Breast reduction

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman or a teenage girl-feel extremely self-conscious.

Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

You may be a good candidate for breast reduction if you have one or more  of the following conditions:

  • breasts that are too large in proportion to your body frame
  • one breast is much larger than the other
  • heavy, pendulous breasts with nipples and areolas that point downward
  • back, neck or shoulder pain caused by the weight of your breasts
  • skin irritation beneath your breasts
  • indentations in your shoulders from tight bra straps
  • restriction of physical activity due to the size and weight of your  breasts
  • dissatisfaction or self-consciousness about the largeness of your  breasts

Breast reduction can be performed at any age, but usually, we recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later.

If you plan to breast-feed in the future, you should discuss this with us. During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved.

We will examine your breasts, taking measurements and perhaps photographs for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. It is important for you to provide complete information. You should tell us if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss.

Depending on your age, or if you have a history of breast cancer in your family, we may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast reduction, you will still be able to perform breast self-examination. Breast reduction surgery will not increase your risk of developing breast cancer. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Whether you are released the first day after of surgery or the following day, you will need someone to drive you home and to stay with you for the next day or two.

The operation is performed under general anesthesia and needs 1-2 days in the hospital. Individual factors and personal preferences will determine the specific technique selected to reduce the size of your breasts.

Surgical procedure

1. Classical Techniques

There are many ways to perform a breast reduction. The method must be tailored to the patient. A common method of surgery is to mark the new nipple position. Then with the blood supply of the nipple preserved on a pedicle of tissue, the excess breast is removed. The nipple is then moved into its new position and the new breast shape is reconstructed. The incision is often around the nipple and on the under surface of the breast, like an upside down T. The operation is done under general anesthesia while the patient is asleep.

Patients who receive this procedure usually remain in the hospital over night. If the breasts are not too large and the skin has good elasticity then liposuction may be possible. This is especially useful in women who wish to avoid long scars. It is possible that this technique may preserve the ability to breast-feed. For many surgeons it has become the most popular way to perform breast reduction on a patient who is about a DD size. Very large and pendulous breast still requires the more traditional methods that result in longer scars.

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. The surgeon then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areola tissue.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, Liposuction alone can be used to reduce breast size, leaving minimal scars. Your doctor will discuss the different methods used for breast reduction and describe his technique that is best for you. Complications are rare – but must be thoroughly discussed and considered before you decide to have surgery.

2. Peraareolor Techniques or Ronndblock Techniques with leave scan only around nipple. This Techniques will Made unnatural  shape of New breast but have no inverted T Scar

3. Scarless Brest reduction

If the breasts are not too large and the skin has good elasticity then liposuction may be possible. This is especially useful in women who wish to avoid long scars. It is possible that this technique may preserve feeling and the ability to breast feed. For many surgeons it has become the most popular way to perform breast reduction in the patient who is about a DD size. Very large and pendulous breast still require the more traditonal methods with the longer scars.

Contrast all of this with the “Scarless” breast reduction. It is performed in our certified surgical center, with twilight sleep anesthesia, plus local anesthesia. There is little or no pain during the postoperative period. Patients are encouraged to resume full activity as soon as they feel up to it.

Remember, the female breast is composed of at least 50% fat by the age of 35.  Liposuction, with special instruments, will remove fatty tissue but not the firmer glandular tissue.  After surgery, the skin shows a dramatic degree of shrinkage, with the nipple/areola often rising 1-2 inches once fully healed.  So you can see that the operation provides a significant lift in most patients, but the amount of lift is determined by the patient’s elastic skin characteristics, not skin removal.  This allows the operation to function without scars

Another wonderful feature of the Scarless surgery is its use in “asymmetry”.  This is a condition were the two breasts are different sizes. As this is often present in the young patient, we are especially pleased to be able to offer this operation to adjust the size, without leaving a visible scar.

AnesthesiaGeneral Anesthesia.
Surgery Length4-7 hours
Side EffectsHematoma, Inflammation and Infection.
Recovery Period3 – 6 weeks
Stay in Hospital2 days
Stay in Thailand14 – 17 days
  • After surgery, you’ll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.
  • You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain.
  • The bandages will be removed a day or two after surgery, though you’ll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.
  • If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.
  • Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
  • Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.
  • The surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it’s not too strenuous) and social activities in about two weeks. But you’ll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You’ll also need a good athletic bra for support.
  • You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.
  • A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don’t hesitate to call the doctor.
  • Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.
  • Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can even wear low-cut tops.