Breast Reduction Surgery Procedure

Deciding to undergo breast reduction surgery is usually easy. Your painful neck aches; deep grooves in your aching shoulders made by bra straps; chafed skin that sports bras cause under bouncing breasts; and then, possibly, intertrigo, a painful, oozing skin infection located under the breasts that exercise contributes. help. ​Basically, your body tells you that you need a reduction mammaplasty. Yes, for many, having big boobs isn't fun. If you are one of the more than 40,000 individuals who choose to have breast reduction surgery in the U.S. each year, here is what you can expect from the procedure.

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1. Anesthesia Is Administered

Medications are administered for your comfort during the surgical procedure. Often, general anesthesia is administered, so that you will be asleep throughout the procedure. However, a breast reduction also may be performed using a combination of local anesthesia and intravenous sedation. Your surgeon will recommend the best choice for you.

2. Incisions Are Made

Breast reduction incision patterns vary depending on the amount of excess tissue to be removed, the position of the nipples, and patient and surgeon preference. You and your surgeon will determine beforehand which incision technique will work best for your needs. The incision patterns used in breast reduction surgery include:

  • The “Micro-Incision” Technique — When fat makes up much of the breasts' size, instead of excess skin, the breast reduction procedure may consist only of liposuction of the area. In these cases, incisions are very small (just large enough to allow the liposuction cannula to enter and move around as needed).
  • The “Donut” Incision — The incision is made around the perimeter of the areola only; it is also called a peri-areolar incision.
  • The “Keyhole” Incision — Also known as a “lollipop” incision, the incision is made around the perimeter of the areola and vertically down from the areola to the breast crease.
  • The “Anchor” Incision - The incision is made around the perimeter of the areola, vertically down from the areola to the breast crease, and horizontally along the breast crease. This incision is the oldest technique (and still the most common) used for breast reduction.

3. The Breast Is Reshaped

After your surgeon makes the incisions, excess tissue (including skin and fat) is surgically removed, and the remaining breast tissue is reshaped. The nipple and areola — which in most cases will remain connected to their existing blood and nerve supply — are then repositioned to a natural, more youthful height.

In extreme cases with very large pendulous breasts, the use of a technique called a free nipple graft may be required. In this type of procedure, the entire nipple and areola are removed and then transplanted to a higher position. If needed, the size of the areola can also be reduced by surgically removing skin around its perimeter.

4. Incisions Are Closed

After excess tissue is removed and your breasts are reshaped, the remaining skin is tightened as the incisions are closed. Sutures are layered deep within the breast tissue to support the newly shaped breasts, along with the possible use of skin adhesives and/or surgical tape to help close and support the skin.

5. Post-Op Care and Instructions

After surgery, you will be taken to a recovery area where you will be monitored by surgical staff. In some cases, small tubes will be placed in your breasts to help drain excess fluid. Additionally, dressings may be placed on your breasts and then covered with an elastic bandage or surgical bra.

Usually, you will be permitted to go home a few hours after your procedure. However, in some cases, your surgeon may determine that you need to stay in the facility overnight. If you are going home, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least 24 hours.

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  1. American Society of Plastic Surgeons. 2018 Plastic Surgery Statistics Report.

  2. American Society of Plastic Surgeons. What are the steps of a breast reduction procedure?