BREAST REDUCTION

Dr Chia Hui Ling

Macromastia is disproportionately large and heavy breasts on an otherwise average size patient. Women often seek breast reduction surgery due psychological reasons, physical reasons, or both.


Breast reduction removes excess breast tissue, fat, and skin to create smaller, lighter, better-supported breasts. Unlike most cosmetic breast surgery, it is often driven as much by physical discomfort as by appearance, and many patients describe it as one of the most relieving procedures they have had.


•      Reduces the physical weight pulling on the neck, shoulders, and back, which can ease chronic pain

•      Lessens skin irritation and rashes under the breast crease

•      Reduces deep grooving from bra straps digging into the shoulders

•      Makes it easier to exercise and be physically active

•      Improves breast shape and proportion, alongside the physical relief

•      You experience ongoing neck, shoulder, or back pain attributable to breast size

•      You have skin irritation, rashes, or discomfort under the breast fold

•      You are at a stable, healthy weight and not planning significant weight changes

•      You have finished breastfeeding or are not planning to breastfeed in the near future

•      You accept permanent scarring in exchange for the reduction in size and symptoms


Reduction surgery leaves scars (see below) in exchange for meaningful symptom relief, and most people who have needed the operation for physical reasons feel the trade-off is worthwhile.


 The surgery also lifts the breasts and nipples , improves the shape of the breast and reduce the size of enlarged areolae at the same time. Your plastic surgeon may offer the additional option of liposuction to contour the sides of your breasts.


TREATMENT

Breast reduction is performed under general anaesthesia, usually with an overnight stay, though some smaller reductions are done as day surgery.



•      Common incision patterns include an anchor shape, or a shorter vertical (lollipop) pattern for smaller reductions

•      Excess glandular tissue, fat, and skin are removed, and the remaining tissue is reshaped

•      The nipple-areola complex is repositioned higher, usually kept attached to its own blood and nerve supply

•      Surgery typically takes two to four hours depending on the amount of tissue removed

•      Drains may be used for a day or two to reduce fluid build-up

•      Most people take one to two weeks off work

•      Swelling and firmness settle over six to twelve weeks

•      Scars remain pink and raised initially, softening and fading over twelve to eighteen months

•      Physical symptom relief is often noticeable almost immediately after swelling subsides


  • Preparing for Surgery

    Do inform your plastic surgeon of previous breast conditions and surgeries, any medical conditions and medications. If you are approaching or more than 40 years of age, preoperative breast screening is recommended. Avoid blood-thinning medications, anti-inflammatory drugs or herbal supplementations as they can increase the risk of excessive bleeding during surgery, unless indicated by your doctor.



  • Surgery

    The surgery is usually perfomed under intravenous sedation or general anaesthesia, and often in a day surgery.


    The plastic surgeon starts with marking of the breasts in a standing or sitted position before the surgery. During the surgery, the excess skin and breast tissues are removed, the breast tissue is reshaped and the nipples are lifted. 


  • Post-Surgery Care

    You may be asked to wear a support bra after surgery. The breasts will be more lifted and swollen straight after surgery and this will settle to a more natural shape over the next few months.

COMPLICATIONS AND MANAGEMENT

Because reduction involves more extensive tissue removal and repositioning than augmentation, the range of possible complications is a little broader.


•      Permanent scarring, which is usually well-hidden in a bra or swimsuit but is a certainty, not a risk

•      Temporary or, less commonly, permanent changes in nipple sensation

•      Reduced ability to breastfeed, though many people retain some capacity

•      Delayed wound healing, particularly at the T-junction where incision lines meet

•      Asymmetry in size, shape, or nipple position

•      Fat necrosis, felt as firm areas within the breast

•      Rarely, in very large reductions, compromised blood supply to the nipple, which may need further surgery




FAQs

Will breast reduction relieve my back and neck pain?

Most people with genuine size-related symptoms notice meaningful relief once swelling settles, though reduction will not resolve pain that has other causes, such as posture or an unrelated spinal issue.

Will I be able to breastfeed afterwards?

Many people retain some ability to breastfeed, especially with nipple-sparing techniques, but a reduction can reduce glandular tissue and ducts, so there is no guarantee of full milk supply.

How visible will the scars be?

Scars are permanent but are usually positioned under the breast fold and around the areola, so they are generally well concealed by a bra or bikini top. They fade considerably over the first one to two years.

Will my breasts sag again over time?

Gravity, ageing, and weight changes continue to affect the breasts after surgery, so some degree of change over many years is normal, though most people retain a noticeably lifted, reduced shape long-term.

Is there an age I should wait until?

It is generally advisable to wait until breast growth has stabilised, and many surgeons prefer to operate once major weight changes or family planning are largely settled, though this varies by individual.

How much smaller will my breasts be?

This is planned together with your surgeon based on your frame, symptoms, and preference, ranging from a modest reduction to a substantial decrease in cup size.