Breast Reduction

Macromastia refers to disproportionately large breasts (typically exceeding 500 g per breast above an ideal proportional size) causing chronic functional symptoms — neck pain, thoracic kyphosis, deep bra strap grooving, intertrigo (submammary rash), and activity restriction. Gigantomastia is a more severe condition involving breast weights exceeding 1.5 kg per breast, often with juvenile or pregnancy-related onset and progressive hormonal hypersensitivity. Gigantomastia requires larger resections, careful pedicle planning for nipple vascularity, and occasionally a free nipple graft technique for very large ptotic breasts where vascular pedicle length would be unsafe. Surgical complexity, resection weight, and technique choice are directly calibrated to the severity of the condition.

The nipple-areolar complex (NAC) is kept alive by its blood supply carried within a dermoglandular tissue pedicle — a bridge of breast tissue left attached to the chest wall while surrounding tissue and skin are resected. Common pedicle designs include the inferior pedicle (SPAIR or Wise-pattern), which is the most widely used globally for its reliability; the superomedial pedicle (used in vertical scar techniques like the Hall-Findlay or Lassus); and the central mound technique. Pedicle selection depends on the degree of breast ptosis, planned resection weight, and NAC-to-inframammary fold distance to ensure a well-vascularized, sensate nipple after significant elevation.

Sensory nerve preservation depends on the pedicle technique used. The superomedial and inferior pedicle techniques have the highest rates of preserved nipple sensation and lactation capacity — the primary sensory nerves of the NAC (branches of the fourth intercostal nerve) travel within the retained pedicle. Most patients retain normal nipple erogenous sensation; temporary numbness or heightened sensitivity resolves within 6 to 12 months. Breastfeeding after reduction is possible in a significant proportion of patients, though milk-producing capacity may be modestly reduced, particularly after very large resections (>1 kg per side). Family planning discussions are part of all pre-operative consultations.

Yes — breast reduction is classified as a reconstructive rather than purely cosmetic procedure when macromastia causes documented functional symptoms (back/neck/shoulder pain, neurological symptoms, recurrent intertrigo, or postural deformity). Insurance providers typically require: documented BMI within accepted limits, recorded functional complaints in medical notes, conservative treatment trial (physiotherapy, specialized brassiere support) without adequate relief, and occasionally a minimum planned resection weight (commonly ≥500 g per side). A formal letter of medical necessity from your plastic surgeon, supported by GP or physiotherapy records, is submitted for pre-authorization prior to scheduling.

Modern breast reduction techniques aim to minimize scar length while maximizing breast shape. The standard Wise-pattern (anchor or inverted-T) produces scars around the areola, vertically down to the breast crease, and horizontally within the inframammary fold — all easily concealed in a bra or swimwear. The vertical short-scar technique (Hall-Findlay, Lejour) eliminates the horizontal IMF scar, leaving only a periareolar ring and a vertical midline scar — preferred for moderate reductions where the scar-quality trade-off favors a smaller scar pattern. Scar maturation with silicone therapy, massage, and UV protection over 12 to 18 months produces inconspicuous final scars.

Walking and gentle mobility begin on day 1 to prevent DVT. Light office work resumes at 7 to 10 days. You should avoid all upper-body exertion, lifting (>2 kg), and sports for 4 to 6 weeks to allow pedicle tissue, parenchyma, and skin closure to heal without tension. High-impact sports (running, swimming, contact sports, gym classes) resume at 6 to 8 weeks once confirmed by your surgeon. A well-fitted sports bra (without underwire) providing firm compression is worn for the first 6 weeks at all times, transitioning to structured underwire bras after 6 to 8 weeks.