Breast Reduction Techniques: How the Operation Is Done

Surgeons choose a technique based on breast size, shape, skin and the nipple’s position. The aim is to remove tissue safely while preserving blood supply and creating a natural shape.

The basic steps

Under general anaesthesia, the surgeon removes excess breast tissue, fat and skin, reshapes the remaining breast and repositions the nipple and areola, usually keeping them attached to their blood supply. Operation time depends on the extent of surgery, and many people stay in hospital for a day or less.

Inverted-T (anchor) technique

Scars go around the areola, down the breast and along the fold. It suits larger reductions and gives good control of skin and shape. It has the longest scar.

Vertical technique

Scars go around the areola and down to the fold, without a long scar along it. It is used for moderate reductions in suitable breasts.

Liposuction-assisted reduction

When breasts are mostly fat, liposuction may reduce volume with small incisions. It does not lift or remove skin and is not suitable for dense breasts.

Pedicle choices and nipple safety

In many reductions, the nipple and areola remain attached to a section of tissue, called a pedicle, that carries blood supply and nerves. The surgeon chooses its design according to breast size, anatomy and the planned reduction. In a very large reduction, a free nipple graft may be safer but has different trade-offs.

Shape cannot be reduced to a cup size

Technique affects width, projection, upper fullness and scar length as well as volume. Natural differences between breasts can remain after surgery. Ask the surgeon to explain the goals for your own proportions and what they would do if safely achieving the planned size conflicts with preserving blood supply.

Free nipple graft

In very large reductions or where blood supply is a concern, the nipple and areola may be removed and replaced as a graft. This carries a high chance of lost sensation and loss of breastfeeding ability, and the graft may change colour.

Drains and dressings

Some surgeons use drains for a short time. Dressings and a support bra are standard.

Tissue examination

Removed tissue is usually sent for pathology to check for unexpected findings.

Questions to ask

• Which technique do you suggest, and why?
• What scars will I have?
• Will the nipple stay attached to its blood supply?
• How will this affect breastfeeding?