Breast reductions and breast lifts

Breast Reductions and Breast lifts are essentially the same operation because the incisions are the same, the only difference is that in reduction, we remove breast tissue. So the remaining presentation talks about reduction.

Why have a breast reduction

For ladies with large or sagging breasts, there is both a shape and comfort issue. Large breasts are heavy, cause back neck or shoulder pain, restrict physical activity, may cause hygiene issues. It also restors the nipples to the correct position, because large or sagging breasts cause the nipple to fall down. Nipples that are low (ptosed), or where the areolar are very large ( as these are reducted in a breast reduction) can be embarrassing. 

The decision is yours but you should discuss this with a plastic surgeon. We will also discuss your expectations and what is surgically possible. Breast reduction is considered a medical procedure and a rebate is available. For mastopexy, rebates are sometimes available but not always and this should be discussed with Dr Mahajani. 

When to have a breast reduction

Most women wait until they have had children and finished breast feeding. Some women, however, desire breast reduction before childbirth. There are pro's and con's for this and will be discussed with you - see the section on risks and complications.

Before the operation

Discuss any queries regarding the operation and post operation requirements with Dr Mahajani and his staff. Any fee enquiries please discuss with the practice administration. Do not smoke 2 weeks before the operation to 3 months after the operation. Stop any medications you have been advised to by the anaesthetist. Go to your anaesthetic appointment. We will give you the name of your anaesthetist so you can make contact with them. We will give you your operation date and time. The day before operation you will come for a mark up where the nipple position is determined and the operation is discussed. Please bring the completed consent form with you. The practice will also advise you about a bra to wear after the operation. If you are due for a mammogram please get this done and bring the results with you to your appointment.

What does the operation involve

The operation is done under general anaesthetic or occasionally under sedation anaesthesia. Incisions are made around the areolar and on the breast. The nipple and areolar are kept attached to the blood supply. Then using these incisions the breast size is reduced and nipples are lifted to a new position. In a mastopexy, the same incisions are made but the breast gland tissue is not removed. The incisions are around the areolar, vertically down to the breast base and then horizontally accross in the crease. Some breast reductions require less incisions but in this practice, we mainly perform the operation described. This means the scars will lie around the areolar, a vertical scar and a horizontal scar. The horizontal scar falls in the crease and relatively hidden.

After the operation

Dressings are applied and you are admitted to the ward. There are drains in each breast and stockings on the legs to prevent deep vein thrombosis. Pain relief is given and you rest in hospital for 1-2 days. Drains and stockings are removed before discharge. Upon discharge, you will be given pain relief medication, antibiotics and instructions to come back for dressings. 

After the operation and returning to normal activities

We would like you to rest for 1-2 weeks. It is common to be tired. The pain in general decreases over 2 weeks. You will come for dressings and reviews and histology is given to you. The support bra is worn for 6 weeks. You can return to work after 1 week for an office job and 2 weeks for other jobs. You can drive after 1 week but be careful with seatbelts. Do not lift anything heavy for 3-4 weeks. Sexual actvitiy should be avoided for 3-4 weeks. After 6 weeks, you can return to normal activities. There is a review at 6 weeks and 3 months.

Surgery Expectations, Risks and Complications

For most people breast reduction is a safe and straightforward procedure. We would however like you inform you of what to expect along with risks and complications.


The operation does produce a scar around the areolar, vertical downwards and a horizontal scar. This scar is red up to 12 months but then settles down. In some people the scar may thicken or stretch. These scars are permanent but over time the majority do lighten. Whislt we attempt to make scars as fine as possible, scars in these areas can thicken and we cannot predict how scars will manifest.


Generally heal over 2 weeks but can take longer. They tend to settle down finally at the 6 week mark and the scar matures thereafter. One area where the skin can take time to settle is the T junction. This is where the horizontal and vertical scars meet at the base of the breast. Occasionally this takes 6 weeks and heals by itself. Very rarely it requires a skin graft.

Incisions can get infected and usually only requires antibiotics to treat. Occasionally stitches that infect need removal. We will help manage your dressings. Rarely some wounds break down and the patient needs a revision of this. Infections that require more than antibiotics like severe necrotic infections requiring surgery are very rare.


Both breasts are always different. The operation is designed to make the breasts as symmetrical as possible but there may be some minor asymmetry between side to side. Mostly this is not significant or noticeable and it rarely needs any correction.

Dog ears

At the end of the breast reduction scar especially at the sides, there may a bulge that need a minor revision. This is called removal of dog ears. We would wait about 3-12 months to do this to allow the wounds to settle down.

Bleeding and swelling

It is unusual to have significant bleeding but if you do bleed, we may be required to stop the bleeding and or give a transfusion. There are drains which help indicate this. After a breast reduction the breast swells before it settles down. It takes usually 6 weeks to 3 months to completely settle.

What size will I be?

We will ask you what size would you like to be after the reduction. Dr Mahajani will discuss with you your expectations and also state what is feasible. The problem is how to consider cup size. Cup sizes are different between different bra companies, chest and breast shapes are different from one person to the next. Therefore whilst we aim to match the size you want, this is not a perfect science. In most women, we can match their requirements but post operatively breasts may be slightly smaller or larger than desired however it is rare that this occurs. Slightly larger breasts may require further excision and slightly smaller is more difficult to treat however this is rare.

Numbness and pain

In the breast skin and areolar, numbness may occur. This usually resolves over weeks or months. Occasionally it is permanent but doesnt interfere with function. The nipple may lose erectile or sexual sensativity. Pain lasts 1-2 weeks and settles down after this over a 6 week period in most people but can take longer. In some patients, nerves can be irritated and cause pain that is very severe or longer to resolve. This is unexpected but occasionally occurs. If this happens, our practice will help you to manage this where we can.

Problems in the areolar and nipple

Numbness in the areolar can occur. It may have been pre existing but can occur in up to 1 in 5 patients after breast reduction and lift. In about 1 percent it is permanent. Injury to the nipple and areolar causing loss of the nipple and areolar is very rare. Usually it is more common when there has been a previous breast reduction or incisions around the nipple or if the nipples have a long way to move in the breast reduction. I have never lost a nipple indoint a breast reduction in my practice but if a nipple is lost, then a nipple areolar reconstruction is required. Sometimes an areolar scar is not fine and a patient desires a correction of this.

Other complications

general complications from any anaesthetic include, sore throat, chest infection, deep vein thrombosis, irritation from dressings, rare complications from anaesthetic ( your anaesthetist will discuss ) .

Pregnancy after breast reduction

Whilst most women have breast reduction after having a family, there are women who simply for comfort need a reduction before having a family. Sometimes there is a desire to fall pregnant after breast reduction. Pregnancy and lactation will affect the breast shape and size. It may not be possible to breast feed. It may make the breasts larger and it may not return to the pre pregnancy size and further reduction may be desired.

Realistic expectations from a breast reduction It is important for your expectations to be realistic. We will try as far as possible , within the constraints of your physical health and the state of the breasts to help you achieve your goals. The surgeon cannot guarantee all expectations ( especially size and shape) and nor can guarantee the longlasting effect as the ageing process continues and there may be weight fluctuations. Very uncommonly, breasts regrow for some unknown reason and redo breast reduction is required. This is most unusual however and more commonly, if a person puts on weight or loses weight, this will affect the breast size and shape. Whilst we attempt to locate nipples and areolars to a better position, it could be slightly higher and lower than expected and it may or may not be able to be fixed. This is rare. We would place the nipple slightly lower rather than highter as a slightly lower nipple is easy to fix.