Very often, women with unusually large, sagging or uneven breasts are dissatisfied with their physical appearance. Some experience pain or discomfort from the sheer weight of their breasts and the pressure of brassiere straps on their shoulders. Premenstrual congestion often adds to the discomfort. Large breasts can hamper a woman's physical activities and make it difficult to find properly fitting clothes, particularly brassieres. Today, because of advances in surgical techniques, thousands of women with these problems are being helped through a surgical procedure called reduction mammaplasty or breast reduction. This surgery is designed to improve the body contour, reduce pain, and make the individual more comfortable when engaging in physical activities.

Before surgery
Prior to surgery, a complete medical history is taken in order to evaluate the general health of the patient. The breasts themselves are then examined thoroughly to determine the most effective surgical approach. The physician describes the type of anesthesia to be used, the procedure, what results might realistically be expected and possible risks and complications.

Mammograms or x-rays may be taken as well as photographs. Preoperative instructions often include the elimination of certain drugs containing aspirin for several weeks before surgery in order to minimize the possibility of excess bleeding. Birth control and other estrogen containing hormones may also be discontinued temporarily. Antibiotics may be prescribed for a few days prior to surgery to prevent infection.

The procedure
A breast reduction is usually performed in a hospital or an outpatient surgical setting under general anesthesia with the patient asleep. The physician may choose form a variety of surgical procedures, depending upon what changes are desired. Prior to surgery, pre medication to relax the patient is administered, and the breasts are carefully marked to indicate where incisions are to be made.

One of the techniques most frequently used is called a brassiere pattern skin reduction. This technique involves both vertical and horizontal incisions made around the nipple area after which excess fat, tissue and skin are removed from the sides of the breast. Following the excision, the nipple, areola (dark, pink area circling the nipple) and tissue below are relocated but not detached. Small sutures are used to close the incisions.

A second procedure, used on patients with extremely large breasts, includes complete detachment and relocation of the nipple. After fat and tissue are removed, skin on the sides of the breast is brought down and around the areola to reshape the breast. The incision is then sutured. A breast reduction can take three to five hours or more, depending upon the extent of the surgery.

Following surgery
Following surgery, the patient wears either bandages or a special garment. These are usually replaced in a few days with a surgical bra which is worn for several weeks. Patients who are operated on in a hospital are released in a day or two.

Pain connected with the procedure is minimal to moderate and is controlled with oral medication. Antibiotics may be prescribed to prevent infection. Instructions for the day of surgery include bed rest with limited activities. The physician determines when normal activities can be resumed; however, strenuous exercise and overhead lifting must be avoided for several weeks.

After breast reduction
Sutures are removed in about seven days. Numbness around the treated area may occur, but this condition is usually temporary. Swelling and discoloration disappear in a few days, and scars from incisions, although permanent, fade significantly with time.

Complications of infection and slow healing are rare; however, there are certain inherent risks connected with every surgical procedure which should be thoroughly discussed with the physician. Patients can minimize complications by carefully following directions given by the physician. Some patients who experience poor healing may require additional treatment.

Will insurance pay for this surgery?
Some insurance companies will pay all or part of the costs of this surgery if it is performed as a result of back or neurological problems related to large breasts. Each insurance carrier is different, and it is recommended that individuals check with their own agents to determine if there is coverage.