Breast reduction
Reduction removes breast tissue and skin to make the breast smaller and lighter, using what you already have. For some women it is the operation they wanted in the first place.
What it involves
A reduction removes glandular tissue, fat and skin, and repositions the nipple higher on the reshaped breast. It is a longer operation than a straightforward explant and leaves more scarring — commonly around the areola, vertically down from it, and sometimes along the crease beneath the breast.
It can be performed at the same time as implant removal, or later once tissue has settled. Which is appropriate depends on how much natural tissue you have and what your surgeon finds.
Why women consider it
Where symptoms are mechanical rather than systemic — neck and shoulder pain, grooving from bra straps, skin irritation, difficulty exercising — reduction addresses the cause directly.
Breast reduction has consistently high patient satisfaction in the surgical literature, and is associated with improvement in neck, back and shoulder pain in women with symptomatic macromastia. It is one of the better-evidenced procedures in plastic surgery for symptom relief.
This is worth separating clearly from the explant question. Reduction has good evidence behind it for mechanical symptoms. That evidence says nothing about systemic symptoms, and we would be overstepping to imply otherwise.
Insurance
Reduction is more often covered than explant, because the functional indication is established. Insurers typically require documentation of symptoms, a period of conservative treatment, and sometimes a minimum tissue-removal weight. Requirements vary considerably, and your surgeon’s office will usually know what your insurer asks for.
Trade-offs worth knowing
- More scarring than explant alone, though scars mature and fade over a year or more.
- Changes in nipple sensation are common, and can be permanent.
- Breastfeeding may be affected. Say so before surgery if this matters to you.
- Wound healing complications are more frequent than after simple removal, particularly in smokers.
- Breasts continue to change with weight and age afterwards.
A fuller page is in progress, covering technique choice, what recovery involves week by week, and the insurance documentation process in more detail. It publishes once a physician has reviewed it.
See also: explant surgery and lifts (mastopexy).