Female breast reduction, also known as reduction mammoplasty, is an operation to reduce the weight and volume of the breasts.

During the procedure, fat, glandular tissue and skin are removed from the breasts, which are then reshaped and the nipples repositioned.

Breast size is determined by genes, hormones, body frame and weight. For most women, breast size is proportionate to the body, but for some, the breasts are particularly large.

Breasts are sensitive to the hormone oestrogen. They can grow during adolescence or later in life following the menopause or because of the use of hormone replacement therapy (HRT). Some women also develop a noticeable asymmetry (difference in size or shape) between their breasts.

Breast reduction surgery can help women who are unhappy with the shape, weight or droop of their breasts by making them smaller and more lifted. However, breast size alters with body weight, so even after surgery, your breasts may increase in size if you put on weight or become pregnant.

Men can also experience enlarged breasts, known as gynaecomastia. Read more information about male breast reduction.

Availability on the NHS

Because breast reduction is usually done to improve appearance rather than health, it is not normally available on the NHS.

The NHS will not pay for surgery for cosmetic reasons alone. To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have to have a consultation with a plastic surgeon and possibly an assessment by a psychiatrist or psychologist. They will consider whether there is enough social, psychological or physical benefit to justify surgery, for example if your breasts are causing you significant pain or mental health problems.

The final decision is usually made at a meeting by a panel run by your primary care trust (PCT). The panel will take into account the information from your assessments and review your individual case.

Read more information about cosmetic surgery.

When breast reduction may be provided on the NHS

You may be considered for a breast reduction operation on the NHS if you have physical discomfort due to having large breasts. Physical problems may include:

• backache 
• neck pain
• skin irritation
• poor posture
• excessive sweating, rashes and skin
• infections under the breasts
• weals or grooves on the shoulders from bra straps
• an inability to exercise or take part in sports

Large breasts can also cause psychological distress. Common complaints from women with large breasts include not being able to wear fashionable clothes and finding it difficult to take part in active sports. Psychological distress may also include:

• unwanted attention or harassment
• self-consciousness
• depression

Before having surgery

It is important to discuss your problems and options with your GP and surgeon before going ahead with a breast reduction. This will help you to get a clear idea of what change you can expect to see and ensure you are aware of any risks involved.

Read more information about things to consider before breast reduction surgery.

Although any surgery carries risks, the potential complications specific to breast surgery include:

• scarring 
• unevenly shaped breasts or nipples
• wound healing problems 
• loss of nipple sensation

Read more information about the risks of breast reduction surgery.

The operation

Breast reduction surgery takes several hours under general anaesthetic. You will usually need to stay in hospital for a few nights afterwards.

There are several techniques the surgeon might use depending on the size of your breasts and the desired result. Read more information about how breast reduction surgery is performed.

You will need to rest for two to six weeks when recovering from breast reduction surgery, depending on your age and general fitness. It is likely that you will have sore breasts for a few weeks.

Breast reduction should only be considered by women who have taken medical advice from a qualified cosmetic, plastic or breast surgeon.

Many patients gain a better quality of life following a breast reduction as symptoms, such as back pain, are often dramatically reduced. However, any kind of cosmetic surgery, including breast reduction, should not be undertaken lightly. You may feel it will improve your appearance and quality of life but it can be expensive and time consuming and, as with any form of surgery, there are a number of risks.

The decision to have a breast reduction should only be taken after a lot of careful thought and questioning.

Do your research

If you feel that you will benefit from a breast reduction, it is important that you are as well informed as possible.

Talk to your GP to get information and general advice on the procedure, and look into the surgeons, hospitals and clinics that perform breast reductions.

Your GP should refer you to an appropriate surgeon who can discuss your problems, examine you and advise you about the options available, along with their advantages and disadvantages.

Do not be nervous about asking for information from your GP or a surgeon. The Department of Health has a checklist of questions about cosmetic surgery that can help you get all the details you need to make an informed decision on whether surgery is right for you.

Choosing a surgeon

Surgeons who are trained in general surgery should have FRCS (Fellow of the Royal College of Surgeons) after their name. Surgeons trained in plastic surgery in the UK will usually have FRCS(Plast) after their name.

Doctors who are also considered to be suitably trained are listed on the specialist register kept by the General Medical Council (GMC).

You can find out if a doctor is on the specialist register by using GMC website to check whether a doctor or surgeon is registered or by calling the GMC on 0845 357 0022. The website gives details of the surgeon’s primary specialty, but it doesn't provide information about any other specialist qualifications that they may hold.

Before choosing a surgeon, find out about their experience of doing breast reductions and make sure you meet them before committing to surgery.

When you find a surgeon, be honest and clear about your expectations and find out if a breast reduction can really give you the results you want. A surgeon should provide full details of the procedure before you decide to go ahead with it. Expect the consultation to take half an hour or longer.

Read more information about choosing a surgeon and qualifications to look for in a cosmetic surgeon.

Expected results

It is important to discuss your expectations with your surgeon. Sometimes, a very radical reduction will alter the shape and look of the breasts. There will be scarring and sometimes also a loss of nipple function and sensitivity.

For women with very large breasts, the benefits of a reduction may outweigh any potential imperfections. For women with only moderately large breasts, the benefits may not be worth the potential risks and side effects.

Your breasts can still change in size and shape after surgery. They should not regrow, unless the operation is done at an age when your breasts are still growing, but they can increase in size if you put on weight or become pregnant. They can also decrease in size if you lose weight. Normal breasts also have a tendency to droop over time.

Arranging for surgery outside the NHS

You will be asked to sign an agreement form before having your breast reduction operation. Make sure you understand and are happy with the agreement before you sign.

The agreement should include details of cost. Make sure you understand what this covers, especially in terms of aftercare and any revision surgery (surgery to treat any complications or problems) that may be needed. There may also be financial penalties if you decide to cancel the agreement.

Your records

The provider of your procedure, a private clinic or hospital, will keep a record of your treatment that may contain before and after photographs of you. Think about whether you would mind the provider showing these to other potential patients. The provider should ask for your consent before showing any part of your records to other patients.

Surgery abroad

Cosmetic surgery may be cheaper abroad than it is in the UK. However, this needs to be weighed up against the cost of travel and accommodation and any follow-up or revision surgery that may be needed.

The Care Quality Commission, which is responsible for regulating and checking private cosmetic surgery in England, does not cover procedures abroad and will not be able to help if you experience any problems. If you are not confident that the procedure you are having is safe, it could end up being more costly in terms of risk, pain, revision surgery and aftercare.

Read more information about cosmetic surgery abroad.

You will be asked to undergo some general health tests before your operation to check that you are fit to have surgery.

Before the operation

If you smoke, you may be asked to quit in the weeks before your operation. This is because smoking increases your risk of chest and wound infections and can slow the healing of your wounds, leaving you with worse scarring. Being overweight can also slow the healing process, so if you are overweight you will be encouraged to lose weight before your operation.

Read more information about how to quit smoking and losing weight.

If you take the oral contraceptive pill or hormone replacement therapy (HRT), your surgeon may advise you to stop taking it a few weeks before your operation because they can increase your risk of developing deep vein thrombosis (a blood clot in a leg vein). Also avoid aspirin and anti-inflammatory drugs.

Before your operation, you will be asked to sign a consent form. This is to confirm that you understand the risks, benefits and possible alternatives to the operation.

Read more information about the risks of breast reduction surgery.

The operation

Breast reduction surgery is usually done under general anaesthetic (when you are asleep). You will be asked to follow fasting instructions before your operation. Typically, you cannot eat or drink for six hours before having the anaesthetic.

Surgery takes between two to four hours. You are usually required to stay in hospital for one or two nights.

The surgeon will use a pen to mark areas of the skin where the incisions (surgical cuts) will be made. With your permission, the surgeon may also photograph your breasts for confidential before and after images for your records.

Most breast reduction surgery begins with the nipple, which is moved to its new position, usually while still attached to the blood supply. If you have extremely large breasts, the nipples may be removed and repositioned as a skin graft. They will develop their own blood supply.

Excess skin and breast tissue are then removed. The remaining breast tissue is reshaped to create smaller and more elevated breasts.

Breast reduction techniques

There are various different ways to do a breast reduction. Your surgeon will decide which is most appropriate for you depending on the size of your breasts and the desired outcome. The most common techniques are described below.

• Anchor type or inverted T reduction: the most common type of breast reduction, this results in an anchor-shaped scar starting around the areola, travelling vertically down and then horizontally across the breast crease.
• Vertical pattern breast reduction: this results in a circular scar around the areola, and a vertical scar passing downwards. This technique has the advantage of leaving no scarring under the breast and a lower chance of wound complications. However, this technique may leave a small fold of skin initially at the lower end of the vertical scar. This usually resolves itself within a few months but may require removal under local anaesthetic if it does not resolve. 
• Circumareolar reduction: this only results in a circular scar around the areola. This technique is only suitable when removing a small amount of tissue.

It is likely that your breasts will be swollen and feel tender and lumpy after surgery. The final appearance of your breasts may not be obvious for several weeks.

After surgery

When you wake up after having breast reduction surgery, your breasts will be bandaged and plastic tubes may be attached to your breasts to drain blood away.

After one to two days, any tubes will be removed and you should be able to go home. You may experience some pain for a few days, which can be relieved with painkillers.

Getting back to normal

Once you have returned home, depending on your age and general fitness, you will need to rest for two to six weeks. The length of time you need to keep the dressings on will depend on how quickly your wounds heal. After one to two weeks, your stitches will either dissolve or be removed at an outpatient clinic.

At your follow-up appointment, your surgeon will advise you when you can resume your normal activities and return to work. You may need to take two to four weeks off, depending on what your work involves.

Avoid stretching, strenuous exercise and heavy lifting for up to six weeks after your operation. You also need to keep your breasts supported by wearing a well-fitting, wireless sports bra.

Scars are usually quite red for the first six weeks after surgery. They then change to a purple colour over the next three months before fading to white. Most scars heal well but occasionally patients are left with red and lumpy scars that do not improve in appearance.

The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot. Complications specific to breast reduction surgery are described below.

Scarring

The main disadvantage of having breast reduction surgery is that you will be left with permanent scarring. The operation, when done using the anchor technique, leaves three scars:

• one around the nipple (areola)
• one from the nipple to the crease below the breast (this is the worst scar as it takes the most tension)
• one from the breast bone to the armpit along the crease below the breast

The severity of scarring largely depends on the individual. Some women are left with red and raised scars but most scars fade over time and should be invisible under normal clothing and most bras or bikini tops.

Uneven shape

Your breasts will change shape after reduction surgery. There is a chance that they may end up slightly lopsided, lumpy or with uneven nipples.

Wound healing problems

Wound healing problems after breast reduction surgery are common, particularly after the anchor scar procedure where the vertical and horizontal scars meet.

Most wound problems are minor and can be simply managed and treated. More severe wound complications, such as infection, skin loss and wound separation may take longer to heal.

Occasionally, some fat in the breasts dies off, leaving them red and lumpy. This is called fat necrosis and can take some time to settle. There can also be some excess skin left around the scars and, if this does not  settle after a few months, it may need to be surgically removed.

If you smoke or have diabetes, you may have poor circulation which will affect how quickly your wounds heal.

Loss of nipple sensation 

Some women lose sensation in their nipples after a breast reduction, including their ability to become erect. This is because the nerve supply to the nipple can be damaged during surgery.

Very rarely, a disrupted blood supply may cause your nipple to die and fall off. This is more likely if you are a heavy smoker or you have poor circulation.

Depending on the type of breast reduction you have, if your nipples have been separated from the milk ducts during the operation, you may be unable to breastfeed after the operation.

Infection

Any kind of surgical procedure carries a potential risk of infection. This can be treated with antibiotics and sometimes further surgery. If you do get an infection after your surgery, this will delay the healing process.

Haematoma

Occasionally bleeding occurs inside the breast tissue makign it swollen and painful. This is called a haematoma and generally occurs within the first 24 hours after the operation. If this happens, you may need to have another operation to drain the blood and stop the bleeding.

Enlargement of male breasts is known as gynaecomastia.

Causes of male breast enlargement

Large breasts in men are often believed to be a result of obesity, but this is not the only cause. Men, like women, can have an abnormal growth of glandular breast tissue, usually due to a hormone imbalance.

Other causes of enlarged male breasts include:

• excessive alcohol intake
• use of certain drugs, particularly anabolic steroids
• certain diseases, such as liver failure and cancer
• congenital abnormality (a problem from birth)
• dramatic weight loss, which can cause the skin to sag

For men who feel self-conscious about their appearance, breast reduction surgery may be considered to flatten the breast area.

Before surgery

When breast enlargement is due to obesity, poor health or excessive alcohol intake, breast size may be reduced through eating a healthy diet and doing regular exercise.

Consult your doctor and consider all your options before choosing to have breast reduction surgery.

Procedure

Male breast reduction surgery usually takes around 90 minutes. The surgeon will make an incision around the areola and liposuction may be used to suck out excess fatty tissue. If there is a lot of tissue to remove, cuts may extend down the chest from the areola and the nipples may need to be repositioned.

You will be required to stay in hospital overnight, take a few days off work to rest and avoid lifting or strenuous physical exercise for one month after the operation. An elastic garment also needs to be worn for one to four weeks after the operation to encourage smooth results.

Read more information about having an operation.

Results

Male breast reductions are usually required to reduce the size of the breast area and give a flattened shape.

Results are permanent but weight gain, hormonal imbalances and the use of certain drugs can cause the breast area to enlarge again.

Risks

Surgery can leave red and lumpy scars. These may last for several months but should eventually fade to your natural skin colour. Other risks include uneven results and loss of sensation in the nipples.

You may consider having a breast reduction operation if you have physical discomfort or psychological distress due to having large breasts.

Physical problems may be:

• backache
• neck pain
• shoulder ache
• skin irritation
• poor posture
• excessive sweating, rashes and skin infections under the breasts
• weals or grooves on the shoulders from bra straps
• an inability to exercise or take part in sports

Psychological distress can be:

• unwanted attention or harassment
• self-consciousness
• difficulty finding clothes that fit
• depression

For both women and men, breasts can become large due to fatty deposits within them. Losing weight by eating a healthy diet and doing regular exercise may help reduce the size of your breasts without the need for surgery.

Glossary

Pain

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Ache

An ache is a constant dull pain in a part of the body.

Depression

Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.