Breast reduction surgery is a cosmetic procedure done for women to

• give smaller, better-shaped breasts in proportion with the rest of the body and
• to reduce the size of the areola by removing fat, glandular tissue, and skin from the breasts.

Breast reduction is essentially done to reduce the size of enlarged breasts for cosmetic reasons such as

• Disproportion of size of breasts with the body
• Personal satisfaction

And more importantly for physical relief in the following cases where they cause

• cystic breast infections (polycystic mastitis)
• back pain, neck pain, shoulder pain, breast pain, or headaches
• loss of sensation in the breasts, arms, or fingers
• sleeping problems or poor posture resulting from large breasts
• pigmented bra-strap groove
• scar lines on the breasts

• Women who are physically healthy, psychologically healthy and have realistic expectations from the procedure
• Women who do not intend to breast feed
• Women whose breast development has stopped
• Women who seek to improve their physical appearance
• Women who seek physical relief due to the problems resulting from enlarged heavy breasts.

Though complications occur in very rare cases, they may include

• Bleeding, infection, or reaction to the anaesthesia
• Small sores may develop around the nipples after surgery which can be treated with antibiotic creams.
• Slightly mismatched breasts or unevenly positioned nipples.
• A permanent loss of feeling in the nipples or breasts.
• Loss of blood supply to the nipple and areola, causing the tissue to die. In such cases, the nipple and areola can be rebuilt using skin grafts from other areas on the body.

• During the initial consultation, a thorough discussion on the expectations of the patient is understood.
• Photographs are taken for further comparison after procedure
• A mammogram is taken before the surgery.
• If a large amount of breast tissue is to be removed, the patient is advised to have a unit of blood drawn ahead of time, if a transfusion should be needed
• The doctor provides guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications
• The doctor discusses and advises on options of anaesthesia, implants, type of facilities and cost with the patient.
• The patient must arrange for transportation and assistance to leave for home after the surgery.

• After the patient is given general anaesthesia, incisions are made circling the areola, extending downwards along the natural curve of the crease beneath the breast. 
• The new location of the nipple is defined by a key-hole shaped incision above the areola.
• The excess glandular tissue, fat, and skin are removed and the nipple and areola are moved into their new position.
• If the breasts are very large the nipples and areolas may have to be detached from the blood vessels and nerves and grafted into a higher position.
• Finally the skin from both sides of the breast is brought down and around the areola, shaping the new contour of the breasts after which the incisions are sutured.
• Gauze dressings will be placed on the breasts and covered with an elastic bandage or surgical bra
• Chest tubes may be inserted to drain any accumulated fluid.

The surgery usually takes one to three hours to complete

The surgery is mostly done on an outpatient basis except for rare complex cases where a short stay in the hospital is required after surgery.

• The patient may feel some pain for the first couple of days especially while moving around or coughing.
• There may be some discomfort for a week or more for which the surgeon may prescribe medication.
• The bandages will be removed a day or two after surgery but the patient must continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside.
• The patient is instructed to sleep on her back to avoid pressure on the breasts
• The stitches are removed in one to three weeks.
• The breast skin may become very dry following surgery requiring application of a moisturizer several times a day making sure to keep the suture area dry.
• The first menstruation following surgery may cause the breasts to swell and hurt.
• There may be random, shooting pains for a few months and some loss of feeling in the nipples and breast skin, caused by the swelling after surgery which fades over the next six weeks, though in some cases it may last a year or more or remain permanent.
• A small amount of fluid draining from the surgical wound, or some crusting, is normal but any other unusual symptoms, such as bleeding or severe pain, must be reported to the doctor immediately.
• Much of the swelling and bruising will disappear in the first few weeks but it may take six to twelve months for the breasts to settle into their new shape, which may continue to fluctuate in response to the hormonal shifts, weight changes, and pregnancy.
• The scars formed as a result of the surgery are extensive and permanent and may often remain lumpy and red for months and gradually become less obvious.

• The patient may be up and about in a day or two but the breasts may still ache occasionally for a couple of weeks.
• The patient must avoid lifting or pushing anything heavy for three or four weeks.
• The patient must follow the surgeon’s instructions regarding resuming normal activities.
• Patients can return to less strenuous work and social activities in about two weeks
• The patient must limit exercises to stretching, bending, and swimming until full stamina is regained.
• The patient must use a good athletic bra for support.
• The patient must only allow gentle contact with the breasts for about six weeks.
• Any sexual activity should be avoided for a minimum of one week.

The final result ensures that the patient is rid of the physical discomfort of large breasts and the physical appearance is better proportioned.

Mammogram - breast x-ray