Breast Reduction Surgery | Comfort & Confidence by Dr Tremp

Reduced breast size for a relaxed attitude to life

Large and heavy breasts can not only be aesthetically unpleasant for affected women, but can also cause physical complaints such as neck and back pain (posture). Postural problems and inflammation of the underbust crease are common consequences.

There are various reasons for an increase in breast tissue and size, such as the menopause or pregnancy. After pregnancy, the glandular tissue of the breast can shrink considerably. A breast reduction and lift can help to restore the desired firm breast shape.

During breast reduction surgery, excess breast and glandular tissue is removed. The breast size can be aesthetically adapted to the body size and shape. If desired, the result can be a significantly smaller but still feminine-looking breast.

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Cause big breasts

Large breasts (mammary hypertrophy, macromastia or gigantomastia) can be unilateral or bilateral. In many cases, there is a symmetrical increase in size, i.e. both breasts grow to the same extent.

Macromastia is diagnosed when the expected resection weight of 500g per breast is exceeded in a greatly enlarged mammary gland. The height and weight of the affected person must always be taken into account. For smaller and slimmer women, even a lower breast weight can be a great burden. There are no exact guide values for macromastia, as it always depends on the physical characteristics of the patient.

Large breasts with overweight and hormonal changes

In the case of obesity, the amount of fat in the breasts also increases. However, not only overweight women can be affected by gigantomastia. Women of normal weight can also suffer from large breasts, sometimes due to genetic causes. Overly large breasts can also be caused by hormonal changes, e.g. during puberty, pregnancy or the menopause. However, the development of giant breasts due to pregnancy is rather rare.

Physical and psychological complaints

Overdevelopment of the breasts is usually an enormous burden for women with large breasts who often suffer from neck, spine and shoulder pain. Excessively large breasts can be a hindrance in everyday life and during sport. These physical complaints can lead to great stress.

What are the reasons for a breast reduction?

The size of the breast is individual and can be perceived differently. Disproportionately large breasts are referred to as macromastia. This can cause aesthetic reasons, an increased feeling of insecurity, back pain, posture problems, spinal column, difficulties with clothing and sport as well as psychological stress.

Breast reduction methods

The optimal method depends on the shape, volume and size of the breast and the patient’s wishes. It runs around the areola and vertically underneath it. As a rule, the areola is also reduced slightly. If necessary, a further incision along the natural breast crease may be required.

I incision for removal of larger excess skin

The vertical lift (Lejour method) enables a large breast lift with minimal scarring. It is also suitable for large breasts and sagging breasts with medium to large excess skin.

T- and L-cut for extensive breast reduction

The T and L incision techniques differ only slightly from each other. Both are based on the I method (according to Lejour), but the vertical incision is continued in the inframammary fold. These techniques make it possible to reduce and lift the breast in cases of medium and large excess skin.

New position and shape of the nipples

The position of the nipples is changed by removing breast tissue and skin. The areola is moved upwards to achieve an aesthetic result. The shape and size of the nipple are also adjusted and corrected.

Breast reduction surgery and anesthesia

During a breast reduction, skin, glandular, connective and fatty tissue is removed to reshape and firm the breast. The procedure is usually performed on an inpatient basis under general anesthesia. Depending on the size of the breast, either a vertical (scar-saving) or a small T-shaped incision is used. The choice of incision depends on the patient’s physical condition and wishes. The nipple is repositioned during the operation, resulting in a circular scar in the area of the nipple. Skin and parts of the central glandular body are removed.

Risks and complications of breast reduction surgery

Problems rarely occur with this procedure. Occasionally, infections or postoperative bleeding may occur in the first few days after the procedure. During the healing process, scars may thicken or widen if the breast is subjected to excessive strain or movement.

Aftercare and sport

Such scars can be treated and corrected after 6 months at the earliest. Options include fine injections with cortisone, treatment with autologous blood or radiofrequency, as well as microneedling (Genius®). However, most scars heal without any further discomfort. After a few days, the pressure bandage is replaced by a sports support bra. The reduced breasts should be supported with a sports bra for 4 to 6 weeks after the procedure, including during the night. Sports activities should be suspended for 4 weeks after the operation. It is usually possible to return to work after 10 to 14 days. Regular skin and scar care as well as sun protection are very important after the treatment for an optimal result.

Access via the nipple (periareolar)

Access via the nipple is used less frequently. It is well suited for adjustments or reductions of the areolas. The scar is less visible due to the darker skin pigmentation. However, access is limited to smaller implants and there is an increased risk of infection and possible limitations in the ability to breastfeed. Access via the nipple is useful for tightening and repositioning of the areolas. However, for larger implants and safe procedures, access via the breast fold or armpit is preferred.

Pain after breast reduction

Swelling and pain can occur after breast surgery. Painkillers are usually administered to relieve this. The extent of swelling, bruising and pain varies from person to person. The surgical technique and the patient's physical condition influence the healing process.

Scars from a breast reduction

After the operation, the scars will initially be red but will fade within a few months. Absorbable sutures dissolve on their own, while other sutures remain for up to three weeks to support fine scarring. Special suture patches can be used during the healing phase to minimize scar expansion. Nourishing creams can be applied after the wound has healed. UV radiation of the scars when sunbathing should be avoided for the following six months.

Breast reduction surgery and anesthesia

After a breast lift (and also breast augmentation or breast reduction) it is perfectly possible to breastfeed. Your decision to undergo surgery does not usually affect your ability to breastfeed your baby. In most cases, women can successfully breastfeed after a breast lift.

During your surgical consultation, you should explain your goals and discuss how these can be accommodated. The surgeon may place incisions in specific locations, dissect the tissue differently and make other modifications to preserve the nipple ducts and minimize scar tissue formation. It is important to keep the central breast mound intact so as not to interfere with milk production. If you were able to breastfeed before the operation, this should also be possible after the operation.

Costs for the breast reduction

The costsare discussed in detail with the patient beforehand and are The costs for breast surgery are to be understood as a flat rate and include anesthesia, use of the operating theatre and compression garments, but not a sports bra and overnight stay. Costs can only be covered by health insurance in exceptional cases if the overly large breast causes health problems. A detailed medical assessment is required in order to meet the criteria for cost coverage.