Breast Reduction

By Robert Clement, M.D. – September 5, 2012

Breast hypertrophy (excessive breast tissue) is a fairly common problem that affects one physically, mentally, and emotionally. As both women and men develop breast buds, they are affected by the amount of estrogen production or the estrogen-testosterone balance as puberty advances. The other factor in breast tissue development is its responsiveness to that estrogen, which is hereditarily dictated. When breast development usually begins, the breast buds respond to the estrogen and have an increased deposit of fat and fibrous tissue to increase their size. If a person is hereditarily predisposed to large breast development, this usually starts at age 11 to 13 and continues through the mid to late teens.

In males, estrogen increases the breast bud and fatty deposits. As puberty progresses and the amount of estrogen decreases and testosterone increases, the breast buds usually reduce in size and the fatty component is reduced, especially if the male is physically active. However, there are many males, probably 15 to 18 percent of the population, who will have residual breast tissue and fatty development on the chest wall through puberty and throughout life. This usually increases in volume, especially from the fat deposit as one reaches middle and later age.

This condition in males is called gynecomastia and can be corrected with surgical excision of the breast tissue and removal of fat with liposuction. If there is very minimal breast tissue and it is predominantly a fatty issue, then liposuction alone will improve the contour dramatically. It has been my experience that, in nearly all males, there is enough breast tissue present that it requires surgical removal of this breast tissue to get the male chest configuration that they want. This will be a permanent cure unless the patient gains a significant amount of weight. At that point, fat would be redistributed over the chest wall, especially if there is an increase in the estrogen level.

In females, large breasts can limit the ability to exercise, cause back and neck pain, and sometimes subject the person to unrelenting teasing. If the problem of weight is so severe as to limit activities or cause pain early on, the correction or reduction can be done as early as 19 to 20 years of age. If the problem is moderate, patients may elect to wait until after childbearing age or when breast-feeding is over. However, breast reduction does not mean that a woman cannot breast-feed. One of the reduction procedures, the inferior pedicle, can make it possible for the patient to be able to breast-feed even after a breast reduction procedure as a significant amount of breast tissue is left attached to the nipple and this tissue is capable of producing enough milk. I have had several patients write me after having breast-fed their children when their reductions were done at an early age.

As a group, breast reduction patients are probably my happiest patients. It changes their lives, allowing them to wear clothing that matches top and bottom, to exercise without discomfort, and to live without the constant shoulder and neck pain even when they are not exercising.

There are multiple patterns used to reduce the breast including the circumareolar, an incision around the areolar complex with liposuction. Liposuction alone can be used for reduction but this has no ability to lift the breast. In order to lift the breast, some of the skin must be removed. There are two primary patterns that are used; the anchor, which is an inverted “T,” and the lollipop, which is a circumareolar with a vertical component. In larger breasts, the anchor is more supportive and gives a better contour because more skin can be removed and the breast tissue can be contoured in a more defined manner.

Physical advantages of breast reduction are decreased back and shoulder pain, increased mobility, a decreased fatigue factor, and the ability to buy the clothing with the same size top and bottom. Running or any other type of bouncing exercise can create significant problems with these patients due to the breasts’ extreme weight and the shift in the center of gravity forward in their body. Following the breast reduction, I still suggest wearing a good support bra while doing heavy exercise like running and aerobics. There are several good brands of support or exercise bras on the market. One is called the Ta Ta Tamer, from lululemon Athletica, which I think is very supportive and works extremely well.

After surgery, the return to full activities is approximately four weeks (walking after one week to ten days and mild swimming at two weeks). Patients may increase activities to an elliptical trainer or treadmill at three weeks and then, at four weeks, return to full activities. The risks include the usual surgical problems of bleeding, infection, skin problems, and the fact that there will be a permanent scar, which usually is of fairly good quality.


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