Overview of breast reduction
- Juliana Hansen, MD
Juliana Hansen, MD
- Shiliang Chang, MD
Shiliang Chang, MD
- Assistant Professor
- Oregon Health & Science University
- Section Editors
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
The extent to which extremely large breasts can negatively impact a woman’s life is often underappreciated. For those who live with unwanted macromastia and its associated symptoms, the relief from pain and tension that breast reduction can produce is immediately noticeable after surgery. Recovery from surgery leads to additional benefits and the majority of women enjoy an improved quality of life.
An overview of breast reduction, including patient selection, techniques, and complications, is presented here. An overview of the flap and graft techniques used for breast reduction is reviewed separately. (See "Principles of grafts and flaps for reconstructive surgery".)
Women with excessively large breasts (macromastia) who seek breast reduction often experience chronic pain and tension in their neck, shoulders, and upper back, and a feeling of heaviness of the breasts. Symptoms are generally worse at the end of a day of upright posture. The sturdy support bra worn by many women with macromastia can cause visible, as well as palpable, tender grooves, overlying the trapezius near its insertion site on the acromion (picture 1). Over the years, these can become permanent troughs that do not resolve even after the bra is removed.
A typical woman seeking breast reduction (reduction mammoplasty) will have two to five pounds (900 to 2200 grams) of excess breast tissue weight that pulls the shoulders forward (picture 2). The trapezius muscles may hypertrophy to compensate. Women with macromastia complain of chronic pain in the breasts, shoulders, neck, or back as a result of the weight of their breasts. (See 'Indications' below.)
Women who choose to undergo breast reduction surgery desire more attractive appearing breasts which usually means breasts with nipples that point outward (not downward), and that are rounded and full on top and in proportion to the rest of their body.
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- PATIENT SELECTION
- COUNSELING AND INFORMED CONSENT
- Impact on future breastfeeding
- Effects of future development or weight fluctuation
- BREAST CANCER SCREENING AND BREAST REDUCTION SURGERY
- SURGICAL PLANNING
- SURGICAL TECHNIQUES
- Pedicle techniques
- - Inferior pedicle
- - Medial pedicle
- - Others
- Free nipple grafting
- Handling the skin
- - Short-scar techniques
- POSTOPERATIVE CARE AND FOLLOW-UP
- SUMMARY AND RECOMMENDATIONS
- Shiliang Chang, MD