What is a Breast Reduction?

Many women have breasts that are too large and choose to have them made smaller by undergoing a procedure known as a breast reduction or ‘reduction mammoplasty’.

During this surgery breast tissue is removed, making the breasts smaller and lighter. The breasts are reshaped, leading to a more lifted and youthful appearance. The nipples are moved to a new, higher location on the breast. There will be less breast tissue below the ‘inframammary fold’ (IMF) – the area where a wire sits in a wired bra. This relationship of the breast tissue relative to the IMF is how we measure the degree of ‘ptosis’ or ‘droopiness’.

Breast reduction surgery leads to one of the highest satisfaction rates of all cosmetic procedures. The commonest ‘regret’ from my breast reduction patients is why they waited as long as they did. Universally, most reduction patients say “if I had known how much better I would feel and look, I would have done this years ago…” They are often pleasantly surprised and remark that “it was a much easier recovery than I was expecting.”

What is ‘symptomatic macromastia?’

Many women suffer from a condition known as ‘symptomatic macromastia.’ This means that they are getting symptoms from having excessively large and heavy breasts. These symptoms can include:

1. Chronic neck and/or shoulder pain
2. Chronic back pain
3. Shoulder grooving – the weight of the heavy breasts in the bra, leads to a permanent indentation from their bra strap along the shoulder region.
4. Chronic skin irritation and, in some cases, fungal infection, known as ‘intertrigo’ under the breast in the IMF region.
5. Poor cosmesis: in many cases, very large breasts tend to elongate due to the heaviness of the breasts. This leads to droopy or ‘ptotic’ breasts which is less attractive than the usual teardrop shaped breasts.

Am I a Breast Reduction Candidate?

If you feel that your breasts are too big for you and you are healthy enough to undergo general anesthesia, you should be a candidate for a breast reduction. If you are a smoker or vaper, you will need to quit smoking and vaping, (also no nicotine substitutes such as gum or patches), for a minimum of 8 weeks before your surgery. This is because nicotine is known to block wound healing. Some insurances will only cover your breast reduction surgery if you are planning to have a certain amount of tissue removed. This is something to discuss with your plastic surgeon during your consultation. The amount of breast tissue to be removed depends on your current breast size and the size you wish to end up with. It is unrealistic to predict the exact amount of breast tissue to be removed. I usually give patients a range. Some women, typically younger women, have more dense breast tissue. Therefore, the breast tissue removed may be heavier than expected.

Is Breast Reduction Covered by Insurance?

A breast reduction surgery is often considered to be a cosmetic procedure. In some circumstances it may be covered by in-network surgeons by your insurance, provided strict rules are applied. These are often referred to as the ‘breast reduction weight requirements.’ This means that the insurance will only authorize the surgery (and cover the costs of surgery) if the plastic surgeon guarantees a certain minimum amount of breast tissue will be removed during surgery. 500g is a common threshold. I’ve seen plastic surgeons struggle to meet this threshold and will do so at the expense of a poor outcome, in order that the insurance will cover the surgery. Dr Li at LA Breast and Body does not believe operating under these strict arbitrary rules provides the best esthetic outcome and care. Dr Li is not in network with any insurances but, together with her team, she will work with PPO insurances, provided patients are able use their out of network benefits. Some patients prefer to pay cash for their breast reduction surgery. Please contact our office for a consultation and discuss these options further.

Benefits of a Breast Reduction

There are numerous benefits of a breast reduction. These include psychological benefits, such as improved self-esteem, better body image, improved self-confidence. Physically: patients will notice they have better fit of clothing and a more active lifestyle, by being able to do things they could not with oversized breasts. These include running without feeling self-conscious, swimming, weight lifting and racquet sports, such as pickleball. For those with skin irritation under the breast and fungal rashes, decreasing the size and weight of the breasts usually eliminate these problems entirely.

Complementary Procedures to a Breast Reduction

In addition to the breast reduction surgery, some patients may benefit from complementary procedures, such as:

Accessory breast tissue excision or liposuction

Many women benefit from additional procedures to get rid of extra tissue in the armpit area or ‘axilla’. These are commonly known as ‘axillary rolls’ or ‘accessory breast tissue’. If this extra tissue is minor, liposuction can be used, where the extra tissue is liquified and removed using a suction device, involving small incisions. However, if there is extra skin, as well as a moderate amount of excess tissue, then a separate incision needs to be made to remove both the extra tissue and the redundant skin. Most patients are very happy to get rid of this tissue, which often hangs over clothing or strapless gowns and is typically difficult to hide in clothing.

Nipple areolar complex reduction

The nipple areolar complex includes the nipple (the part that sticks out) and the pigmented skin immediately around the nipple. Typically, a nipple areolar complex is a mound, rather like a shallow cone. In very large breasts, during the growth of the breast, this mound can become very stretched out and widen in diameter. During a breast reduction, this nipple areolar complex can be reduced in size, in proportion to the newly reduced breast size. Most patients prefer this nipple areolar complex size reduction and this is usually included in the breast reduction procedure.  

Why You should Choose Dr Wai-Yee Li for your breast reduction?

As a female board-certified plastic surgeon who worked at a busy cancer center on the West Coast of southern California for 10 years, Dr Li has extensive experience in performing breast reductions. She has performed many standard breast reductions, in addition to oncoplastic breast reductions in cancer patients. This is discussed in more detail in the breast reconstruction section. She is also experienced in symmetrizing breast reductions, where only one breast is reduced to match a smaller breast on the other side. Many women naturally have one breast large than the other, resulting in asymmetry and difficulty wearing clothes. Patients may be very self-conscious about this breast asymmetry and benefit greatly by a symmetrizing reduction. As a woman herself, Dr Li understands the importance of having a breast size and shape that you are proud of. She also recognizes the emotional attachment many women may have to their breasts, in terms of their identity and femininity.

What is Oncoplastic Breast Reduction?

Dr Li has performed many ‘oncoplastic breast reductions.’ This means that she will carry out the breast reduction surgery on the same day that breast cancer patients have a tumor removed by their breast surgeon, known as a ‘lumpectomy’. In these circumstances, the goal is to reshape the breast to hide the defect created by their cancer surgeon. This is a much more challenging surgery compared with normal breast reductions because she is limited by the location of the tumor and the surgery being performed by the cancer surgeon. This is discussed in greater detail under our ‘breast reconstruction’ section.

Female and Pediatric Plastic Surgeon Specialist

As a female plastic surgeon and mother of two teenage girls, Dr Li is very aware of the extra challenges involved in taking care of teenage and young adult women, who may be considering breast surgery and breast reductions. Following her residency training at University of Southern California, Los Angeles, she underwent craniofacial and pediatric plastic surgery fellowship training. During this time, and since then, she has treated teenage girls with breast asymmetry. She is very comfortable consulting with children, teens, tweens and young adults, employing a sensitive approach. Her extensive experience, petite stature and personable style allow these younger patients to feel comfortable and feel less intimidated, especially within an all-female practice environment.

Breast Reduction Surgery Types

There are different approaches to breast reduction. The primary goal of this surgery is to reduce the volume of the breast, resulting in smaller breasts that are less heavy. Other important goals include improved shape, by reducing the skin envelope and moving the nipple into a higher, more youthful, position. When we reduce the breast size, we are limited in how much tissue can be removed, if we plan to keep the nipple. This is the commonest scenario and means that we need to keep the tissue behind the nipple intact, with the blood supply still attached. This tissue with the blood supply is also known as the ‘pedicle’. There are different versions of this ‘pedicle’ depending on how much tissue needs to be kept.

How much breast tissue is removed during a breast reduction surgery?

This depends on the current breast size and the desired breast size. In patients with very, very large breasts, the nipples cannot be maintained on the existing blood vessels, known as the pedicle. There is an option known as ‘free nipple grafting’ that allows the nipples to be carefully cut out and then sewn back into the new higher location, once the breast have been reshaped. While the majority of patients seeking breast reduction surgery wish to keep their nipples, some patients may choose not to keep their existing nipples. This is particularly true if the nipples are very large or very low down on the breast. In these cases, patients may choose to get nipple replacements. These include nipple reconstruction, a second surgery and 3D nipple areolar tattoo. Please refer to our section on ‘nipple replacement options’, which gives detailed information on these procedures. 

What happens to the breast tissue that is removed?

The breast tissue that is removed during surgery is typically weighed and documented in your surgery note. Dr Li will send all tissue to pathology to make sure that there are no abnormal tissue or cancer. In woman of mammogram screening age (40 years and above) Dr Li recommends obtaining a mammogram within 6 months prior to surgery, to avoid any surprise findings during the breast reduction surgery.

Your Breast Reduction Consultation 

When you meet with Dr Li, she will first listen to you, to ascertain your goals for your surgery. In particular, she will focus on the breast size you are at the time of presentation and the size you wish to be after the surgery. She will go through your past medical and surgical history, as well as obtain a social history, including smoking history. She will perform a physical examination, which includes standard breast measurements. She typically takes photos of your upper body for charting, excluding your head and face. She will then explain to you the risk and benefits of surgery, as well as the steps involved and what she recommends for you. She likes to educate patients using photos and sometimes diagrams to help you understand. There will be plenty of opportunities for questions. Many patients like to bring their partners, spouses, sisters, mothers (especially younger patients) or best friends. Patients find the consultation to be comfortable and educational. It is helpful to bring photos of the desired outcome.  

Will There Be Any Scars After Surgery?

Because of the need to reshape the breast during a reduction surgery, there will be scars. The extra skin has to be removed to fit nicely around the smaller breast volume. Also, the nipple needs to be moved to a higher location on the breast. The typical scar is known as an ‘Anchor’ scar and goes around the nipple (‘circumareolar’), extends down vertically and then sits along the inframammary fold (IMF) – this is where the wire typically sits in a wired bra. In some cases, if not much lower breast skin needs to be removed, then a ‘lollipop’ incision may be sufficient. This is similar to the Anchor scar, without the IMF scar or a shorter IMF scar. With time these scars will fade in majority of patients.

Are there any special risks of Breast Reduction surgery?

Aside from the risks of any surgery performed under general anesthesia, including bleeding, infection and scarring, the risks of breast reduction surgery include: altered sensation of the breasts and decreased ability to breast feed. The sensation changes are unpredictable and may be permanent. A lot of women with very large breasts tend to have decrease sensation due to the nerves having been stretched over the years by the weight. In these patients, altered sensation is less of a concern. Breast feeding is often possible after breast reduction but usually less milk is produced, because there is less milk-producing breast tissue available. One of the commonest problems after a breast reduction is slowed wound healing along the bottom ‘T’ junction of the wound. This is simply managed with creams and dressing and Dr Li and her team would guide you during this time.

What Can You Expect After a Breast Reduction Surgery?

Day of surgery

When you wake up from your breast reduction, you will already notice a difference! Congratulations! You will have smaller breasts. You should not have extreme pain. During surgery Dr Li uses special intercostal ‘nerve blocks’, where she will inject a long-acting (typically 5 days) numbing medication, local anesthetic along the nerves that serve this area. You will have drains – typically one drain per breast. A drain is a small plastic tube that comes from inside the wound to the side of the chest. This removes the residual fluid that is left after surgery and the fluid made by your tissues in a response to surgery. The drain collects fluid into a small grenade-shaped plastic bulb that can be measured and emptied away. This is very important to avoid a fluid collection, (known as a ‘seroma’), that can lead to infection. You and your family will be taught how to manage the drains during your first consultation and before you are discharged from the hospital. Dr Li usually places dressings along the incisions and applies a light-weight surgical bra at the end of surgery. Most patients can go home the same day. For more details on getting drains after surgery, please refer to Dr Li’s Blog post, Dr Li’s Guide to getting drains after surgery.

First week after surgery

You may feel a little sore after surgery. You will be able to shower the day after surgery – usually with assistance. Make sure you remove all the dressings before you get in the shower! Dr Li likes the wounds to be dressed with antibiotic ointment and gauze every day for 3 days after surgery. Most patients notice some pain along the incision but not intense pain. The drains can be uncomfortable. You should not lift anything above 5 pounds in weight for the first 4 weeks after surgery. You will be seen in the post op clinic by Dr Li or her team and your drains may be able to be removed at that visit. You should refrain from driving.

4-6 weeks after surgery

You should be back to normal during this time and able to resume work and driving. Dr Li will see you for a visit and provide any wound care support and her team can supply return to work paperwork if needed. After 4 weeks, Dr Li and her team may allow you to start using gentle upper arm weights but we would advise you refrain from any upper chest exercises.

3 months

You should be back to normal at this point and can resume normal physical exercise.