A breast reduction:

surgery also known as reduction mammaplasty

The goal of breast reduction surgery is to reduce the size of your breasts and reshape them so that they are proportionate to the rest of your body and are no longer a source of physical discomfort. This commonly requested, predictable procedure has the dual benefits of improving your appearance while relieving the physical and emotional burden of overly large breasts.

you will consider Breast Reduction

If your breasts are too large for your body frame and create neck, back, or shoulder pain
If you have heavy breasts with nipples and areolas (pigmented skin surrounding the nipples) that point downward
If one breast is much larger than the other
If you are unhappy and self-conscious about the large appearance of your breasts

If you are in good general health and have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

How is a breast reduction procedure performed?

Breast reduction surgery, which usually takes from three to five hours, is performed in a hospital or surgical center. An overnight stay is not usually required. The surgery commonly involves three incisions. After the surgeon removes excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areolas may be reduced in size. Skin that was located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.
Microincisions are used for breasts that are fatty (not fibrous) and not sagging. Liposuction is used to decrease breast size. Small incisions allow the liposuction cannula (tube) to enter the breast.
A donut incision, or periareolar incision, is made solely around the border of the areolas.
A keyhole incision, also known as a lollipop incision, is made around the border of the areolas and vertically down from the areolas to the breast crease.
An anchor incision, the most common technique used by plastic surgeons, involves three distinct cuts. One incision is made around the border of the areolas; the second extends down vertically from the areolas to the breast crease and merges with a third incision along the breast crease.
Your surgeon will remove excess breast skin and fat with a scalpel and/or cautery instrument based on the size breast you desire. If your breasts are asymmetrical (or uneven), the surgeon may remove more tissue from one breast than the other. He or she will then reshape the remaining skin and fat to create a more youthful breast shape and move the nipple-areola complex to a higher position.
In most cases, drains will be placed in the breasts to collect excess fluid.
Breast incisions are then closed with sutures that go from the deep tissue layers to the more superficial layers (the skin).

Liposuction for breast reduction

Breast liposuction may be right for you if you have fatty breasts, need a minor-to-moderate reduction, and do not need to correct sagging. Here are some considerations:

Results may be acceptable for women who need significant reduction but do not want the scars and loss of sensation and are willing to accept some sagging.
With the onset of menopause, breast tissue is gradually replaced by fat, so postmenopausal women are among the best candidates for liposuction-only breast reduction.
Patients with fibrous tissue and minimal fat in their breasts are not good candidates.
Ptosis (sagging), poor skin condition with little tissue elasticity, and low nipple position are also contraindications.
Liposuction alone may be used to treat asymmetry up to one cup size.
Following liposuction of the breast, the elastic qualities of the skin cause it to contract, and subsequent uplifting of the breast contour should occur to some extent.

The common anchor incision follows the breast’s natural contours and defines the new location for the nipple.
Once breast tissue, fat and skin are removed, the skin is brought down and together to reshape the breast.
Large breasts that sag can cause back pain and other physical and emotional discomfort.
After surgery, breasts will be in proportion to your body and scars will fade over time.

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for breast reduction and clarify what a breast reduction surgery can do for you. Once your surgeon understands your goals, he or she may suggest additional or related procedures such as breast lift, liposuction, or an upper body lift.

Your plastic surgeon will examine, measure, and photograph your breasts for your medical record. Your surgeon will consider:

The current size and shape of your breasts
The breast size and shape that you desire
The quality and quantity of your breast tissue
The quality of your skin
The placement of your nipples and areolas

If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. The surgeon may recommend that you stabilize your weight before undergoing surgery.

If you think that you may want to become pregnant in the future, discuss this with your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your breast reduction.
In advance of your procedure, your surgeon will ask you to:

Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
Stop smoking at least six weeks before undergoing surgery to promote better healing.
Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and critical outcomes.
Keep alcohol consumption at less than two to three drinks per week.
Before surgery, stock your refrigerator with high-protein, low-sodium foods, including premade meals, fresh fruits and vegetables and lots of caffeine-free beverages and water. Avoid food and drink containing salt during your recovery.
As you heal, your arms will have a limited range of motion, so store all the supplies you’ll need during recovery where they’re easily accessible (at counter level, not in overhead or very low cabinets).
Stockpile movies or prerecorded programs and novels and magazines. If possible, have a speaker phone by your bed and a remote control for the TV.

Avoid hot showers, hot tubs and saunas for two to three weeks.
Decide what you will wear for the first few days; pick items that open in front. Wear slip-on shoes so you don’t have to bend.
Breast reduction surgery is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

What can I expect on the day of my procedure?

You may be asked to wash your body with antibacterial soap prior to surgery.
Make sure not to wear cosmetics (including nail polish), lotions, perfumes or other substances.
Dress in or bring soft, comfortable clothes that you’ll be able to wear after the surgery, including a top that opens in the front and shoes that slip on.
Bring only the essentials (ID, insurance card, cell phone, etc.) and leave other personal belongings such as jewelry at home.
Medications are administered for your comfort during the surgical procedure.
General anesthesia is commonly used during your breast reduction procedure, although local anesthesia or intravenous sedation may be desirable in some instances.

Recovery time frame after breast reduction
It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
Soreness and pain. You will feel tender, stiff and sore for a few days and will more than likely not want to move too much. This will subside. Be sure to take your required medications and follow the precise instructions provided by your surgeon. You may be given a pain pump; pain pumps deliver pain medications directly to the area of treatment and effectively relieve discomfort without making you groggy. Not all surgeons offer this option, so be sure to ask about it.
Swelling. As with all surgeries, swelling will be an issue. You may be swollen for up to three to four months, although this could be very slight and only noticed by you. Your breasts, of course, will be smaller than they were before and higher, so you may not notice swelling too much. Treatment for prolonged swelling includes increasing your fluid intake (preferably water), having normal to low sodium intake, and movement, such as light walking.
Bruising. Bruises may or may not be present after your surgery. This depends entirely on the patient, the technique used, and the effectiveness of the epinephrine that was administered during surgery. Other common side effects during recovery include numbness or changes in nipple sensitivity, itching around incision sites, and increased firmness or fullness in the breast tissue. These side effects should subside over the next few weeks, with some residual effects lasting up to three months after surgery.
Sleeping. It is important to sleep with at least two or three fluffy pillows under your upper back and head, or on a wedge pillow or a recliner chair, to keep your torso elevated. This helps relieve pressure on your treatment area, reducing swelling and pain. Many patients place a pillow under their knees to prevent rolling over during the night. They also place pillows alongside them to create a sort of recovery nest.
Bathing. You may be asked to take sponge baths until your incisions are completely closed and your sutures are no longer in place. You may not be able to wash your hair for a while, because you will not be allowed to raise your hands over your head. If you must wash your hair, have a friend assist you in the sink or basin or with a handheld showerhead.
Activity. Even though you may not feel like it, your surgeon will probably advise you to walk and move around as soon as you can to prevent blood clots and swelling. You will be instructed not to exercise or engage in strenuous activities for at least three to four weeks. Don’t lift anything over five pounds and try not to raise anything over your head until your surgeon releases you for activity. Take your time in healing so that you give yourself the best healing environment possible. Your full range of motion should return between six to ten weeks, depending on how well you have healed. Within six months, you should be able to do all those things you wanted to do but couldn’t because of your oversized chest.

Unless you gain or lose a significant amount of weight or become pregnant, your breasts will remain a consistent size. However, gravity and the effects of aging will eventually cause your breasts to loosen and sag over time.

Choose your surgeon based on quality, training and experience—not cost

Fortunately, serious risks of breast reduction surgeries are rare and the satisfaction rate with these procedures is high. The overall complication rate is small if the operation is done by an experienced plastic surgeon operating in an accredited facility.

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

Adverse reaction to anesthesia
Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
Infection and bleeding
Changes in skin sensation
Allergic reactions
Damage to underlying structures
Unsatisfactory results that may necessitate additional procedures
Blood clots in the legs or lungs
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your breast reduction.