Some patients complain of big breasts causing shoulder, back pain and sometimes embarassment.  This procedure reduces the amount of breast volume into a more manageable and appealing "breast form."

Definition
Breast reduction  ( reduction mammaplasty )  is a surgical procedure performed to decrease the size and reshape  the breasts.

Purpose

Women

• Women with  very large breasts (macromastia, or mammary hyperplasia) breast reduction will render  relief of  back, shoulder, and neck pain.
• Women may also feel uncomfortable about their breast size and have difficulty finding clothing that will fit properly.
• Large breast size may also limit women’s abilities to perform routine daily activities and may cause significant emotional distress.
• Additionally, breast reduction may be needed after reconstructive surgery following mastectomy ( the surgical removal of cancerous breast tissue ), to make the breasts more symmetric.

Men

• Men who  have enlarged breasts (gynecomastia) may also be candidates for breast reduction surgery.
• Gynecomastia  maybe secondary  to  excessive alcohol intake, marijuana use or anabolic steroids . Surgery is not recommended for men who continue to use these products.

Preparation
Consultation is necessary between surgeon and patient to ensure that there is an understanding and agreement with the expected final results  .  Measurements and photographs are taken pre – operatively . Most  doctors also recommend a mammogram before the operation to ensure that there is no cancer especially for high risk  patients.

Description
Breast reduction ( reduction mammoplasty  )  is most often performed in a hospital, under general anesthesia. The surgical operation usually requires approximately two to four hours. The most commonly made incision encircles the areola (darkened area around the nipple) and extends downward and around the underside of the breast which  produces the least conspicuous scar. Excess tissue, fat, and skin are removed, and the nipple and areola are repositioned. Liposuction (fat suctioning) , is used to remove extra fat from the armpit area is necessary in few cases . Recovery  may require a hospital stay of up to three days.

Breast reduction surgery for males with gynecomastia is almost  similar to that described for females. The surgical options are discussed by your chosen plastic surgeon which will range from open surgery to liposuction depending on the grade of the gynecomastia.

In  breast reduction surgery, the breast tissue is cut along predetermined lines and (A) excess tissue is removed (B). The nipple is placed higher on the breast (C), and the two sides of the incision are brought together (D), removing any excess skin (E).

Aftercare
A special supportive bra or an elastic bandage is placed over gauze bandages and drainage tubes after surgery . The bandages and tubes are removed in a day or two  however  the bra is worn around the clock for several weeks. Sutures  ( stitches ) are removed one to three weeks after the operation. Scars will typically remain red and perhaps raised for  several months  gradually  fading  and less noticeable. It takes  a year before the breasts achieve their final position and size. Normal activities (  including sexual relations ) may be restricted for several weeks.

Risks
Women whose breasts are not fully developed or who plan to breastfeed are not good candidates for  breast reduction surgery .
Risks include bleeding , infection ,  anesthesia reactions , or unexpected scarring common to any operation. Breast reduction may result in decreased sensation  in the breasts or nipples and/or impaired ability to breastfeed. The breasts may be slightly uneven, or the nipples may be asymmetric  when healing is complete which is  consistent with normal breast tissue.

Normal results

• Smaller breast size should be achieved  and the accompanying pain and discomfort should be alleviated.
• Self-esteem should be improved for both females and males having breast reduction surgery.

Morbidity and mortality rates
Mortality (  deaths )  rates associated with breast reduction surgery are extremely rare and are generally attributed to anesthesia errors, overdoses of pain medications, or postoperative infections.

In very rare cases , the skin of the breast or nipple does not heal properly.  Additional surgery maybe necessary to graft skin. Approximately 10% of women experience some loss of sensation in their nipples.

Permanent scars are left after breast reduction surgery which becomes less prominent over time. However women who smoke often experience more prominent scars because smoking interferes with the healing process.