Breast Reduction

Breast reduction is also known as reduction mammoplasty. During surgery, the necessary amount of breast tissue, fat, and stretched skin is removed, and the remaining tissue is reshaped to create a smaller breast.

Breast reduction almost always includes a lift because reducing volume alone does not remove excess skin or reposition a sagging nipple. For this reason, breast reduction with a lift - reduction mammoplasty combined with mastopexy - is commonly performed.

The nipple and areola are usually repositioned higher while preserving their connection to the breast tissue, blood supply, and nerves. Only in cases involving very large volumes may a different technique be required.

Can breasts be reduced without surgery?

It is not possible to reduce the amount of glandular breast tissue or remove excess skin without surgery.

Weight loss may reduce breast volume if a significant proportion of the breast is composed of fatty tissue. However, the result is not predictable, as glandular breast tissue does not necessarily decrease with weight loss.

When is breast reduction surgery needed?

Surgery may be considered when breast size and weight cause:

• persistent neck, shoulder, or back pain,
• deep grooves on the shoulders from bra straps,
• recurrent irritation, moisture, or intertrigo beneath the breasts,
• difficulty with physical activity or exercise,
• significant asymmetry,
• difficulty with everyday movement or clothing choices,
• significant psychological discomfort.

There is no specific bra size, such as D, E, or F, above which surgery is automatically considered medically necessary. Breasts of the same cup size may have different weights and cause different symptoms in people with different body types. Symptoms, body proportions, and the actual volume of the breasts are assessed.

Contraindications

Breast reduction is postponed during pregnancy and breastfeeding, as well as when breast development has not yet been completed.

The risk of surgical complications is higher in cases of uncontrolled diabetes, significant obesity, certain severe cardiovascular diseases, and smoking. These factors are assessed and, when possible, managed before surgery.

Smoking is an especially important risk factor because it reduces blood supply to the tissues and increases the risk of delayed wound healing and infection.

If the patient plans pregnancy and breastfeeding in the future, this should be discussed before surgery, as some surgical techniques preserve milk ducts and nerve connections better than others.

Surgical techniques and types of scars

The surgical technique is selected according to breast size, degree of sagging, amount of excess skin, and the planned extent of reduction.

Anchor-shaped or inverted-T incision.
The incision runs around the areola, vertically down to the inframammary fold, and then continues along the fold. This technique allows a large amount of tissue and skin to be removed and is most often used for significantly enlarged and sagging breasts.

Vertical or “lollipop” incision.
The incision runs around the areola and vertically down to the inframammary fold without a long horizontal scar. It may be used for small to moderate breast reductions.

Periareolar incision.
The scar is limited to the border of the areola. This approach has limited capabilities and is more suitable for minor corrections than for large-volume reduction mammoplasty.

How is the procedure performed at Nairi Medical Center?

Before surgery, the plastic surgeon assesses breast size, symmetry, skin condition, nipple position, and the planned degree of reduction.

The necessary laboratory tests are performed before surgery. Depending on the patient’s age and breast condition, ultrasound or mammography may be required. Nairi Medical Center offers breast ultrasound, digital mammography, MRI, and other examinations when needed.

Reduction mammoplasty is usually performed under general anesthesia and takes approximately 2–3 hours, although large-volume or combined procedures may take longer.

The surgeon removes the calculated amount of breast tissue, fat, and skin, reshapes the remaining tissue, and repositions the nipple-areola complex higher. The diameter of the areola may also be reduced if necessary.

The removed breast tissue is sent for histological examination to rule out possible previously undiagnosed changes. Histological assessment of tissue removed during reduction mammoplasty is a commonly used standard approach.

After surgery, the breasts are supported with a supportive or compression bra. A drain may be placed if needed to remove accumulating fluid.

Some sutures are often absorbable and do not need to be removed. If non-absorbable skin sutures are used, the timing of their removal depends on the surgical technique and wound healing.

Recovery by week

First week.
Swelling, a feeling of tightness, tenderness, and bruising are common. Physical activity is significantly limited, but walking is encouraged and patients are advised not to remain in bed all day.

Weeks 2–3.
Pain and swelling gradually decrease. Many patients can return to desk-based work after about 2–3 weeks. Heavy lifting and strenuous exercise should still be avoided.

Weeks 4–5.
Everyday movements generally become much easier. The supportive bra continues to be used, and physical activity is increased gradually.

After week 6.
In many cases, patients can gradually return to exercise and more demanding physical activity.

Complete resolution of swelling and final breast shaping may continue for several months.

Scars

The location of scars after reduction mammoplasty depends on the incision technique used.

With the anchor technique, the scar runs around the areola, vertically downward, and along the natural inframammary fold.

With the vertical technique, the scar remains around the areola and extends downward from it.

With the periareolar technique, the scar is located along the edge of the areola.

Initially, scars are usually pink or reddish and more noticeable. Over time, they generally soften and fade but do not disappear completely. Final scar maturation may take around one year or longer.

Silicone gel or silicone sheets should only be used after the wound has completely closed.

Breastfeeding after surgery

Breastfeeding after reduction mammoplasty may be possible, but full preservation of breastfeeding ability cannot be guaranteed.

The likelihood depends largely on how well the breast tissue, milk ducts, and nerves connected to the nipple are preserved during surgery. Techniques that completely detach the nipple are more likely to reduce the ability to produce milk later.

If the patient is planning pregnancy in the near future, the timing of surgery should be discussed in advance, also because the breasts may enlarge again during pregnancy and alter the surgical result.

Risks and possible complications

Possible complications after reduction mammoplasty include:

• temporary or permanent changes in nipple or breast sensation,
• asymmetry of the breasts or nipples,
• delayed wound healing or wound separation,
• infection,
• hematoma or seroma,
• noticeable scarring,
• reduced ability to breastfeed,
• rarely, impaired blood supply to the nipple or an area of skin.

The surgeon should be contacted immediately if rapidly increasing swelling, significant one-sided pain, high fever, purulent discharge, or a sudden change in skin color occurs after surgery.

Shortness of breath or chest pain requires immediate medical attention.

Does the result last?

The result of breast reduction is generally long-lasting because part of the breast tissue is physically removed during surgery.

However, breast size and shape may change later due to significant weight gain or loss, pregnancy, hormonal changes, aging, and the natural weakening of tissues over time.

If there is significant weight gain, the remaining fatty tissue may increase in volume, and the breasts may enlarge again during pregnancy.

Why have breast reduction at Nairi Medical Center?

The Aesthetic and Plastic Surgery Service at Nairi Medical Center performs breast reduction, mastopexy, correction of breast asymmetry, liposuction, abdominoplasty, and combined plastic surgery procedures.

Breast ultrasound, digital mammography, MRI, and histological examinations are also available at the center. This allows the necessary preoperative examinations and subsequent follow-up to be carried out within the same medical center.