Karol Gutowski, MD, FACS

Questions? Call Ellen: 773-985-3993

Breast Reduction

Large breasts can cause pain & discomfort. Learn about breast reduction before you meet Dr Gutowski in person.


Women with large breasts experience more than dissatisfaction with body image. Breast size may impair a woman's ability to lead an active lifestyle and may cause physical discomfort and pain.

An equally important issue is the self-consciousness a woman with overly large breasts may feel about her body image. Breast reduction is plastic surgery to reduce breast size and enhance breast shape and position. Breast reduction brings better proportion to a woman's body and can alleviate the physical discomfort associated with large, pendulous breasts.

Where breast reduction is performed to relieve medical symptoms, the procedure is considered reconstructive. Contributing conditions include back, neck and shoulder pain, physical indentations from bra straps, and skin irritation. You may be eligible for insurance coverage. Pre-certification is always required.

In addition, breast reduction can reduce an enlarged areola; the dark skin surrounding the nipple, and correct saggy and stretched breast skin, and a low breast profile. This program presents an overview of breast reduction. It is not a substitute for a complete consultation with a plastic surgeon certified by the American Board of Plastic Surgery, or the Royal College of Physicians and Surgeons of Canada.

Good candidates for breast reduction are healthy women who do not have life-threatening illnesses or medical conditions that can impair healing. Breast reduction surgery is generally performed at an age when the breasts are fully developed. If it is performed at an age before the breasts are fully developed, the outcomes can change.

Outcomes can also change following significant weight fluctuations and as a result of changes in the breasts during pregnancy. Breast reduction can impair the ability to breastfeed, relative to the amount of breast tissue that is removed. A consultation with a board certified plastic surgeon, a member of the American Society of Plastic Surgeons, who may also be a member of the American Society for Aesthetic Plastic Surgery, is the first step to learn how breast reduction can alleviate the physical symptoms of overly large breasts, and improve your body image.

A consultation is designed to fully educate you about breast reduction, with a discussion of your goals, the options available in breast reduction surgery, the likely outcomes of breast reduction surgery, and potential risks and complications. Your surgeon will also describe the course of treatment recommended for you, and answer your questions.

During the consultation, you will be asked to share your expectations for breast reduction, and your personal health history. Full disclosure of your health history is important to your safety. This includes any history of breast cancer in your family and your personal breast health. You must also be candid about current medications you may be taking, the use of vitamins and herbal supplements, and alcohol, tobacco, and drug use.

By making the decision to consult with a board certified plastic surgeon, and following all of the instructions you are given, you are taking an important step in helping to assure your safety. A board-certified plastic surgeon is a physician who is specifically trained in plastic surgery of the face and entire body.

Prior to your procedure, you'll be asked to sign informed consent documents. These documents assure your plastic surgeon that you fully understand the procedure you will undergo, and any potential risks and complications. In addition, you must commit to precisely following all of the instructions you are given.

These instructions include pre-surgical considerations, such as testing and medications, day of surgery instructions and medications, and specific information related to the use of anesthesia. A mammogram may be recommended prior to your procedure to ensure breast health, and serve as a baseline for future comparison.

Breast reduction is generally performed on an outpatient basis. In an office-based surgical facility, an ambulatory surgical center, or hospital setting. Members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery are required to use only accredited surgical facilities.

Local anesthesia with sedation or general anesthesia is required. Breast reduction is performed by surgically removing excess breast tissue, fat, and skin. Incision patterns vary based on the amount of tissue and skin to be removed, the quality of skin elasticity, patient anatomy, and patient and surgeon preference.

A keyhole incision pattern is one of many techniques for breast reduction. It begins with an incision around the areola, continuing vertically down to the breast crease, then horizontally near the breast crease. An alternative is a circular incision pattern around the areola. A ragged pattern incision is another alternative, that extends the circular incision with a line vertically down the lower breast.

Through the incision, excess fat and tissue is removed, and the nipple is repositioned. The nipple generally remains tethered to its original blood supply when repositioned. However, in some cases, the nipple and areola may need to be removed, and transplanted to a higher position on the breast.

The underlying breast tissue is then lifted and shaped with absorbable or permanent sutures below the skin's surface. Surface incisions are then closed with sutures, skin adhesives, and/or surgical tape. Liposuction techniques may be used in conjunction with excision techniques to reduce breast size.

In cases where breast size is largely due to fatty tissue, and excess skin is not a factor, liposuction alone may be used for breast reduction. In general, complications from plastic surgery of the breast include bleeding, poor healing at the incision sites, thick, discolored or raised scars, changes in nipple sensation, and infection.

Women who smoke are at increased risk of poor healing and are therefore advised to stop smoking for several weeks before and after surgery. In addition, there are risks related to use of anesthesia. Immediately following your breast reduction surgery, dressings will be applied to the incisions, and an elastic bandage or support bra will minimize swelling, and support the breasts as they heal.

A small, thin tube may be temporarily placed under the skin to drain any excess fluid that may accumulate. Before being released, you and an accompanying family member, friend or caregiver, will be given specific instructions that may include how to care for the breasts following surgery, medications to apply, or to take orally to aid healing, and to reduce the risk of infection.

Specific changes to watch for at the surgical site, or in overall health, and when to follow up with your plastic surgeon. In general, your recovery from plastic surgery of the breast may include swelling and discomfort at the incision sites, and in breast tissue overall.

Discomfort is common and can be controlled with medication. You should begin light walking as soon as possible following your breast surgery. In addition, a support bra may be recommended for the first few weeks following breast surgery.

Initial wound healing may take one to two weeks, at which time sutures will be removed, if necessary. The initial results of breast reduction are visible immediately. You should be ready to return to work or normal activity within a week or two following breast reduction if you feel ready.

But do not engage in any heavy lifting or vigorous exercise until your plastic surgeon gives you clearance to do so. Intimate contact with the breasts and more vigorous exercise may resume when healing is more fully completed. Usually within four to six weeks following breast reduction surgery.

Healing will continue for several weeks as swelling resolves, and breast position and shape settles. Your incision lines will continue to fade over the next year or more. Even though incisions are placed inconspicuously, incision lines will result in permanent scars.

Breast reduction is a highly satisfying plastic surgery procedure. Your new, more proportionate breast size and body contour will free you from the discomfort of overly large breasts. You will find few limitations due to your breast size, both in physical activities and your fashion choices.

While the results generally are permanent, your breasts can change due to aging, weight fluctuations, hormonal factors, and gravity. Choosing to undergo breast reduction, or any plastic surgery procedure, whether cosmetic or reconstructive, is an important decision.

So is selecting a plastic surgeon. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have prepared this educational program to supplement your personal consultation with a plastic surgeon, who is certified by the American Board of Plastic Surgery, or the Royal College of Physicians and Surgeons of Canada.

Plastic surgeons with this certification have completed approved surgical training, and rigorous examinations in plastic surgery, including both cosmetic and reconstructive procedures of the face and entire body.