Are large, pendulous breasts causing you:

• Back or neck pain?
• Bra-strap grooves in your shoulders?
• Rashes under the breasts?
• Pain or discomfort while exercising?

If you are burdened by large, pendulous breasts, breast reduction surgery can give you a new sense of freedom. Breast reduction surgery, or reduction mammoplasty, can give you a higher, firmer bustline—and relieve you of the physical and emotional discomfort of heavy, sagging breasts.

Imagine how much more comfortable you will feel while running or exercising—or wearing the fashions you've been wanting to wear—when you don't have to worry about your breasts weighing you down.

The photos below show an actual patient who had breast reduction surgery by Dr. Sterry.

This woman was wearing a size 46 DDD bra before surgery. Dr. Sterry performed breast reduction without removing the nipples (as advocated by some surgeons). The patient actually has more breast sensation after surgery than before it.

For more before and after examples, visit our photo gallery

Where are breast reduction incisions made?

There are several breast reduction surgery techniques:

• The Wise pattern—also called the anchor or the inverted T—allows Dr. Sterry to remove the most excess skin from below the nipple and reduce sagging to the greatest degree. There are three incisions: one is made around the areola, or darker tissue surrounding the nipple. Another incision runs vertically from the bottom edge of the areola to the inframammary crease under the breast. The third is a side-to-side incision beneath the breast that follows the natural curve of the breast crease.

  After Dr. Sterry removes the excess breast skin and shapes the remaining breast tissue, he shifts the nipple and areola to a higher position. If the areola is stretched out, it can also be reduced in size. Skin that was located above the areola is brought down and together to reshape the breast. In some cases, Dr. Sterry may also use liposuction to improve the contour on the sides of the breasts.

  Because the nipples and areolae remain attached to the underlying mounds of breast tissue, breast sensation and the ability to breastfeed are normally preserved.

• The lollipop or vertical incision works best for breasts with mild to moderate sagging, where the nipple is near the breast crease. There are two incisions—one encircling the areola and the second extending vertically from the nipple to the crease beneath the breast.

  Dr. Sterry removes the excess skin from below the nipple and repositions the nipple-areola complex at a higher level. Then he brings together the remaining skin and sutures it.

What is breast reduction surgery?

“Breast reduction surgery, or reduction mammoplasty, is plastic surgery performed to decrease the size of overly large breasts.

In women who have had massive weight loss, I may perform breast reduction surgery as part of an upper body lift.”

How can extremely large breasts affect a woman?

“Unusually large breasts can make a woman or teenage girl feel extremely self-conscious. Women with very large breasts may also experience a variety of medical problems caused by the excessive weight, including back pain, neck pain, skin irritation and breathing problems.”

What is the goal of breast reduction surgery?

“Breast reduction surgery is designed to create smaller, better-shaped breasts in proportion with the rest of a woman's body. It can also reduce the size of the areola, or the darker skin surrounding the nipple.”

Can breast reduction ever be done just by liposuction?

“Breast reduction by liposuction alone is becoming more popular, but I do not offer it because I believe the results are not reliable. In many cases, when you remove volume from large, hanging breasts, you end up with even more sagging.”

Will insurance cover breast reduction surgery?

“Yes, if the procedure is considered medically necessary and the insurance policy covers breast reduction surgery. If I do a breast reduction and I don't take away enough tissue to make it medically necessary, then the procedure is considered a breast lift or mastopexy, which is a cosmetic case.

“The difference between breast reduction surgery and a breast lift is strictly a matter of degree—it's how much tissue you take away.”

What type of incision do you recommend for bariatric patients?

“With massive weight loss patients, I usually suggest a Wise pattern incision, although not every time. These patients typically have so much more skin from side to side that I really need to tailor that. Otherwise, when we're lifting the breast, what are we going to do with all that other skin? It's just got to go somewhere.

“I believe massive weight loss patients do better with an incision underneath the breast as well as up and down. And of course, everybody gets a scar around the nipple.”

How do you reduce the size of the areola?

“People don't realize this, but we literally have surgical cookie cutters in the operating room. That's how we get the areolas to be perfectly round and the same size.

“There are several standard cookie cutter sizes, ranging from 4 to 4-1/2 centimeters. I always discuss this with the patient before surgery.”

Can a breast reduction reduce or eliminate nipple sensation?

“Yes, in some cases. Years ago, I read a study saying that about 20% of women lose nipple sensation after breast reduction surgery. Newer surgical techniques have since been developed that yield better results, but I have not yet seen a recent scientific study measuring the number of women who lose nipple sensation with these techniques.”

Can breast reduction surgery ever restore nipple sensation?

“Yes, it is possible. Many times, woman with especially large breasts have no nipple sensation. Then, after I've done a breast reduction, these women have sensation in the nipples. We think that happens because the nerves had been stretched by the weight of the breasts. When you relieve all of that stretch, the nerves start to work again and women get sensation back in their nipples.”

Do you have to cut the nipples off to reposition them?

“No. In my private practice, have never done a procedure known as a “free-nipple graft,’ where you cut the nipple off and reattach it as a skin graft. That has never been necessary.

“The way I perform a breast reduction, the nipple stays attached throughout the procedure. It simply gets shifted into a new position.”

Can a woman still breastfeed after having a breast reduction?

“Yes. Because I am not removing the nipple, all of the connections between the nipple and the breast tissue will still be intact after breast reduction surgery. But since breast reduction takes away some of the breast tissue itself, a woman may produce less milk.

“I tell my breast reduction patients, 'Yes, you can still breastfeed and your baby will get all the benefits of a mother's milk. However, you may need to give supplemental feedings, depending on how much milk you actually create.' You should monitor your baby to be sure he or she is getting enough milk.”

Should a woman wait until after having children to have breast reduction surgery?

“No. Breast reduction surgery is normally considered reconstructive, not cosmetic, surgery—if you need it, you need it. If you have long, hanging breasts that are causing you problems, or you're just not happy with them, there is no reason to wait until after having children to have breast reduction surgery.

“People are surprised by this, but on the board exam when they present a case of a 15-year-old girl with enormous breasts, the right answer is to go ahead with breast reduction. There's no other treatment and without breast reduction, young girls with large, pendulous breasts suffer.”

When should bariatric patients have breast reduction surgery?

“As with any body contouring procedure, I recommend that bariatric patients stabilize their weight before having breast reduction surgery.”

(For more information, please see Special Issues in Plastic Surgery for Bariatric Patients.)

Does breast reduction surgery require a hospital stay?

“No. Across the board, insurance companies do not approve breast reduction patients for an overnight hospital stay. It's unusual for a patient to stay in the hospital overnight; 75% of my patients go home the day of surgery.

“However, if your breast reduction is done in conjunction with an upper body lift, you can expect to spend one night in the hospital.”

How long does breast reduction surgery take?

“Breast reduction surgery takes about three hours, depending on the size of the breasts.”

What kind of anesthesia is used for breast reduction surgery?

“Breast reduction surgery is performed under general anesthesia; you will be asleep during the entire procedure.”

What should you expect immediately after a breast reduction?

“You will wake up wearing a surgical support bra, and in most cases, you will have surgical drains that will be removed the next morning.”

How long does it take to recover after breast reduction surgery?

“The first three days after surgery may be tough, but by a week later, most breast reduction patients are still sore but they're up and functional.

“A week after breast reduction surgery, most patients are in my office very happy and wearing a nice, tight sweater.

“By 10 days after surgery, you can expect to be back to work. I recommend that you don't exercise for about a month after breast reduction surgery.”

What results can you expect from breast reduction surgery?

“Your breasts will look more youthful and uplifted and will feel firmer after breast reduction surgery. The position of your nipples and areolas will be higher and your areolas will be more attractively proportioned.

“Although breast reduction surgery leaves permanent scars, your incision lines will fade over time and the scars will be easily concealed under clothing—even under most swimsuits and low-cut tops.”