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    Breast reduction

    Breasts that are too large and therefore too heavy can cause physical discomfort such as shoulder, back or neck pain. The weight of the breasts can cause a stooped posture and thus lead to health problems. With extremely voluminous breasts, women also have difficulty finding clothes that fit the size of their breasts. Due to the weight of the breasts, many women suffer from cutting bra straps. In the underbust fold, skin rashes can occur, especially during the warm season. In addition, patients with a very large bust size also report performance limitations due to the heavy breasts and a feeling of shame due to the movements of large breasts during sports. If you have excessively large breasts, even a sports bra won’t help. Some women even complain of impaired breathing due to the pressure of the breasts. Many women report a psychological burden because their large breasts unwantedly attract all eyes. Sufferers complain that the dimensions of the breasts are perceived as unharmonious and affect self-confidence. For this reason, some women purchase so-called minimizer bras in order to cache bust size, which, however, cannot solve many of the problems described above and can also only provide limited optical relief. In addition, excessive bust size can also have a negative impact on sex life and, in extreme cases, cause anxiety or depression. Breast reduction, also called mammary reduction, facilitates physical activity and motivates weight loss [1].

    What is breast reduction?

    Breast reduction or “breast reduction” involves the removal of excess skin and glandular tissue to correct the size and position of the breast. At the same time, the nipple is moved to give the breast a youthful appearance. For optimal results, the areola is often reduced in size. The incision runs around the areola, in the lower breast fold and along a connecting line between these points.

    Knowledge of different surgical techniques is important in order to be able to do justice to different findings and wishes. In addition to reduction, special attention is always paid to harmonious proportions and optimal symmetry and shape of the breasts.

    1 Vergrößerte Brustwarze 2 Zu entfernende Haut 3 Hautnaht 4 Vergrößerter Warzenhof 5 Überschüssige Haut des Warzenhofs 6 Naht mit nicht auflösbaren Fäden 7 Raffungsnaht

    When is a breast larger than average?

    The average size of breasts changes depending on body weight, age and ethnicity. For example, Australian women with a BMI of 18.5 to 24.9 were measured to have an average volume of 327 milliliters [2]. In Turkish women aged 18 to 26 years (BMI 20 to 25), the calculated volume was 407 milliliters [3]. In American women, this averaged 405 milliliters in women aged 22 to 82 years [4].

    As the size of the breast increases, the distance from the jugular pit to the nipple increases. The volume of a breast can therefore be calculated using certain metrics [5]. Alternatively, breast volume can be determined with a 3 D scanner or magnetic resonance imaging.

    It is generally accepted that a giant breast (gigantomastia) exists when a breast reduction procedure removes at least 1500 grams or more than 3% of the total body weight [6]. For the definition of an above-average breast size, also called macromastia or mammary hypertrophy, different criteria can be found. Some refer to a D cup size as oversized breasts [7].

    When does the health insurance pay for a breast reduction?

    According to SGB V § 27, insured persons are entitled to medically necessary treatment for illnesses. For example, health insurance will cover the cost of a breast reduction if a rash does not improve despite months of dermatological treatment. In this case, there is a medical necessity. Another reason for covering the costs are cases in which an orthopaedic surgeon or trauma surgeon assumes a causal connection between a back problem and large breasts. In addition, it is often necessary to prove that conservative treatment measures could not contribute to an improvement of the complaints. If the health insurance pays for a breast reduction on the basis of a medical indication, the benefits according to § 12 para. 1 SGB V do not exceed what is necessary. Justified aesthetic claims, which for example require the additional performance of liposuction, are not included in the benefits catalogue of the health insurance companies.

    Breast reduction procedure

    To ensure that you are optimally prepared on the day of the operation, you will already receive all the necessary information during the consultation and the subsequent preparatory consultation. The joy of the new figure is usually greater than the tension before the operation. You do not need to take any luggage with you, as you can be picked up a few hours after the operation. Due to the combination of local anaesthetics and painkillers, you will need very little anaesthetic. General anesthesia is not necessary for the procedure. A long-lasting anaesthetic ensures less pain after the operation. Due to the small amount of anaesthetic, the risk of nausea and thrombosis is lower. Therefore, this method is also called fast recovery technique.

    Immediately before the operation, your aesthetic plastic surgeon will meet you. For harmonious proportions, optimal shape and symmetry of the breasts, the surgical plan is drawn on your breast with a special marker. The anaesthetist will then discuss the procedure with you again. Before you are escorted to the operating room, you will be given an antibiotic as a preventive measure. The entire surgical team routinely makes multiple assurances that the surgery is taking place under the safest and best circumstances. Thanks to state-of-the-art equipment, you will lie comfortably, warmly and well padded while you are administered a little sleeping pill. You usually don’t get to hear anything about the subsequent preparations. Due to the very gentle form of anaesthesia, you can still tell the anaesthetist or the expert in aesthetic plastic surgery at any time if there is something you are lacking.

    After careful disinfection and sterile covering of your breasts, the operation can begin. The surgeon first anaesthetises the intercostal nerves and also injects a tumescent solution. This numbs the tissue and prevents the formation of bruises. While you sleep or are distracted by a movie on 3D glasses, the entire surgical team is highly concentrated. The procedure takes two to three hours, depending on the findings. The wounds are sutured with fine self-dissolving skin threads. Drainage tubes are only inserted if it appears necessary, and these can usually be removed again the following day. The duration of the operation is about 2.5 hours.

    After dressing the wound, the surgical team will already put on the support bra (compression bra) ordered for you. Immediately after leaving the operating room, patients are usually awake and pain-free and can eat or drink something. Normally you can be picked up after a short observation period. You’ll be given a letter to take with you that notes all the behavioral measures. Here you will also find the dates of the follow-up examinations and a telephone number where you can reach your aesthetic plastic surgeon at any time.

    What are the methods of breast reduction?

    All surgical methods have in common the removal of excess breast tissue (mammary gland tissue and fatty tissue) and skin. Each surgical technique has certain advantages and disadvantages. Depending on the size and shape of the breasts, the advantages or disadvantages of a particular technique may outweigh the disadvantages. Therefore, the key to a perfect result lies in the selection of the surgical method that is specifically appropriate for you, which is characterized by the incision and incision technique:

    Thus, a distinction is made between an O technique (Benelli method), an I technique, a J or L technique and a T technique. The O technique is mainly suitable for tightening slightly sagging breasts. In the case of a noticeable reduction or tightening of the breast, the T-technique is usually used. You can find out more about this on our “Breast lift” page.

    When can you see the final result of a breast reduction?

    In 95 percent of patients, the “new breast” has reached its final size after 3 months and its final shape after 6 months. The change in size can be seen immediately after the procedure. An unavoidable slight swelling will disappear after a few weeks. While the final result can already be seen, scar healing is not complete at this point. Depending on age and predisposition, the scars may be firm, raised and reddened in the first few months. Regular massaging of the scar and the application of silicone plasters support rapid and fine scar healing. The skin mantle still adapts slightly to the new shape. Especially between the nipple and the underbust fold, the tissue usually gives a little. One year after the operation, no noticeable changes are to be expected.

    At what age is breast reduction recommended?

    The patient’s level of suffering is a major factor in determining the timing of the operation. If very large breasts are already causing considerable physical and emotional discomfort during puberty, we recommend a detailed consultation in the presence of the parents. If the growth of the breasts of young women is not yet complete, there is a risk that the size of the breast will increase slightly after the reduction. The surgical risks depend to some extent on the physical conditions. In general, they are lower in young, healthy patients than in older patients and smokers. About two-thirds of patients can still breastfeed after breast reduction [8]. For more information and answers to common questions about breast reduction, see Breast Surgery FAQ.

    Where or with which doctor should I have a breast reduction?

    Aesthetic operations of the breast, such as breast lifts, breast augmentations or breast reductions are an integral part of the training to become a plastic and aesthetic surgeon. A good education, many years of experience and a certain talent are certainly important qualities. It is best if the attending physician and plastic surgery expert excels in all three of these qualities. You can get an idea of the human qualities such as empathy, a sense of responsibility and reliability during the consultation. To be able to judge the skill in terms of cosmetic surgery, you must have already observed many surgeons at work.

    So how can you make a judgment? Take a look at the surgeons’ resumes. A doctor with a good education and a lot of experience will usually provide this information readily on the internet. Be suspicious if you only find seals and awards from private companies on a website. Often these eye-catchers are available for purchase. Certificates from state universities, scientific awards from professional societies, and leadership positions such as a senior physician or chief resident usually attest to a certain level of professional qualification.

    What are the risks of breast reduction?

    Your satisfaction is our focus. That’s why CenterPlast’s doctors take the time to get to know your goals in detail and show you ways to achieve them. Breast reduction must take into account a harmonious relationship with the physique. To create a youthful and beautiful shape of the breasts, the most suitable technique for cosmetic surgery should be chosen for you. An open and trusting discussion with your plastic and aesthetic surgery expert is an important prerequisite for achieving your goals.

    Operational risks are influenced by various factors. Depending on the state of health, physical condition and lifestyle habits, the possible risks may be higher or lower. Numerous studies show that older age, obesity and cigarette smoking increase the risks [9]. In addition, the rate of possible complications is also influenced by the extent of the surgical procedure (removal of 500 versus 1500 grams). The risks include secondary bleeding, accumulation of wound water, inflammation, wound healing disorders and circulatory disorders of the nipple. As a guideline, the risk of treatment-emergent complications in patients in the United States is estimated to be 1 to 2% [10]. Keep in mind that study data on surgical risks are not applicable to every country, every patient, every clinic, and every practitioner.

    Combination of breast reduction with liposuction

    The combination of liposuction with breast reduction makes it possible to operate in a scar-saving and gentle way. Liposuction is helpful in shaping the lateral contours of the breasts. In addition, excess fat (love handles) in front of the armpit can be corrected. In the case of very large breasts, the combination of breast reduction and liposuction is very useful in order to promote rapid and safe wound healing.

    Are drains placed during breast reduction?

    It can never be completely avoided during a surgical breast reduction that small amounts of blood from hair vessels spill into the wound. In small amounts, blood components are broken down and excreted by the body. Particularly in the case of large wounds, there is a risk of blood accumulating in a tissue cavity. This is called a bruise. To avoid bruising, a fine drainage tube is inserted into the wound during breast surgery. The tube carries the blood to the outside and can usually be removed the following day. CenterPlast doctors often manage without a drain. An unremarkable blood test with normal coagulation values does not rule out a bleeding tendency. Therefore, the decision whether to place a drain should be made during the surgical procedure.

    Important information for the preparation and aftercare of a breast reduction

    How you can best prepare for a breast reduction and what you need to bear in mind afterwards so that healing takes place optimally and the scars are inconspicuous, you can find out in detail on our page Breast Operations – FAQ.

    What is a tissue stem/bridge?

    With a beautiful youthful breast, the nipple is on the highest point of the breast when standing. After removing the excess tissue in the lower part of the breast, the nipple must be lifted. In order to move the nipple, it must be detached from the surrounding tissue. In order for the nipple to heal well and retain sensation, vessels and nerves leading to the nipple must be spared.

    The tissue that connects the nipple to the chest wall after it is detached is called the pedicle or tissue bridge. If the tissue layers above the nipple are cut, this is called a lower tissue bridge. The techniques are often named after the surgeon who first described them:

    • Lower Tissue Bridge [11]
    • Tissue union upwards and downwards [12]
    • Tissue bridge to the side and middle [13]
    • Midline tissue bridge to depth [14]
    • Tissue bridge to the middle and top [15]

    Each technique has certain advantages and disadvantages. In very large breasts, the lower tissue bridge is usually shorter and therefore ensures a better blood supply to the nipple. No significant differences in nipple sensation were found among the different tissue bridges [16]. Compared to the lower tissue bridge, the upper half of the breast is fuller in the upper central tissue bridge. An advantage of the upper central tissue bridge is that the technique can be combined with the inner bra method. The Inner Bra technique can be used in breast lifts to help sagging breasts become fuller. You can read more about this on our page about breast lift.

    Before and after pictures of a breast reduction at CenterPlast Saarbrücken

    It is not permitted by law to publish comparative pictorial representations of the treatment success by before and after photos on the Internet. That is laid down in Paragraph 1(1)(2) of the Heilmittelwerbegesetz. Nevertheless, such before-and-after pictures of a breast reduction can be used to inform the patient during the consultation. It goes without saying that the data protection regulations are complied with. The pictures were taken with the consent of the patients and help to show the possibilities and limitations of cosmetic surgery. In addition, a special bra in the desired target size can illustrate how large the breasts will be after surgery. You can find more information about this on our page about before and after pictures in the menu category “About us” in the section “Quality”.

    Experience reports of a breast reduction at CenterPlast Saarbrücken.

    Before undergoing a mammoplasty, patients usually research the Internet for well-rated plastic aesthetic surgeons. Here, make sure that the practice has enough testimonials and reviews, as this is the only way to draw a realistic picture of the patients’ perception. Patient testimonials, reviews and ratings of the CenterPlast practice can be found on well-known sites such as Jameda or Google. This information has also been bundled in the category “About us” under the menu item Testimonials.

    What are the costs of breast reduction?

    The cost of a breast reduction depends on several factors. An individual calculation of the price must therefore be made within the framework of an individual consultation with an examination. The most important questions can be discussed in a video consultation that can be booked online at any time. If you would like to find out about the price of a breast reduction before a personal consultation, please visit our menu category Costs. There you will also find information regarding the financing of breast surgery.

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    The author

    Dr. med. Stéphane Stahl

    “We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”

    Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.

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