Breast Reduction Surgery

What is a breast reduction?

Reduction mammoplasty removes breast tissue, fat and excess skin, then reshapes what remains into a smaller, lighter and higher breast. The nipple and areola are repositioned and, where they have stretched, reduced in size. Breast reduction generally results in the breast being lifted as part of the procedure.

Disproportionately large breasts — macromastia — place sustained load on the neck, shoulders and back. Patients commonly report:

• Persistent neck, shoulder and upper back pain
• Grooving and indentation from bra straps
• Skin irritation, rashes or infection in the fold beneath the breast
• Difficulty exercising or finding clothing that fits
• Poor posture
• Self-consciousness or unwanted attention
• Restricted participation in sport and physical activity

Breast reduction is also used to correct significant asymmetry, and to treat gynaecomastia in men — a separate procedure, assessed individually.

Am I a suitable candidate?

Suitability is determined during a consultation following examination and discussion of your symptoms and medical history. Generally, candidates are:

• Experiencing physical symptoms attributable to breast size, or seeking reduction for well-considered personal reasons
• Physically healthy and at a stable weight
• Non-smokers, or willing to stop well before and after surgery — smoking increases the risk of complications, including infection, delayed wound healing and nipple-related complications
• Realistic about scarring, which is permanent and unavoidable

Patients ideally need to have completed breast development before undergoing breast reduction. Although it is not a prerequisite to have completed one’s family, it must be appreciated that pregnancy and breastfeeding will change the results of a breast reduction, as do weight fluctuations. Results are not permanent and will continue to change over time with hormonal and weight fluctuations. Where symptoms are significant in a younger patient, timing is discussed individually.

Reduction techniques

There are several examples of breast reduction techniques. Here are just a few examples:

Vertical (lollipop) reduction

An incision around the areola and vertically down to the breast crease. Suited to small and moderate reductions. Avoids the horizontal scar in the breast fold.

Anchor (inverted-T) reduction

An incision around the areola, vertically down, and horizontally along the breast crease. The most widely used technique for larger reductions, allowing removal of substantial tissue and skin.

Liposuction-assisted reduction

In selected patients whose breasts are predominantly fatty and whose skin has good elasticity, liposuction may reduce volume with minimal scarring. It does not remove skin or lift the breast, so it suits a narrow group of patients.

Free nipple graft

Used in particularly large reductions, however there is a significant risk of impairing nipple sensation and the ability for future breastfeeding. It is used only where necessary and discussed thoroughly beforehand.

What is involved

Before surgery

An initial consultation and physical examination is undertaken to determine your suitability for this procedure. The risks and recovery will be discussed with you. Formal clinical photography and measurements will be undertaken prior to surgery. Where a Medicare rebate may apply, documentation of your symptoms and any prior conservative treatment — physiotherapy, supportive bras, weight management — is important, so bring relevant records.

Breast imaging may be arranged depending on your age and history. You must cease smoking, and pause medications or supplements that can increase bleeding risk.

On the day

Surgery is usually performed under general anaesthetic administered by a specialist anaesthetist, in an accredited private hospital. The length of your operation depends on your anatomy, the volume being removed and the technique used. Most patients stay one night.

Tissue and skin are removed, the remaining breast is reshaped and supported, and the nipple and areola are repositioned — usually remaining attached to their blood and nerve supply. Drains are sometimes used. A surgical bra is applied.

After surgery

Arrange for someone to drive you home and stay with you initially. Pain relief is prescribed. Follow-up appointments monitor healing, drain removal where used, and scar maturation.

Your recovery

Recovery varies between individuals. The following is a general guide only.

Many patients notice relief of neck, shoulder and back symptoms relatively early, though swelling means the final shape takes months to emerge.

Support garments are typically worn for six weeks. Scars are permanent, usually fade substantially over 12 to 18 months, and should be protected from sun exposure during that period.

Potential benefits

Breast reduction may:

• Relieve neck, shoulder and back pain related to breast weight
• Reduce bra strap grooving and skin irritation beneath the breast
• Improve ability to exercise and participate in physical activity
• Improve posture
• Improve proportion, fit of clothing and ease of finding bras
• Reduce self-consciousness related to breast size

Breast reduction provides both symptom relief and improves posture. Nonetheless, outcomes vary between individuals and cannot be guaranteed, and results depend on your anatomy, healing and the agreed surgical plan.

Costs and Medicare

The total cost includes the surgeon's fee, the anaesthetist's fee, hospital fees and follow-up care.

Unlike most breast surgery, breast reduction is frequently performed for medical reasons, and a Medicare item number may apply where specific clinical criteria are met — generally relating to documented physical symptoms and the volume of tissue to be removed. The relevant Medicare Benefits Schedule (MBS) item number is typically 45523 (bilateral reduction mammaplasty with surgical repositioning of the nipple), though this can vary depending on your individual circumstances. Where an item number applies, private health insurance may also contribute to hospital costs, subject to your level of cover and any waiting periods.

Eligibility is assessed individually and cannot be confirmed before consultation. We encourage you to check with your private health fund and Medicare about your eligibility for relevant rebates ahead of your appointment — this can give you a clearer picture of your likely out-of-pocket cost before you come in. Bring documentation of your symptoms and any prior treatment, as this supports the assessment.

You will receive a written quote setting out all costs and any expected rebates before committing to surgery. For questions about fees or health fund cover, contact the practice on 03 9075 0005.

Why Evolve

Dr. Namrata Anavekar is a Fellow of the Royal Australasian College of Surgeons and a specialist plastic and reconstructive surgeon. She graduated with honours from Monash University and completed the Australian Plastic Surgery Training Program, with rotations through St Vincent's Hospital, The Royal Children's Hospital, The Alfred and The Austin, followed by an international fellowship in Switzerland and France.

Dr. Anavekar is a board member of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) and has authored multiple research publications. She holds several public and private hospital appointments, and is a professional member of ASAPS, the Australian Society of Plastic Surgeons (ASPS), the Royal Australasian College of Surgeons (RACS), the Australian Medical Association (AMA), and the International Society of Aesthetic Plastic Surgery (ISAPS).

Dr. Anavekar is part a relatively small group of experienced female specialist plastic surgeons in Melbourne, and consults from Bulleen and Sunbury locations.

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