NEW YORK, NY, UNITED STATES, May 23, 2023/ — Women with very large breasts often have chronic back, neck, and shoulder pain due to the strain of constantly being forced to bear the heavy weight of their breasts. They can also have problems finding clothes that fit well or bras that are comfortable and then have to contend with strangers staring at their chest. The constant rubbing of the overhanging breast skin on the upper abdomen can lead to skin rashes. Large breasts can also be a barrier to many athletic activities. As a result, women with large breasts may not only feel physically uncomfortable but they may also feel self-conscious about their bodies.Dr. Constance M Chen, a plastic surgeon who specializes in breast and body procedures, explains that a breast reduction removes breast tissue and breast skin, and then repositions the nipple-areola complex (NAC) higher on the chest wall to create a smaller and more lifted breast. The key components of the surgery are the orientation of the blood supply to the NAC and the scar pattern.

A traditional breast reduction bases the blood supply to the NAC inferiorly and uses an anchor pattern scar. The inferior blood supply coming from below means that the tissue resected is from above. Over time, that can lead to bottoming out of the breast. The anchor scar leaves a round scar around the circumference of the NAC, a vertical scar from the NAC to the inframammary fold (IMF), and then a horizontal scar along the IMF. In some cases, the long horizontal scar can extend beyond a bathing suit or bra and be visible. The horizontal scar is also vulnerable to healing issues and can even become wider or hypertrophic (raised) as it heals.

To address the drawbacks of the traditional breast reduction, the short-scar breast reduction (also known as limited-scar or vertical breast reduction) was developed. Often, the short-scar breast reduction uses a superior or superomedial pedicle. With the blood supply coming from above, the excess breast tissue is from below and laterally. The remaining breast tissue starts out higher and is also rotated and repositioned higher so that the breast keeps its shape to stay lifted longer. In addition, the horizontal scar is eliminated altogether. Thus, there is only a lollipop scar around the NAC and vertically from the NAC to the IMF, which usually heals well. There is no horizontal scar under the breast in a short-scar or vertical breast reduction. .

The best technique for each woman takes into consideration the size and shape of the patients’ breasts and the amount of breast tissue that will be removed. Each surgeon may also be more comfortable with one type of breast reduction over another based in part on his or her training and skill level.

Patients who undergo a breast reduction should expect to leave the hospital or surgery center the same day as surgery since breast reduction is considered an outpatient procedure. There may be drains to remove breast fluid after surgery – especially after larger breast reductions – because the body will fill the potential space left by the resected tissue with fluid. The fluid starts out looking bloody immediately after surgery, and then becomes thinner, clearer and less red over time. Most patients will take a couple of weeks to recover at home before returning to work. The normal wound healing process in a healthy uncomplicated patient takes 6-8 weeks. Despite this, some patients may feel relatively normal about a month after surgery. To be safe, it is prudent to wait a couple months after surgery before returning to a fully active and vigorous lifestyle.

Breast reduction surgery is most appropriate for healthy non-smoking women with fully developed breasts. While high-school teenagers with very large breasts do undergo breast reductions, they need to keep in mind that if their breasts are still growing they may feel a need to return for another breast reduction if their breasts keep growing larger after surgery. In addition, young women should keep in mind that any breast surgery could affect later breastfeeding, even though the proportion of women who breastfeed successfully after breast reduction is the same proportion of women who breastfeed successfully without breast reduction. At the end of the day, women don’t have to live with the physical and emotional discomfort of large breasts. Breast reduction has a very high patient satisfaction rate, because after surgery women discover that they can actually be comfortable in their own bodies.

Constance M. Chen, MD, is a board-certified plastic surgeon with a special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast and body surgery. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.