Breast reduction for women

Breast reduction surgery

Breast reduction surgery removes excess breast fat, glandular tissue and skin. Breast reduction aims to achieve a breast size in proportion with your body. The surgery may be performed to relieve the discomfort associated with overly large breasts. This procedure is also called reduction mammoplasty.

Overly large breasts can cause some women both health and emotional problems. The physical discomfort may include back, neck and shoulder pain, and skin irritation beneath the breast crease. The weight of excess breast tissue can restrict a woman’s ability to lead an active life. Some women also feel very self-conscious about having large breasts.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives. Talking to a counsellor or psychologist may help you overcome your concerns about your appearance.

Changes to laws that affect cosmetic surgery

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal for:

• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health Private hospitals page and expand the ‘contact details for private hospitals’ link
• email the Department’s Private Hospitals Unit privatehospitals@health.vic.gov.au
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding liposuction, cosmetic surgery or anaesthesia in Victoria.

Things to consider before breast reduction surgery

Some important issues to consider include:

• The procedure is best done when breasts are fully developed.
• Breast and nipple piercings can cause an infection.
• Breast reduction surgery can interfere with some diagnostic procedures.
• Your ability to breastfeed after breast reduction surgery may be limited. Talk to your medical practitioner if you are planning to breastfeed a baby in the future.
• Changes in the breasts during pregnancy or significant weight loss or gain can alter the outcomes of previous breast reduction surgery.
• Think about the financial cost. Breast reduction is commonly considered a reconstructive surgical procedure (although there is a cosmetic component to it), so the surgery may be covered by health insurance if it is performed to relieve medical symptoms. For more information:
• Ask your medical practitioner about any out-of-pocket costs you can expect, and if you will be eligible for a rebate.
• Visit PrivateHealth.gov.au for more information on private health insurance.
• Smokers are at increased risk of complications. To decrease the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible, before deciding to have breast reduction surgery.

Finding a qualified medical practitioner

Ask your GP for advice on a reputable medical practitioner or hospital where breast reductions are performed.

At your first consultation, ask the medical practitioner about their training and experience.

This procedure should be done by a medical practitioner who is specially trained to perform breast reductions and has a lot of experience in carrying out this type of surgery. Ask to see the medical practitioner’s certificates that show them to be qualified to perform this specialised surgery.

All doctors practising in Victoria must be registered with the Medical Board of Australia (the Board). Find out if your medical practitioner is registered with the Board by searching on the AHPRA website.

Your current medical status and breast reduction surgery

If you are considering having breast reduction surgery, you need to discuss your current medical status with your medical practitioner. This includes discussing:

• your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate
• your mental health – any mental illnesses or issues and their treatments
• medications you are currently on, including vitamins and supplements
• past reactions to medications
• any allergies you have.

As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Breast reduction surgery – what happens during surgery

All surgery, including breast reduction surgery, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

Breast reduction surgery is usually performed under general anaesthetic. In some cases, when the reduction is only small, the medical practitioner may opt for local anaesthetic with sedation.

Generally speaking, breast reduction surgery involves:

• The medical practitioner makes an incision (cut) around the nipple. The incision is continued in a straight vertical line to the breast crease. Sometimes, a further cut is made in the crease beneath the breast.
• In most cases, the nipple remains attached to its blood and nerve supply at all times. Sometimes, however, an extremely heavy breast may need a ‘free nipple graft’. The nipple is removed and reattached at a higher point on the breast.
• Excess skin, fat and glandular tissue is removed. Sometimes, the medical practitioner will use liposuction to help remove excess fat. (Occasionally, the medical practitioner can reduce the size of breasts by liposuction alone.)
• The medical practitioner puts stitches deep inside the breast tissue to add support.
• Skin incisions are brought together and closed.

Immediately after breast reduction surgery

After breast reduction surgery, you may expect:

• a drainage tube in the wound to help prevent fluid build-up
• bruising and swelling
• possible numbness
• pain and discomfort
• dressings or bandages
• the results of the breast reduction surgery to be immediately visible.

Potential complications with breast reduction surgery

All surgery carries some degree of risk. Some of the possible complications of breast reduction include:

• surgical risks such as bleeding or infection
• breathing difficulties due to general anaesthetic or the endotracheal tube which can cause swelling, noisy breathing and discomfort
• fluid accumulation around the operation site(s)
• allergic reaction to suture materials, tape adhesive or other medical materials and lotions
• skin discoloration, permanent pigmentation changes, swelling and bruising
• damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
• fatty tissue deep in the skin could die (fat necrosis)
• changes in breast and nipple sensation
• temporary or permanent areas of numbness
• wrinkling of the skin over the implant
• keloid, or lumpy scar tissue, which is raised and irregularly shaped. These scars may be inflamed and itchy
• asymmetry (unevenness) of the breasts
• breastfeeding difficulties, including reduced milk supply
• further surgery to treat complications
• risks of anaesthesia including allergic reaction or potentially fatal cardiovascular complications such as heart attack
• a blood clot in the deep veins of the legs (deep vein thrombosis), which can move to the lungs (pulmonary embolus) or to the brain, and may be life threatening
• potential partial or total loss of nipple and areola
• need for further surgery to treat complications

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your medical practitioner for more information.

Self-care after breast reduction surgery

Your medical practitioner will provide you with post-operative care instructions, such as:

• how to care for your surgical site(s) following surgery
• medications to apply or take orally to aid healing and reduce the risk of infection
• specific concerns to look for at the surgical site(s) or in your general health
• when to follow-up with your medical practitioner.

Long-term outlook after breast reduction surgery

Over time, swelling from the surgery will reduce. It may take about 18 months for the scarring to fade into faint lines. Satisfaction with your new image should continue to grow as you recover. Your new breast size should help relieve the pain and physical limitations experienced prior to breast reduction, and you may find that a better proportioned figure will boost your self-confidence.

The results of this procedure should be permanent. However, over time, your breasts can change due to ageing, weight fluctuations, hormonal factors and gravity.

Alternatives to breast reduction surgery

Alternatives to breast reduction can include:

• significant weight loss, if you are overweight
• professionally fitted bras
• liposuction
• talking to a counsellor or psychologist – this may help you overcome your concerns about your appearance.

Where to get help

• Your GP (doctor)
• A psychologist, psychiatrist or counsellor
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Information Hotline Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495