Breast Reduction

Disproportionately enlarged breasts, also known as macromastia, can be quite debilitating both physically and emotionally. Commonly associated symptoms and findings include neck, back, and shoulder pain, skin irritation, rashes, infections, compensatory postural changes and grooving of the shoulders from bra straps.

Women with such large breasts are frequently faced with real challenges and restrictions including in the types and amount of physical activities that they can engage in due to the associated discomfort. Being able to find comfortable, properly fitting bras that provide well needed support as well as clothes that are attractive, complementary and stylish can be daunting tasks.

Women elect to undergo breast reduction surgery in order to alleviate symptoms or address issues that are directly affected by their enlarged breast size. The most common reasons include:

• Breasts that are disproportionately too large
• Neck, back and shoulder pain that are secondary to the weight and traction effect of the heavy breasts
• Large, pendulous breasts that hang down over the abdomen
• Irritation, pain and indentations of the shoulders caused by pressure from the bra straps
• Chronic rashes or infections between the drooping breasts and underlying skin
• One breast is significantly larger than the other
• Limitations in the ability to engage in sports and other physical activities due to the associated breast pain
• Feelings of self-consciousness and low self-esteem that are often exacerbated by jokes and unwarranted attention to one’s breasts
• Difficulty finding bras that are comfortable, supportive and which can reduce symptoms related to the weight of the breasts
• Limitations in finding clothes that will fit or that one would like to wear

Breast reduction surgery involves decreasing the size of the breasts by removing excess breast tissue and skin along with recontouring and elevating the remaining tissue. The nipple-areola complexes, which are usually enlarged and below their appropriate locations, are reduced to a more proportionate size as well as elevated to a more ideal, natural position while still remaining attached to the breast tissue. This technique allows for the possibility of being able to breastfeed in the future (when relevant) and for preserving some sensation and sensuality of the nipple-areola complexes.

A variation of this procedure is where the nipple-areola complexes are physically detached from the underlying tissue and then replaced as “skin grafts” in the appropriate locations after the reduction and recontouring are accomplished. This technique, which is called the “free nipple graft” approach, does offer some significant advantages to select women. A few indications for its usage include massively enlarged or elongated breasts, women who are heavy smokers, patients who are at higher risk medically, women who have or are at risk for impairment of the blood flow within the breasts and those who want to be extremely small. Disadvantages include loss of sensation and sensuality, inability to breastfeed, a variable amount of depigmentation of the areola and lack of any nipple projection.

The most common incisions used in a breast reduction are in the shape of an inverted-T or anchor and extend from around the nipple, down to the crease at the bottom of the breast and then along this crease. With time, complete maturation of the tissues and when performed with meticulous technique, these scars can become relatively inconspicuous.

There are other less common configurations for incisions, often with the intended goal being to minimize the overall scar length. Unfortunately, these approaches often limit the ability to precisely reduce and sculpt the remaining tissues which result in less than desirable breast shapes; create abnormal or asymmetrical nipple positioning; produce scars that can extend below the breast fold and be visible when wearing more abbreviated clothing; and increase the likelihood that a follow-up corrective procedure would need to be performed. In Dr. Turkeltaub’s opinion, the sacrifices you would make just to have shorter incisions are not worth it.

Liposuction breast reduction is a niche procedure that utilizes liposuction in order to reduce the breast size. Because liposuction does not remove glandular breast tissue, the only tissue that is being removed is fat which, therefore, limits its applicability to select few women. Furthermore, because this technique involves no skin resection that would otherwise be necessary to recontour and elevate the breasts, droopy breasts will remain that way. The distinct advantage of this technique is that relatively small breast reductions in women with minimal or no drooping can be accomplished employing a few short incisions (1/4 to 3/8 inch) through which cannulas are inserted in order to facilitate the liposuctioning.

In general, the only way to reliably reduce the size and weight of the breasts is through breast reduction surgery. Some patients may see minor improvements through weight loss. However, non-surgical techniques typically may only be able to reduce fatty tissues in some individuals.

Furthermore, non-surgical modalities are typically unable to address excess skin and glandular tissues which contribute to a droopy, pendulous breast appearance even after successful weight loss.

Ultimately, breast reduction surgery offers the most consistent, comprehensive and predictable results for those seeking lighter, smaller, perkier and more proportionate breasts.