Breast reduction: benefits and recovery

What is breast reduction?

When breasts are very large, people may experience discomfort such as pain in the neck, shoulders, and back, skin problems, and limits on their activities. A 2021 meta-analysis regarded overly large breasts (breast hypertrophy) as a chronic health problem and described breast reduction as an important treatment for it ^[1].

Breast reduction is surgery that removes breast tissue and skin, reshapes the breast with the remaining tissue, and moves the nipple and areola to an appropriate position. How the stalk of tissue that supplies blood to the remaining tissue (pedicle) is chosen and designed is an important part of surgical planning ^[3].

Evidence on the benefits of surgery

A 2021 systematic review and meta-analysis included 7 randomized controlled trials with 285 participants, and pooled 4 of them in its analysis ^[1]. After breast reduction, pain, physical function, and psychological function all improved to a statistically significant degree, and the authors concluded that it is an effective treatment for breast hypertrophy that causes symptoms ^[1].

A 2012 evidence-based guideline from the American Society of Plastic Surgeons also summarized that breast reduction has been confirmed to improve quality of life ^[2]. However, the same guideline stated that the amount of tissue removed is not directly proportional to the degree of symptom relief after surgery ^[2]. In other words, removing more does not mean symptoms will improve by that much more.

Breast reduction techniques are also applied for women with large breasts who have breast cancer. A 2010 review examined 10 studies in which 276 patients had reduction surgery on both breasts, and summarized that breast cancer patients with large breasts who were candidates for breast-conserving surgery gained oncological and cosmetic benefits as well as improved quality of life ^[6].

Surgical methods and shape

A 2016 publication described the Wise pattern reduction as the most commonly used method in the United States for moderate to large reductions ^[3]. With the Wise pattern, scars typically remain in an anchor or inverted-T shape, running around the areola, along a vertical line, and along the breast fold.

Flaws in the design, how the surgical technique is carried out, and complications after surgery were cited as causes of shape deformities after surgery ^[3]. The same publication explained that shape deformities can be reduced by carefully planning the skin removal design, choosing and designing an appropriate tissue stalk, preventing skin necrosis (death of skin tissue), and managing scars ^[3].

Complications and risk factors

The 2012 guideline considered that the more tissue is removed, the higher the risk of complications may be ^[2]. On the other hand, it stated that the evidence has not reached a conclusion on whether a higher body mass index (BMI) raises the risk of complications ^[2].

The same guideline summarized that antibiotics given around the time of surgery can reduce the risk of infection, and that drains do not help in a typical reduction performed without liposuction ^[2]. A 2013 evidence-based review also organized the evidence on when breast imaging is needed before surgery, risk factors that can be modified, and the use of antibiotics and drains, and it pointed out gaps between actual practice and the evidence ^[5].

Chronic pain is another risk worth knowing about. A 2020 review explained that chronic pain lasting 3 months or longer after surgery has been reported after various breast operations, including breast augmentation, breast reduction, and mastectomy ^[4]. Younger age, higher body mass index, shorter height, heightened sensitivity after surgery, depression and anxiety before surgery, and high pain catastrophizing scores (a tendency to dwell on and magnify pain) were presented as related factors ^[4].

Recovery and pain management

The same 2020 review reported that improving pain management around the time of surgery, such as regional nerve block anesthesia before surgery and continuous infusion through a catheter after surgery, improves chronic pain outcomes ^[4]. It summarized that chronic pain is still difficult to treat but that various prevention strategies have been proposed ^[4].

The 2013 review also discussed the use of questionnaires that track surgical results in the short and long term as part of evidence-based practice ^[5]. The speed of recovery and how scars settle vary from person to person, so it is a good idea to have your progress checked on a set schedule after surgery.

The research summaries reviewed here either did not state the ethnicity of the study participants or were based on practice in the United States, so the same results cannot be expected to apply directly to Korean patients.

What to check during your consultation

Breast reduction is surgery that takes both symptom relief and shape into account. It is a good idea to check the following during your examination and consultation.

• The symptoms you currently have and the changes you can expect from surgery
• How much tissue will be removed and the related risk of complications
• The incision pattern and the shape of the scars
• Whether breast imaging is needed before surgery
• The plan for pain management before and after surgery