Breast reduction surgery for a new balance

Breast reduction surgery is a procedure that not only modifies the aesthetic appearance of the breasts but also brings significant functional benefits. Many women with large breasts experience back pain, posture problems, and difficulties in performing daily activities.

«Breast reduction surgery is the procedure that improves our patients’ quality of life the most», states Barbara Cagli, plastic surgeon representative of the Breast Unit at the Campus Bio-Medico University of Rome and Researcher at Link University. «Patients have breasts so heavy that they struggle with any daily activity—from sports to walking and dressing, even simply buying a bra or a swimsuit in a regular store. The most common request is to finally relieve the shoulders, neck, and back from such a significant weight».

The benefits of breast reduction surgery

The benefits are twofold: functional and aesthetic. «From a functional perspective, the benefits are incredible because it feels like being reborn. Imagine what it means to live every day with a huge weight pulling your back forward».

In addition to musculoskeletal benefits, the procedure also has positive effects on cardiovascular and respiratory health. «One thing we must never forget is that, especially for women who undergo it later in life, perhaps after menopause, it becomes even more important. From a cardiovascular perspective, relieving the entire respiratory cage and heart will also make aging much easier».

Regarding the aesthetic aspect, the procedure brings significant improvements. «In 99% of cases, very large breasts sag and lose their position. Imagine the benefit of having the areola facing forward, along with us, and finally having breasts proportionate to the shoulders, abdomen, and chest, staying within the chest area and no longer resting on the abdomen». 

Before the surgery

To ensure the safety of the procedure, pre-operative tests are necessary, and general health information is equally important. This includes smoking habits, possible drug allergies, and information related to weight and height. «Plastic surgery is still surgery, with all its risks. A surgical procedure should always be approached with standard preparation from a cardiological perspective, and above all, before performing a breast reduction, we must study the health of our breasts». 

The choice of tests depends on the patient’s age. «Usually, only an ultrasound is required for young women under thirty-five. Between thirty-five and forty, sometimes just a pre-operative mammogram. From forty onward, both mammogram and ultrasound are needed, as the combination of these two tests ensures the breasts are healthy before surgery». 

Beyond aesthetic and functional improvements, the procedure also serves a preventive function. All removed tissue is sent for histological examination, which sometimes leads to the diagnosis of very small tumors that are undetectable with instrumental exams.

Awareness and expectations

Breast reduction surgery, like any surgical procedure, involves risks. «What patients, in my opinion, should consider the most is that we are not magicians. The scars from breast reduction surgery are certainly not tiny. So, the first and most important thing is to be aware that during the first post-operative year, scar care is crucial. In the first month, many dressings are required, so it’s essential to clearly explain the quality and type of scars to patients – Cagli explains -. However, in all the years I have performed this procedure, not a single patient has regretted it because of the scars. The aesthetic and functional improvement is so significant that the scar-benefit balance is undoubtedly in favor of the benefits». 

It is a procedure that, nonetheless, requires general anesthesia, often lasting about three hours. It is important that there are no comorbidities, such as significant cardiovascular diseases or conditions that make the surgery too risky. For example, connective tissue disorders like Ehlers-Danlos syndrome, which affect scar quality and the stability of results over time. «Unless it’s a case of true gigantomastia, meaning breasts so large that daily activities become impossible, for patients requesting only a small reduction, the benefit must be weighed against the poor scar quality and the limited ability to maintain results over time».

When is the right time for surgery?

A frequently asked question concerns the best time to undergo the procedure—before or after pregnancy. «If you are very young with enormous breasts, you cannot think about waiting ten years before having a breast reduction. So, I recommend reducing the breast weight – says Cagli -. For those planning to have children, I suggest undergoing surgery after pregnancy».

Breast volume can have practical implications for breastfeeding. Extremely large breasts can make the process more challenging. In such cases, a breast reduction can facilitate easier breastfeeding.

«The technique I use preserves the ducts, meaning the small tubes that carry milk to the nipple. In most cases—except in cases of excessively large gigantomastia, where this is not always possible—the areola remains, along with its pedicle and ducts that allow breastfeeding».

Scars and post-operative care

The post-operative phase is delicate due to the presence of significant scars. During the first four weeks, in particular, it is crucial to get assistance for optimal scar healing. «There is a scar around the areola, another one from the areola to the inframammary fold, and a horizontal one. If, in the first four weeks, we start doing housework, driving, or lifting our arms, the scars will not heal properly. The more they become inflamed, the wider they get».

Dr. Cagli advises her patients to wear anti-thrombosis stockings and a front-closing bra, preferably in a light color. This way, if there is any serum leakage from the scar in the first days or weeks after surgery, it can be detected and addressed immediately.

Factors influencing the final outcome

Active patient collaboration is essential. Two key factors must be considered: smoking and weight stability. «In my opinion, I require a drastic reduction, if not complete abstention from smoking for at least four to eight weeks before surgery. This is crucial to minimize the risk of complications, wound dehiscence, and small areas of fat necrosis in the breast tissue – explains Dr. Cagli -. The second factor is weight stability. When deciding to undergo this surgery, we must maintain a stable weight. If there are significant weight fluctuations after the procedure, our work will be compromised. Patients who have had very large breasts often have overstretched skin, sometimes with small stretch marks, making the skin weaker than usual and more susceptible to weight changes». Proper preparation, a personalized approach, and well-managed post-operative care maximize success. «The beauty of breast reduction surgery is that we can achieve everything using the patient’s own tissues, making this procedure permanent without requiring future maintenance», concludes Cagli.