A Candidate?
Women with disproportionately large breasts are good candidates for surgery. This is done for both cosmetic improvement and symptomatic relief. In general, women with size DD or greater are the most frequent candidates. However, even size C or D can be too large for a petite woman. While women from any age can benefit from the procedure, it is usually performed after the breasts are fully developed.
What Are My Breast Reduction Options?
Dr. Miguel Delgado—our plastic surgeon in San Francisco—can perform breast reduction surgery using several different techniques, each of which is highlighted below. The most appropriate option will depend on the unique needs and goals of the patient and can be discussed in full detail at the time of the consultation.
Short Scar Breast Reduction
The short scar breast reduction technique is also termed “vertical” breast reduction or “lollipop” breast reduction. The term “lollipop” is used because the resulting scar is in the shape of a lollipop. This short scar breast reduction was popularized in Europe and quickly spread to the United States due to its advantages. This technique avoids the incision that goes across the inferior breast crease and is a great option for those who have moderate-sized breasts. The advantage of this technique, other than the shorter incision, is that the breast is reduced and reconfigured in a conical shape, then it is sewn so that the shape of the breast is maintained by its new construction and not the skin envelope. Therefore, the breast shape is better maintained over the long-term with less bottoming out. The disadvantage of this technique is that more skin tension is created in the shorter scar and skin breakdown is possible, which can prolong healing. Alternative short scar breast reduction procedures are performed like the medial pedicle technique, but the short scar breast reduction is the most popular.
Inverted-T Breast Reduction
The inverted-T—or anchor-shaped—technique is a time-tested gold standard. This procedure can be used for breast reductions of virtually all sizes (excluding extra large reductions, which generally require the free nipple graft technique). The skin incision is made like the lollipop incision, but an additional horizontal incision is made along the crease. This can tighten the skin to a great extent, but at the expense of a slightly larger incision. The shape of the breasts relies largely on the skin-tightening component.
Liposuction Breast Reduction
Liposuction breast reduction can often be an excellent option for patients with good skin quality who have minimal to moderate breast enlargement and sagging caused by excess fatty tissue. The procedure involves strategic lipo-sculpting of the breasts, which creates a smaller, improved breast shape with minimal scarring and potentially no sensory changes to the nipple-areolar complexes. Unfortunately, not every woman seeking breast reduction is a candidate for this technique, making patient selection critical. For more information, please visit our page devoted to liposuction breast reduction.
Breast Reduction with Implants
Silicone or normal saline breast implants are sometimes used in breast reductions. This is not a common procedure but occasionally has an application. Some women desire a very youthful appearance of their breast, which includes superior fullness. Breast reduction surgery attempts to create this—and some techniques work better than others (like the short scar breast reduction)—but over time, the breast tissue settles downward with gravity and creates more bottom fullness and less upper fullness. For women who desire lasting upper fullness, this can be accomplished with the placement of breast implants at the time of the breast reduction.
Other circumstances for the use of breast implants may include: women who have had over-resection of the breast tissue and desire to be larger, as well as women who have had a breast reduction and, over time, desire an increase in size and fullness to the surrounding skin envelope to correct volume loss resulting from weight fluctuations and/or aging.
Free Nipple Graft Breast Reduction
The free nipple graft technique is used for very large-breasted women, in which the anchor type of procedure is not safe. The free-nipple technique excises the nipple off of the underlying blood supply. The skin and breast is then reconstructed much like the inverted-T technique, and the nipple is replaced and sewn intact as a full-thickness skin graft. The resulting scars are similar to that of the inverted-T approach. While the nipple-areolar area usually loses sensation, Dr. Delgado has observed some women gain significant sensation after a free nipple graft.
I should have done this years earlier! I was an uncomfortable 34F and now, thank you to Dr. Delgado, I am a beautiful 34C. Dr. Delgado’s office and nursing staff are professional and friendly. I always felt welcome and comfortable coming to appointments. I truly believe I couldn’t have had better care anywhere else.
How Should I Prepare for Breast Reduction?
Patients considering a breast reduction first need to have a personal consultation with Dr. Delgado. This can be scheduled at either our Marin County or San Francisco office.
During the consultation, Dr. Delgado will want to know how having large breasts has a negative effect on the patient’s life, and what her concerns are about her appearance. During the consultation, Dr. Delgado will also conduct a routine breast exam.
The following issues will be discussed:
- Explanation of the different types of reduction:
- Short scar (or lollipop) reduction
- Inverted-T (or anchor) reduction
- Liposuction breast reduction
- Breast reduction with implants
- Free nipple graft breast reduction
- Revised nipple-areolar position
- Incision locations
- The patient’s desired new size
Patients will also receive a booklet that supplies detailed information on guidelines for before and after surgery, including instructions on medications. Anti-inflammatory products, including Aspirin, must be discontinued for two weeks prior and two weeks after surgery as they interfere with the ability of the blood to clot. The instruction booklet will contain a complete list of medications that the patient must avoid, but any medications that the patient takes should be brought to Dr. Delgado’s attention. Tylenol, or acetaminophen, is safe to take, but the patient must not take more than one gram over four hours or four grams per day, as this may cause liver damage. Homeopathic preparations and a list of vitamins will be included in the booklet, which the patient can use to promote healing and limit bruising—both before and after surgery.
How Is the Breast Reduction Procedure Performed?
Dr. Delgado performs breast reduction surgery at Marin Cosmetic Surgery Center (MCSC), which is his private, fully accredited outpatient surgery center situated on the campus of Sutter Marin County Community Hospital. Being located next to the hospital allows Dr. Delgado’s patients to have the utmost in medical care at his surgery center, with an extra measure of safety and privacy.
To begin treatment, a surgical marking pen is used to draw a detailed map on the breasts and chest before anesthesia is given. Dr. Delgado needs an architectural plan to enable him to make adjustments that will accommodate the changes of the body as it moves from a prone position to an upright position. Whatever technique is used, the skin will need to be tightened as the nipple-areolar complex is moved up. Excess tissue will be removed, and remaining tissue will be contoured and reshaped. Liposuction is used in many cases for removal of excess fat that may be on the sides of the chest.
Once the incisions are made and the breast tissue is reduced, the skin is meticulously closed in several layers. Steri-Strips™ are placed over the sutured incision lines, gauze pads are placed over each breast, and a soft compression bra with front hook closure is put on the patient.
The surgery is done under general anesthesia. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers anesthesia. The anesthesiologist calls the patient the evening before surgery to review her medical history, confirm last minute instructions, and answer any questions she may have regarding the anesthesia.
What Is the Breast Reduction Recovery Process Like?
After breast reduction surgery, the patient will be kept in the recovery room for a few hours. She will be allowed to go home with the help of a family member or friend once she is fully awake. Dr. Delgado may determine that a patient should be kept overnight to keep her comfortable in the early post-operative period. Keeping the head and back elevated while sleeping is very important to control swelling.
In three to five days, the dressings will be replaced, and if drains are used, they will be removed. Approximately 24 hours after the drains have been removed, the tiny incisions will close, making them waterproof—and then it is safe for the patient to shower. Until the drains are removed, the patient may only take sponge baths, as the incision sites are vulnerable to infection and therefore must be kept dry. The surgery booklet has detailed instructions for wound care. Generally, the sutures will be removed in 10 days. Suture and drain removal can be scheduled at either Dr. Delgado’s Marin office or San Francisco office.
For the first couple of days after surgery, the pain should not be too severe, but the breasts will be uncomfortable. Therefore, pain medication is prescribed to keep the patient more comfortable and aid in sleeping. Except for women with a low pain threshold, most are able to discontinue the pain medication by the third day.
After the first week, most of the swelling and bruising will be resolved, but women should allow themselves two full weeks for recovery. Patients able to return to normal activities after the bruising and tenderness have resolved. Driving a car, returning to work, and resuming social activities is generally possible after the first week, though patients need to wait about six weeks after surgery before attempting strenuous exercise or swelling may recur. Typically, patients should also wait a week after surgery before resuming sexual activity, as it could cause swelling and discomfort.
What Are the Risks and Complications of Breast Reduction?
The risks and complications of breast reduction are minimized at Marin Cosmetic Surgery Center due to our highly trained team, but all surgeries carry the potential for infection, bleeding, and anesthesia complications. Reduction mammoplasty will leave scars from the incision around the nipple-areolar complex continuing to the base of the breast (and along the breast fold when using the inverted-T technique). It is possible that there might be a reduction in sensation of the nipple and breast area. It may take up to six months for the feeling to return. Breastfeeding usually remains an option for women that have had breast reductions, but there may be a small minority that will lose the ability to nurse. In rare instances, one breast may be a slightly different size. There may be some slight differences with the nipple-areolar complexes.
What Breast Reduction Results Can I Expect?
Women are able to enjoy immediate results of their breast reduction, but need to plan on at least a couple of months for their breasts to settle into their new position and shape. Right away, women will notice that their balance is better. Shopping and trying on clothes will be a great experience. Improved posture and reduction in back and neck pain will be realized as the body enjoys a lighter gravitational pull. Even though there are scars that result from this surgery, breast reduction patients are some of the happiest plastic surgery patients, often stating that the enhancements the surgery has made are life-changing.
Frequently Asked Questions
Is reduction mammoplasty permanent?
Yes. Your breasts will always be smaller than they would have been without surgery. However, the remaining fat cells will swell and enlarge if you gain weight or become pregnant.
Where are the incisions made?
The size of the breasts determines the technique used and the amount of tissue to be removed. The most common incisions are the short scar (lollipop) technique or inverted-T incision. Both of these incisions circle the border of the areola—where the pigmented skin of the areola meets the lighter skin of the breast—and extend from the inferior edge of the areola down to the breast crease. If the incision is an inverted-T, there is also an incision that runs under the breast, hidden in the crease where the breast meets the chest.
Is there bruising after surgery?
The moderate swelling and bruising from breast reduction surgery usually resolves in seven to ten days.
How long will I be out of work?
Most patients are able to return to work within seven to ten days. Some patients will return to work in as little as five days. The exact amount of time will depend on the extent of your surgery, your pain tolerance, and the physical demands of your work.
When will I be able to see the results?
After surgery, you will immediately notice the decrease in the volume and weight of your breasts. If you have reduction mammoplasty surgery to alleviate back pain, relief will be evident right away. The final aesthetic results take longer. The breasts will settle into place and the incisions will smooth out and eventually fade. This takes almost a year to complete the maturation process.
What is the cost of a reduction mammoplasty?
The cost of breast reduction surgery varies with the surgical time needed, which is dependent on the techniques used and the complexity of the case. In general, approximately $9000-12,000 will cover Dr. Delgado’s fees, the board-certified anesthesiologist’s fee, the surgery center, and all postoperative care.
To whom should I talk about breast reduction?
If you are considering surgery or would like to learn more about reduction mammoplasty, contact us to schedule a consultation. Dr. Delgado, an experienced breast reduction surgeon, will discuss your goals with you and explain how we can help.