Breast reduction: symptoms it may relieve and recovery

For some women, very large breasts are not mainly a question of appearance. They can bring daily discomfort: aching shoulders, grooves from bra straps, sore skin underneath the breasts and difficulty finding clothes or exercising comfortably. Breast reduction surgery, also called reduction mammoplasty, removes some breast tissue and skin to make the breasts smaller and lighter. This guide explains which symptoms it may help with, what to try first, how the operation is done and what recovery usually involves.

Symptoms that very large breasts can cause

The medical term for very large breasts is macromastia. The NHS, MedlinePlus and BAPRAS (the British Association of Plastic, Reconstructive and Aesthetic Surgeons) describe a similar range of problems:

• pain in the back, neck and shoulders, and sometimes in the breasts themselves
• headaches
• deep grooves in the shoulders from bra straps
• red, irritated skin or repeated rashes in the fold under the breasts
• numbness or tingling in the arms or hands related to posture
• difficulty finding well-fitting bras and clothes
• discomfort or pain during sport and exercise
• low confidence, self-consciousness or low mood about breast size

MedlinePlus notes that the pain can be long-lasting and affect daily life. When large breasts are the main cause, a reduction may ease them, but it helps to have them assessed properly first.

Options to consider first

Surgery is not the only approach. BAPRAS notes that losing weight can reduce breast size, and that some people find they no longer want surgery once they have reached a healthier weight. Well-fitting, supportive underwear can improve comfort, and the NHS mentions professionally fitted bras as an option to try. MedlinePlus adds that strengthening the back and shoulder muscles may help. Where body image is a major concern, BAPRAS mentions that cognitive behavioural therapy can be helpful.

BAPRAS also points out that back pain can have other causes. A surgeon will want to understand your symptoms, examine you and consider whether breast size is likely to be the main reason before recommending an operation.

In the UK, the NHS may offer a reduction when very large breasts cause health problems and other measures have not helped. Breast size, weight, general health and smoking may also be taken into account, and the criteria vary between areas. Surgery purely for appearance is usually done privately.

The consultation

BAPRAS describes the consultation as a time to talk through your general health, your symptoms and what you hope to achieve. The surgeon will examine your breasts and your overall build, explain the type of operation that would suit you and discuss the likely benefits, risks and limitations. You may need more than one appointment to take everything in.

Points that usually come up include any family history of breast cancer, whether you plan to have children or breastfeed, and your smoking status. MedlinePlus suggests asking whether you should have a screening mammogram first, depending on your age and risk, and arranging it early enough that any further tests do not delay surgery. Smoking slows healing and increases complications, so you will be strongly encouraged to stop. You will also be asked about all medicines and supplements you take, as some may need to be paused beforehand.

In England, the NHS advises checking that the hospital or clinic is registered with the Care Quality Commission and that the surgeon is on the General Medical Council register, and asking about their experience and follow-up care.

How the operation is done

Breast reduction is a major operation carried out under general anaesthetic, so you are asleep throughout. In the most common technique described by MedlinePlus, the surgeon makes cuts around the areola, down the lower part of the breast and along the crease underneath. Excess fat, glandular tissue and skin are removed, the nipple and areola are moved higher, often while keeping their blood supply, and the breast is reshaped. The areola is often made smaller. Liposuction is sometimes added to refine the shape towards the armpit.

The NHS says the operation takes 2 to 3 hours, while MedlinePlus gives 2 to 5 hours, depending on the technique and the amount of tissue removed. The stitches usually dissolve. The NHS says most people stay in hospital for 1 or 2 nights; drainage tubes, if used, are usually removed after 1 to 2 days. MedlinePlus notes that some people go home the same day.

Recovery step by step

Every recovery is different, and your surgeon will give you a plan. As a general guide, the NHS describes full recovery as taking 2 to 6 weeks. Swelling and tenderness are expected and may last around 3 months, so the final shape is not clear until the swelling settles.

• First days: painkillers help for the first few days. MedlinePlus encourages short walks as soon as possible to help circulation and healing.
• Showering: MedlinePlus says showering is often possible 2 days after surgery once any drains are out; ask your surgeon before bathing, swimming or using a hot tub.
• Bra: some surgeons recommend a soft supportive or sports bra day and night for up to 3 months. Follow your own surgeon’s advice.
• Work: the NHS says you may need 2 to 3 weeks off work.
• Exercise and lifting: avoid strenuous activity, heavy lifting and stretching your arms for up to 6 weeks.
• Driving: wait until wearing a seatbelt is comfortable, which may take several weeks, and do not drive while taking strong painkillers.

Scars usually run around the nipple and down the breast, sometimes with a horizontal scar underneath. The NHS notes they may look red for the first 6 weeks and then usually fade. MedlinePlus explains that scars are permanent and are most noticeable in the first year, and advises protecting them from the sun.

Risks to discuss

As with any operation, there is a small risk of heavy bleeding, infection, a reaction to the anaesthetic and blood clots in the veins. Risks more specific to breast reduction, as described by the NHS and MedlinePlus, include:

• thick or noticeable scars, or wounds that are slow to heal
• breasts or nipples that are uneven in size or position
• reduced or lost sensation in the nipples
• difficulty breastfeeding, or being unable to breastfeed
• bleeding into the breast tissue, usually within the first 24 hours
• death of some fatty tissue, which can feel like a lump
• excess skin that may need removing later

The NHS also notes that breasts can enlarge again during pregnancy, which may affect the result. Your surgeon should explain how likely each risk is for you.

When to contact your surgeon

The NHS advises contacting the clinic promptly if you have severe pain or unexpected symptoms, such as a burning sensation, unusual swelling or changes in skin colour. MedlinePlus advises calling your surgeon if you notice:

• increasing pain, redness or swelling, bleeding or bruising at the wound
• yellow or green discharge from the wound
• a fever of 38°C or higher
• numbness or loss of movement
• sudden swelling of a breast
• side effects from medicines, such as a rash, nausea, vomiting or headache

MedlinePlus notes that many people feel more comfortable with everyday activities after a reduction and that pain and skin problems may improve or resolve. If you are unhappy with the result, the NHS suggests speaking to your surgeon first.

Next steps

If breast size is causing you pain or limiting your daily life, a consultation can help work out whether a reduction is likely to help and which options to try first. You can read more about our plastic and aesthetic surgery specialists, or answer a few questions to be matched with a doctor: Find my physician.