Overly large breasts can cause cosmetic as well as functional problems including neck, back, and shoulder pain, rashes in the under-breast crease, interference with physical activity, and so on. In response to such factors, obesity, self-consciousness, and loss of self-esteem may ensue.
Breast reduction surgery offers the only effective treatment since dieting or exercise cannot provide spot reduction. Often, the underlying cause is genetic and/or age-related redistribution of fat around the body, which is highly resistant to change.
Breast reduction surgery is ideally delayed until after childbearing years since hormonal stresses with pregnancy and breast feeding can significantly alter breast shape and support.
An inverted T incision has traditionally been employed. Incisions are made around the areola, vertically from areola to the junction of the breast and chest wall, and then roughly horizontal following the crease below. Skin, fat, and glandular tissue are removed as needed and the nipple is repositioned upward, after which the wounds are sutured.
Breast reduction surgery is a major operation, and bleeding can be a problem. The recovery period is long, and healing can be compromised by smoking, obesity, and other general health problems.
More recently, a circular incision made around the areola has replaced traditional incisions in milder cases. In addition to less scarring, the natural architecture of the breast can be better preserved, surgical risks decreased, and healing times shortened.
The areola is often quite stretched and can be reduced by trimming around the edges. Liposuction is often employed to aid in better contouring both on the breast and under the arm.
While the nipple and areola can usually remain attached to underlying tissue to preserve innervation, loss of sensation is not rare, which also hold true for the ability to breast-feed.
Some patients opt for liposuction rather than actual surgery to avoid the scarring that can be especially noticeable in Asian skin. Weight and volume issues can be improved somewhat, but the nipple is not repositioned, excess skin is not removed, and the breast may sag once deflated. While liposuction alone may be sufficient in milder cases, surgical incision is required in most cases even though it results in permanent scarring.