A bilateral breast reduction is a surgical procedure performed under a general anaesthetic to reduce the size of the breast. The breast is lifted at the same time, the diameter of the areola is often reduced and the shape of the breast may be improved.

Women who undergo breast reduction surgery do so for a multitude of reasons. The most common reasons include: back pain, neck pain, shoulder pain, shoulder grooving from bra straps, inability to find a bra that fits and generally feeling uncomfortable. Some women suffer from headaches and others suffer from rashes under the breasts, particularly during the summer months.

Let’s talk about some of the key points about breast reduction surgery before you embark on your first consultation with your surgeon.

1. Have an idea of the size you would like to be but don’t be too concerned with choosing a particular cup size.

Many women ask to be made a certain cup size, a 12C for example. Whilst your surgeon will make every effort to get you to your ideal size it is more important that your surgery is performed safely in order to ensure the nipple has enough blood going to it to keep it alive.

2. Be up to date with your breast screening.

Your surgeon will ask about your personal history of breast lumps as well as any family history of breast cancer. If you are over 40 they will want an up to date mammogram and if you are under 40 with a family history they may organise some imaging prior to your surgery. 1 in 7 women will be diagnosed with breast cancer in Australia and this is an important aspect of your consultation. In addition to pre-operative screening, your surgeon will send off the breast tissue they remove during the surgery to a pathologist to ensure there is no breast cancer in it. The second reason that up to date screening is important before surgery is that it is advisable that you do not undergo screening for 12 months after surgery to ensure the breasts have had time to settle. Surgery should not delay breast screening.

3. Tell your surgeon if you have nipple sensation and whether preservation of the sensation is important to you.

Nipple sensation can often be reduced in women with very large breasts. If nipple sensation is present and it is important to you that it is still present after your surgery tell you surgeon. They may be able to modify their technique to reduce the risk of the sensation being lost.

4. So how do you make a breast smaller?

On the day of surgery you will speak with your anaesthetist and your surgeon before being taken into the operating theatre and being put under a general anaesthetic. Your surgeon will draw some markings on your breasts and chest wall prior to this. These markings act like a pattern for your surgeon during the surgery. The first part of the operation is removal of the excess skin. The second part of the operation is leaving behind enough breast tissue to keep a sufficient blood supply to the nipple and areola. The rest of the breast tissue is removed. Your surgeon will ensure there is no bleeding. They may insert a small drain and then sew the skin back together following the pattern they marked on the breasts prior to surgery. This will result in a scar that goes around the areola, then straight down the middle of the breast and under the breast in the fold between the breast and chest wall (the infra-mammary fold). It can look like an anchor or upside down T. Often the breast tissue that has been removed will be weighed so that the same amount of breast tissue is removed from each side. In cases where the breasts are different sizes this ensures that the right amount is removed from each. Dressings are placed over the wounds and a compression bra is fitted. Breast reduction surgery commonly requires an overnight stay for pain relief. The drain, if placed, is usually removed the next morning before you are discharged home.

5. No two breasts are alike.

Or as some would say: “Sisters, not twins.” Your surgeon will do all that they can to ensure the breasts are as symmetrical as possible however small asymmetries may remain after your surgery.

6. Your recovery after surgery is just as important as your planning before surgery.

Breast reduction surgery is major surgery. It brings joy to many patients and is associated with a high patient satisfaction and a relatively low risk of complications. Most women will be taking simple pain killers by the time they return to their surgeons office for their first post-surgery check-up. However, you must take care of yourself and take it easy. Rest and relaxation are key in the recovery after surgery. The more you do immediately after surgery, the higher the risk you will suffer a complication. Listen to your body and let it recover.

7. If you have very large breasts and are seeking a very large reduction talk to your surgeon about nipple loss.

Very large breast reductions are at higher risk of complete nipple loss due to poorer blood supply to the nipple. Your surgeon will discuss this with you and the surgical techniques that may be used if this were to occur.

8. It takes time for the breasts to settle.

Your breasts may look boxy initially and the scars are obvious. If you are expecting this it won’t be quite as confronting. Remember that each week and month that passes the breasts will soften, become more rounded and the scars will begin to fade. Your surgeon may recommend taping your scars or using silicone. They will also advise you as to the ideal length of time for compression. Surgeons often document the progress of the breasts after a reduction and you may ask to view a series of photos that show what to expect at 1 week, 6 weeks, 3 months and 12 months after surgery.

9. Breast reduction surgery can be life changing.

For women suffering from all of the symptoms listed at the beginning of this blog, this surgery can be a game changer. For many women breast reduction surgery is the catalyst that allows them to exercise for the first time, choose the clothes they feel comfortable in and finally be free of debilitating pain.