Introduction: Bigger Is Not Always Better
Breast reduction, or reduction mammaplasty, is a surgical procedure which involves the reduction in the size of breasts by excising fat, skin, and glandular tissue; it may also involve a procedure to counterract drooping of the breasts. As with breast augmentation, this procedure is performed most often on women.

Breast reduction surgery is oriented toward women with large, pendulous breasts, since the weight of their breasts may cause neck, back, shoulder, circulation, and/or breathing problems. The weight may also cause discomfort as a result of brassiere straps abrading or irritating the skin. Even if physical discomfort is not a problem, some women feel uncomfortable with the large size of their breasts in proportion to the rest of their bodies. Reduction mammoplasty affords the recipient smaller, lighter, and firmer breasts. The surgeon may also reduce the size of the areola or nipples.

What Is Breast Reduction?
Breast Reduction, or reduction mammoplasty, is designed to alter the size of the breasts to better the life of the patient.  When one has very large breasts it is difficult to exercise, play sports. swim, fit into clothing, or otherwise stand up straight without pain.  Mixed with the insecure feelings overly large breasts may bring, it is undoubtedly a nightmare for many.

Are You A Candidate For Breast Reduction Surgery?
First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery.  Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.  You must have good elasticity so that your skin is able to bounce back to its former tightness.  Although, if it is a larger area, excess skin removal will be necessary.  Discuss your goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure.  Cosmetic surgery is not getting a cavity filled.  This is an operation which requires patience and stability in dealing with the healing period.

What To Expect At Your Consultation
After checking a surgeon's background and credentials, you will make an appointment for a consultation.  You will meet with this surgeon and discuss your goals and you will disclose all information regarding your health.  Your skin will be examined and the elasticity will be determined.  You will discuss your complaints and concerns and discuss the various techniques available to you.  Your surgeon will explain the tissue reduction methods that may be most appropriate for you. 

You will also discuss the available anesthesia that will be used for your procedure.  Most breast reduction procedures are performed under either General or Light Sleep Sedation.  Either way, discuss this beforehand as many people are not aware of the risks of Anesthesia.

You will discuss the fees, although sometimes you will discuss this with the financial planner instead of the surgeon.  If you have any additional concerns that the surgeon has not mentioned, you should ask for this information at this time.

Before Your Surgery
You will be given a pre-operative information packet that explains everything you should do and know before your surgery date.  The packet should include all the medications you should not take for up to 2 weeks before your surgery.  These medications will include, but are not limited to, aspirin containing products.  Also, your surgeon may or may not advise you of the benefits of Arnica montana for swelling and bruising.

It is quite possible that you will have blood tests (CBC) performed. This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count which ultimately can alert them to disease or disorders beforehand.

In-Office Surgery Centers or a Hospital?
Sometimes, depending upon the doctor, Breast Reduction is performed in a hospital, this can be more expensive and today, more and more doctors have a Surgery Center to perform their procedures.  It is advisable to take a tour of the on-site surgery facility although they may fear that your presence can disrupt the sterility.  A surgery center should be accredited by an Ambulatory Health Care and Surgery Center Accreditation Organization like The American Association for Accreditation For Ambulatory Surgery Facilities or the AAAHC - Accreditation Association of Ambulatory Health Care.  This is very important as the Accreditation Organizations ensure that the facilities are safe, have the correct equipment for monitoring your heart and breathing as well as having an effective emergency protocol.

Although, depending upon the extent of the reduction it may be in your best interest to have your surgery in a hospital and stay a night or two.

The Breast Reduction Surgery
The most common procedure involves an anchor-shaped incision which circles the areola. The incision extends downward, following the natural curve of the breast. Excess glandular tissue, fat, and skin is removed. Next, the nipple and areola are moved into their new position. Finally, remaining skin from both sides of the breast are brought down around the areola and reattached. Recently there has been increasing interest in limited scar techniques which leave only a vertical scar, known as the Le Jour method.

In some extreme cases, the areola and nipple may need to be completely removed for relocation. In these cases, sensation from the areola area will be lost.
Breast Reduction surgery is very tricky, please choose only a qualified doctor who is able to meet your reasonable expectations and keep you out of harm's way with his or her expertise.  The most common methods for breast reduction involve a pedicle, or platform, of tissue that is not excised so that nerve loss or areola (the darker skinned area surrounding the nipple) necrosis is practically nil.

These Pedicle Methods are:

The new position of the nipple may be marked with a surgical marker but it is kept on the pedicle of tissue so the blood supply is uninterrupted.  The areola/nipple is surgically moved to a new position then the skin envelope (your breast) in nipped and tucked and otherwise reconstructed around the lesser tissue.  The incision is usually around the areola and down to the underneath lobe of the breast, like a lollipop and sometimes an anchor shape.  If your breasts aren't too large and do not need major reduction then ultrasonic liposuction (UAL) may be an option for you.  Just know that burns are possible with UAL reduction mammoplasty.

After you are stitched up and your surgical bras placed over your newly reduced breasts # you will be woken up slowly where you will feel very groggy and the pain may or may not start to set in as of yet.  More than likely it will not as the breasts are injected with a Lidocaine and epinephrine mixture that is designed to constrict your blood vessels and capillaries  for less chance of bleeding as well has numb the area of course for comfort.  The Lidocaine also prohibits the body from realizing it is being injured - hence disrupting autonomic responses such as swelling, increased heart rate, etc.

Recovery
A drain is sometimes inserted to allow the fluids an exit from the incision sites or from the bottom most portion of the treatment area.  You will be swollen and bruised and will more than likely be wearing a type of compression garment or surgical bra with ace bandages binding your breasts to your body.  Take your temperature regularly.  An elevated Temperature could mean an infection.  Take those antibiotics ON TIME. And don't forget if you are taking birth control that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well.

You will feel tender, stiff and sore for a few says and will more than likely not want to move too much.  This will subside and your bruises will get better.  Be sure to take your required medications and follow the precise instructions provided to you by your surgeon.

Even though you may not feel like it, your surgeon will more than likely advise you to walk and move around as soon as you are able.  If you do not and lie around you may develop clots and or hold fluid (swelling, edema) a lot longer.  Your sutures may be removed within the first 7 to 10 days but may stay in for up to 14 # depending. 

You will be instructed not to exercise or engage in strenuous activities for at least 4 weeks.  You may be swollen for up to 3 to 4 months, although this could be very slight and only noticed by you.  But, your breasts will be smaller than they were before and you really won't notice swelling too much, probably, just soreness.

For help with keloid prevention and scar flattening some surgeons suggest silicone gel sheeting from www.BioDermis.com (these gel shapes are generally used for mastopexy, or breast lift, but are suitable for common breast reduction with lift incisions). 

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