Breast Reduction

Breast reduction surgery (reduction mammaplasty) is a functional operation that reduces breast volume to bring it into proportion with the body’s measurements and eliminates the mechanical load on the skeletal system by removing excess tissue, fat, and skin. Offering far more than an aesthetic intervention, this procedure is the most effective treatment method for relieving chronic neck, back, and shoulder pain caused by large breasts. While correcting postural disorders and ending limitations in physical activity, the surgical process directly improves the patient’s quality of life and also repositions the nipple-areola complex to its ideal anatomical location, providing a healthier and more aesthetic form.

Is breast reduction surgery only an aesthetic choice?

The clearest answer to this question is no. Having large breasts may be perceived from the outside as a simple clothing issue, but for women who experience it, it is much more than that. Breasts that are excessively large in proportion to body measurements create constant pressure on the spine. It is like carrying a heavy bag hanging from your neck all day. Over time, this mechanical load begins to strain the skeletal system and leads to symptoms that significantly reduce living comfort.

Some of these physical complaints include:

• Chronic neck pain
• Persistent back pain
• Shoulder grooving
• Postural disorder
• Tendency to hunch
• Bra strap marks
• Numbness in the arms
• Loss of strength in the fingers
• Rashes under the breast
• Skin fungal infections
• Restricted mobility

In addition to these physical difficulties, there is also a psychological dimension. Not being able to find clothes, shirts not buttoning up, the constant need to hide the body with loose clothing, or difficulties experienced during sports can restrict a person’s social life. This surgery both relieves the person from these pains and helps rebuild self-confidence.

Who is a suitable candidate for breast reduction surgery?

When determining whether someone is suitable for this surgery, we do not look only at breast size. General health status, age, and expectations are also determining factors for us. Since breast tissue must have completed its development, we generally prefer to operate on individuals who are at least 18 years old. However, in some special cases we call gigantomastia, where the breasts grow excessively and uncontrollably during adolescence, intervention may also be performed at earlier ages to protect the young girl’s skeletal health and psychology.

The main characteristics we look for in the ideal patient profile are:

• Fully developed breast tissue
• Within an ideal weight range
• Not smoking
• Realistic expectations
• Stable mental health
• No chronic disease

Weight is especially important here. In our patients with a Body Mass Index (BMI) above 30, we recommend losing some weight before surgery. Because excess weight increases anesthesia risks and also makes wound healing more difficult. In addition, since breast shape will also change with weight loss, surgeries performed when close to an ideal weight yield results that are much more long-lasting and aesthetic.

Why should smoking be stopped in the preoperative period?

This is one of the most critical factors affecting the success of the surgery and is our most emphasized red line. Cigarettes constrict blood vessels due to the substances they contain and slow down blood circulation. Breast reduction surgery is one of the surgical procedures in which tissues are repositioned, reshaped, and blood circulation is needed the most.

The risks we may encounter in smoking patients include:

• Delayed wound healing
• Wound dehiscence along incision lines
• Risk of infection
• Fat necrosis
• Impaired nipple circulation
• Poor scar healing

As physicians, we do not want to take any step that would put our patients’ safety at risk. Therefore, we require that smoking be completely stopped at least 4 weeks before surgery and not be used for at least 4 weeks after surgery. This is not just a recommendation, but a medical necessity for a healthy healing process.

What are breast reduction techniques and scars like?

One of the topics our patients are most curious about and concerned with is surgical scarring. The basic rule in plastic surgery is this: wherever an incision is made, a biological scar remains. However, our goal is to plan these scars to be as inconspicuous as possible and to hide them within the body’s natural folds. The technique to be used is determined individually according to breast size, degree of sagging, and skin quality.

The incision patterns we most frequently use are:

• Inverted-T shape
• Vertical incision
• Lollipop shape
• Around the nipple

In very large and sagging breasts, we generally prefer the method we call the “Inverted-T,” which descends from around the nipple and sits in the inframammary fold. This technique allows us to lift and shape the breast in the best way. In medium-sized breasts, the “Vertical” technique, which consists only of a vertical line descending from the nipple, may be sufficient.

Scars may be red and prominent in the first months; this is a natural part of healing. However, with patience, from the 6th month onward the color of these scars begins to fade, softens, and over time approaches the skin tone and becomes less noticeable. These scars, which remain within a bra or bikini, are generally an acceptable detail for our patients compared to the shape and relief achieved.

Does breast reduction surgery increase the risk of cancer?

Contrary to misinformation circulating among the public, breast reduction surgery does not increase the risk of cancer. In fact, theoretically we can say it reduces the risk. Because during surgery, a significant portion of breast tissue that could potentially develop cancer is removed from the body.

Another advantage of the surgery is pathological examination. Every piece of tissue we remove is обязательно sent to the pathology laboratory and examined microscopically. Thanks to this routine procedure, even very small focal cellular changes that have not shown any symptoms and could not be detected in radiological imaging can be identified at an early stage. Therefore, this surgery provides our patients with an additional safeguard in terms of breast health follow-up.

What are the recovery process and pain like?

The first sentence we hear from almost all of our patients after surgery is, “It feels like tons of weight have been lifted from my shoulders.” This sense of physical relief is so dominant that patients usually perceive postoperative pain as secondary. The pain experienced after surgery is not unbearable and can generally be very easily controlled with simple painkillers. A feeling of tightness and stinging in the first few days is normal.

Points to pay attention to during recovery are:

• Use of a medical bra
• Sleeping on the back
• Avoiding heavy lifting
• Not straining the arms
• Medication regimen
• Wound hygiene

The special medical bra we put on immediately after surgery is the most important part of the recovery process. This bra supports the tissues, reduces swelling, and helps the breast settle into its new shape. We generally ask that this bra be worn day and night for one month.

When does the return to daily life take place?

Although the recovery process varies from person to person, our patients can usually return to their social lives in a very short time. Patients are discharged on the day of surgery or the next day. After a few days of rest at home, the person can move around the house and meet their own needs as long as they feel well.

The general timeline of the process is as follows:

• First shower
• Return to desk work
• Driving
• Light walks
• Transition to a sports bra
• Intense sports
• Swimming

If you work a desk job, you can usually return to work after 5 to 7 days. In jobs that require more physical effort, this period may be a bit longer. For the first month, you should avoid activities that require lifting your arms excessively or pushing and pulling movements. For returning to the gym or heavy exercises, we generally recommend a waiting period of 6 weeks.

Are the results of breast reduction surgery permanent?

The results obtained with breast reduction surgery are permanent; the removed tissues do not grow back on their own. However, it should not be forgotten that the human body is a dynamic structure and continues to change over time. Processes that will occur in the years after surgery may affect the shape of the breast.

Factors that can affect the result are:

• Excessive weight gain
• Rapid weight loss
• Pregnancy
• Breastfeeding period
• Menopausal changes
• Effect of gravity
• Loss of skin elasticity

If you maintain your weight after surgery, eat healthy, and exercise regularly, you can enjoy the aesthetic and comfortable result we achieve for many years.

Is this method also used for male breast enlargement (gynecomastia)?

Similar principles apply in the treatment of male breast enlargement, i.e., gynecomastia, but the techniques we apply differ. In male patients, our primary goal is to restore a masculine chest contour.

The methods we use for this purpose are:

• Liposuction
• VASER liposuction
• Excision of breast gland tissue
• Skin removal

In most gynecomastia cases, liposuction and removal of breast tissue through a small incision are sufficient, whereas in very advanced cases with significant skin sagging, excess skin may also need to be removed similarly to breast reduction surgery. Recovery in male patients is also quite fast and requires the use of a compression garment.