Breast reduction

Breast reduction (reduction mammoplasty) is surgery to reduce breast volume and weight by removing excess breast tissue and skin. Breasts may be naturally large or may have increased in volume after weight gain, pregnancy, and breastfeeding. We plan this operation for people who would like smaller breasts and reshaping of sagging tissue.

We can begin the consultation by discussing how much reduction you would like and how breast weight affects you. Your wishes may relate to breast width across your torso, forward projection, or sagging. We discuss your desired volume in relation to these details and your body proportions.

Concerns related to breast size

The load large breasts place on the torso may relate to neck, lower back, and upper back concerns. Sweating beneath the breasts and marks left on the shoulders by bra straps are also reasons people seek a consultation.

A difference in proportions between the chest and other body areas can also make choosing clothing difficult. You are welcome to share whether weight, size, or sagging concerns you most. We explain the scope of reduction and reshaping according to your expectations.

Breast weight contributes to the distribution of load across the front of the torso. Pressure from bra straps on the shoulders may accompany these concerns. Neck, back, and shoulder complaints may also relate to posture, muscles, or the spine. The examination considers the load created by the breasts and these other causes separately.

As breast volume and weight are reduced, the position of sagging tissue is also changed. If weight is the main concern, the amount of tissue to be removed takes priority; if sagging is the main concern, nipple position and excess skin are central. Breasts of the same size may have different tissue distributions, so these distinctions determine the scope of surgery.

Breast anatomy and measurements at the examination

Where breast tissue is concentrated guides which areas will have tissue removed during reduction. Skin condition and nipple position affect how the remaining tissue will be reshaped. The size of the areola, the colored area surrounding the nipple, is also among the measurements used in planning skin adjustment.

The breast base is the area the breast occupies on the chest wall. Its width and the shape of the rib cage affect the area in which the reduced breast will sit. The nipple’s distance from the chest midline and its height relative to the fold beneath the breast are measured separately on each side.

Any previous breast imaging and biopsy results are also reviewed at the examination. A biopsy is the removal of a tissue sample for examination. A family history of breast disease helps guide the planning of breast health investigations.

The desired size is understood in relation to existing breast volume and chest circumference. The bra size you have in mind can help describe your expectations for reduction. The amount of tissue to be removed is determined by the breast base, the distribution of the remaining tissue, and the skin’s characteristics.

Breast volume is made up of milk glands, fat tissue, and the connective tissue surrounding them. The distribution of these components varies from person to person. A reduction plan considers both the location of tissue to be removed and the structure of the portion that will remain connected to the nipple. This is why the removal area marked on the skin and the internal tissue distribution are described separately.

Degrees of sagging and nipple position

The inframammary fold is the area where the lower boundary of the breast folds against the chest wall. Sagging is described using the nipple’s position relative to this fold and the breast’s lowest point. The direction the nipple faces and the amount of tissue gathered in the lower breast also inform the reshaping plan.

In mild sagging, the nipple approaches or sits at the level of the fold. In moderate sagging, it lies below the fold but above the breast’s lowest point. In advanced sagging, it descends to the lower boundary and may point downward. The distance it will be moved is determined alongside the arrangement of the internal tissue.

In a large breast, most volume may be concentrated in the lower portion, or the breast may spread across a wide base. Even with the same degree of sagging, these structures require tissue removal from different locations. The lower tissue may also extend past the fold while nipple position is maintained. In this condition, called pseudoptosis or apparent sagging, reshaping addresses tissue distribution in the lower breast.

Reducing and reshaping tissue

In breast reduction, we determine the amount of tissue to remove according to the existing size and desired volume. After removing excess tissue, we reshape what remains and move a low nipple upward. The plan considers where the nipple will sit as well as how much reduction you would like.

Excess skin is removed along with breast tissue during reduction. The remaining skin is adjusted to cover the reduced and reshaped tissue. Excess internal breast tissue and excess skin are therefore considered separately during planning.

The aim of a breast lift is to change the position of sagging tissue. If you would also like to decrease breast weight and volume, we explain how reduction could be included in the plan.

Areas for tissue removal are selected according to where excess volume is concentrated within the breast. The portion that will carry the nipple is preserved, and the surrounding tissue is adjusted accordingly. The distribution of remaining tissue in the inner and outer portions also contributes to the breast’s new shape.

What is a pedicle in breast reduction?

A pedicle is the section of tissue that keeps the nipple and areola connected to the breast tissue. This section contains blood vessels and other tissue connections. Movement of the nipple to its new position is planned around the pedicle’s anatomical connections.

Names such as superior, inferior, and superomedial pedicle describe the direction in which the connection carrying the nipple is maintained. A superomedial pedicle maintains the connection through tissue in the upper and inner breast, while an inferior pedicle uses tissue in the lower portion. The choice relates to how far the nipple will be moved and how the remaining breast tissue will be arranged.

The pedicle describes the internal tissue plan, while a vertical or inverted T incision describes the access and removal lines on the skin. The same skin incision pattern can be used with different pedicle options. At the consultation, you can ask about the direction of the tissue connection that will carry the nipple as well as the external incision lines.

An incision around the areola does not mean the nipple has been detached from all its tissue connections. In pedicle techniques, the surface skin is adjusted while the nipple remains connected to the supporting tissue beneath it. The direction of this tissue and the distance it will move to bring the nipple to its new position on the chest are described in the internal plan.

Incision options for breast reduction

Incision around the nipple

An incision around the nipple follows the outer border of the areola and helps reshape this area. Whether a circular incision alone is sufficient depends on the amount of skin and tissue to be removed. Pronounced excess volume and skin require incision plans extending into the lower breast.

Vertical incision

A vertical incision extends from the line around the areola toward the fold beneath the breast. It provides access to the lower breast and allows excess skin in this area to be adjusted. Skin elasticity, breast base, and tissue distribution determine the scope of this option.

Inverted T incision

An inverted T incision adds a horizontal incision along the fold beneath the breast to the vertical line. This provides space to remove extensive excess skin in different directions. The length of the horizontal portion relates to breast base width and skin distribution in the lower breast.

Lines marked on the skin show the boundaries of skin removal and the nipple’s new position. The distribution of breast tissue to be removed internally follows a separate arrangement that accounts for pedicle position. Incision length describes the skin adjustment, while the volume of breast tissue to be removed depends on this internal plan.

The fold beneath the breast serves as an anatomical boundary when shaping the lower portion. Its height on the chest wall and its extension toward the outer breast can differ from one breast to another. If excess skin spreads widely along this boundary, the scope of horizontal removal is planned accordingly.

Differences in size between the breasts

Mild breast asymmetry, meaning a difference in size or shape between the breasts, is common. A pronounced size difference can make it difficult for a bra to fit both sides in the same way. We plan reduction separately for each breast according to its existing size.

If you would like both breasts to be smaller, we can plan to remove more tissue from one side. If you are happy with the size of the other breast, we also explain the option of reducing only the larger one. We determine the tissue to remove from each side according to existing volume and the desired shape.

Nipple heights, areola diameters, and the positions of the folds beneath the breasts may also differ. These features are recorded separately from the amount of tissue to be removed. The skin removal plan and new nipple position are chosen according to each breast’s own measurements.

Candidacy and anesthesia planning

Cosmetic breast reduction is not planned during pregnancy or breastfeeding. Breast tissue volume and distribution change during these periods. If a medical condition is not under control, the relevant medical assessments need to be completed before a surgical decision. Plans for substantial weight loss are also discussed in relation to the breast volume to be reduced and excess skin.

A report from a previous reduction or lift may contain information about which tissue was used to carry the nipple. A new surgical plan depends on these internal connections as well as existing incisions. Particularly when another reduction is being considered, the location of tissue removed previously and the distribution of remaining tissue are examined together.

Breast reduction is performed under general anesthesia in a hospital operating room. Medical history, current medications, and previous anesthesia experiences are recorded at the anesthesia consultation. The extent of breast tissue removal and any accompanying reshaping procedures also form part of the anesthesia plan.

Breastfeeding and nipple sensation

Breastfeeding involves breast function and the connections of milk glands and ducts to the nipple. A reduction plan considers the amount of tissue to remove and the extent of connections to preserve. You can discuss your breastfeeding expectations at the surgical consultation. The tissues included in the pedicle and the scope of the planned adjustment can be explained during this discussion, but the technique’s name does not establish a definite outcome for breastfeeding function.

Sensation in the nipple and areola relates to nerve branches coming from the chest wall. Their pathways within the tissue are considered when planning the portion that carries the nipple. Existing sensation, previous operations, and the distance the nipple will be moved are recorded during the surgical assessment.