Macromastia, or large breasts, can cause significant back pain, neck pain and shoulder pain. Women with macromastia find it hard to find clothes that fit. They may be plagued with rashes underneath their breasts. They may find it difficult to exercise. Their shoulders carry bra strap indentations due to their heavy breasts.

The surgical remedy for macromastia is breast reduction, also called reduction mammaplasty. Breast reduction is performed by plastic surgeons as a medically indicated operation for a medical problem.

In breast reduction, breast tissue as well as excess skin and fatty tissue are removed and the remaining breast tissue rearranged to make the breasts a normal shape. The nipple is moved to a new position that is anatomically correct for the new breast size.

Prior to the surgery, patients will routinely have a mammogram to make sure that there is no sign of early breast cancer. Patients should also provide a detailed history to make sure that there is no suspicion of a breast cancer genetic defect. If this is suspected, the patient will often be referred to a breast surgeon prior to the breast reduction to assess breast cancer risk.

During the surgery, the breast tissue removed is weighed and the weight documented. This provides information that may be required for insurance companies to verify the medical necessity of the surgery. The breast tissue that is removed is sent to the pathologist, who will exam the breast tissue under the microscope to make sure that there is no cancer.

Surgical drains will typically be placed at the time of surgery. After surgery, patients will need to refrain from certain physical activity for a period of time, as specified by their plastic surgeon. Patients may also need to wear specialized support bras during their initial recovery.

Following a breast reduction, there will be differences on the patient’s mammograms and breast imaging, due to scarring and other post-operative changes. One of the mammographic changes includes development of calcifications, which may look very similar to breast cancer and pre-invasive breast cancer (DCIS or Ductal Carcinoma In-Situ. Patients may require minimally invasive breast biopsies to make sure that they do not have breast cancer or DCIS. 

Other potential side effects and complications of breast reduction surgery include the inability to breastfeed, changes in nipple sensation and nipple sexual function, breast numbness and painful scar tissue formation. In spite of these potential problems, some of plastic surgeons’ happiest patients are those who undergo breast reduction surgery. They are pleased to be able to buy clothes that fit and enjoy activities like running and exercising without restriction.