Breast Reduction


Mastopexy – Breast Reduction
Case #1 Before & After

Also known as reduction mammaplasty
The goal of breast reduction surgery is to reduce the size of your breasts and reshape them so that they are proportionate to the rest of your body and are no longer a source of physical discomfort. This commonly requested, predictable procedure has the dual benefits of improving your appearance while relieving the physical and emotional burden of overly large breasts.

When to Consider Breast Reduction

  • If your breasts are too large for your body frame and create neck, back, or shoulder pain.
  • If you have heavy breasts with nipples and areolas (pigmented skin surrounding the nipples) that point downward.
  • If one breast is much larger than the other.
  • If you are unhappy and self-conscious about the large appearance of your breasts.



    • Your breasts will be in better proportion with your body and will feel firmer.
    • Surgery will alleviate neck, back, and shoulder pain and make it easier to breathe and exercise.
    • Your clothes will fit better and you will feel more confident about your appearance.


    • You may have decreased sensation in some areas, including the nipples and areolas.
    • Some women complain that their breasts and nipples look slightly uneven.
    • Breast-feeding may be a problem.

    These are the top three pros and cons to weigh when considering breast reduction. If you want to focus on those specifically unique to you, please consult with Dr. David Williamson.

    Are you a good candidate for a breast reduction?
    Women who seek breast reduction often have had children, are overweight, have a predisposition for large, disproportionate breasts, or are sensitive to estrogen. Big breasts often run in a family, inherited from mothers and grandmothers.
    Following are some common reasons why you may want to consider breast reduction:

    • You have backaches, neck aches, or skin irritation under your breasts.
    • You have difficulty breathing and notice grooves in your shoulders from your bra straps.
    • You have poor posture or numbness in parts of your breasts and upper chest from excessive breast weight.
    • You find it nearly impossible to buy dresses and blouses and difficult to find tops that fit.
    • You are very unhappy with your appearance because of your breast size.
    • You are in good health with no active diseases or pre-existing medical conditions.
    • You have realistic expectations of the outcome of your surgery. You must be able to discuss what you want with your plastic surgeon so that you can reach an understanding of what can realistically be achieved.
    • Your skin has adequate elasticity, so it can resume its former tightness following surgery.
    • You are mentally and emotionally stable. Breast reduction requires patience and stability to deal with the healing period.
    • You are old enough so that your breast development has stopped.
    • You have finished having children and breast-feeding, because this can have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this with Dr. David Williamson.

    A history of irregular mammograms, undiagnosed lumps or other types of masses, severe obesity, diabetes, wound healing disorders, current breast-feeding, smoking, clotting disorders or a family history of them, and heart or circulatory disorders are all contraindications for breast reduction. If you are in good general health and have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

    Detailed Procedural Info

    How is a breast reduction procedure performed?
    Breast reduction surgery, which usually takes from 2.5 hours, is performed in a hospital or surgical center. An overnight stay is not usually required. The surgery commonly involves three incisions. After Dr. David Williamson removes excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areolas may be reduced in size. Skin that was located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.

    • Dr. David Williamson will use a surgical marker on your skin to indicate where the incisions will be. These markings are especially important, because your breasts change shape once you are lying on your back on the operating table.
    • Most surgeons prefer general anesthesia for this procedure. 
    • Your incision pattern will depend on the size of your breasts, how much your breasts sag and where your nipple-areola complex is positioned. With each technique the areolas can be made smaller if they’re too large. An areolatome, more commonly known as a “cookie cutter,” is used as a circular template to make the new areola size. The cookie cutter diameter ranges from thirty-eight to forty-five millimeters. Here are some commonly used incision patterns:

    Microincisions are used for breasts that are fatty (not fibrous) and not sagging. Liposuction is used to decrease breast size. Small incisions allow the liposuction cannula (tube) to enter the breast.

    •  A donut incision, or periareolar incision, is made solely around the border of the areolas.
    •  A keyhole incision, also known as a lollipop incision, is made around the border of the areolas and vertically down from the areolas to the breast crease.

    An anchor incision, the most common technique used by plastic surgeons, involves three distinct cuts. One incision is made around the border of the areolas; the second extends down vertically from the areolas to the breast crease and merges with a third incision along the breast crease.

    • Dr. David Williamson will remove excess breast skin and fat with a scalpel and/or cautery instrument based on the size breast you desire. If your breasts are asymmetrical (or uneven), the surgeon may remove more tissue from one breast than the other. He or she will then reshape the remaining skin and fat to create a more youthful breast shape and move the nipple-areola complex to a higher position.
    • A drain may be placed in the breasts to collect excess fluid.
    • Breast incisions are then closed with sutures that go from the deep tissue layers to the more superficial layers (the skin). The goal of Dr. David Williamson and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.

    What are my options?
    The size and shape of your breasts and how much reduction you desire are factors that will help your plastic surgeon determine the best technique for you. In some cases it will be possible to avoid the vertical incision that runs from the bottom edge of the areolas to the breast crease or the horizontal incision underneath the breast (typical components of the anchor incision). Rarely, if your breasts are extremely large, the nipples and areolas may have to be completely detached before they are shifted to a higher level. In such a case, you will have made the decision to sacrifice sensation and the possibility of breast-feeding to achieve your desired breast size. Another breast reduction option, which is appropriate only in a select group of women, is liposuction alone.

    Liposuction for breast reduction
    Breast liposuction may be right for you if you have fatty breasts, need a minor-to-moderate reduction, and do not need to correct sagging. Here are some considerations:

    • Results may be acceptable for women who need significant reduction but do not want the scars and loss of sensation and are willing to accept some sagging.
    • With the onset of menopause, breast tissue is gradually replaced by fat, so postmenopausal women are among the best candidates for liposuction-only breast reduction.
    • Patients with fibrous tissue and minimal fat in their breasts are not good candidates.
    • Ptosis (sagging), poor skin condition with little tissue elasticity, and low nipple position are also contraindications.
    • Liposuction alone may be used to treat asymmetry up to one cup size.
    • Following liposuction of the breast, the elastic qualities of the skin cause it to contract, and subsequent uplifting of the breast contour should occur to some extent.
    • Liposuction may also be employed to improve the contour under the arm.

      What will my breast reduction incisions and scars be like?
      These vary according to type of incision Dr. David Williamson suggests for you. Dr. David Williamson can conceal some incision lines in natural breast contours, but others will be visible on the breast surface, however some people will have noticeable scaring. Although incision lines are permanent, in most cases they will fade and significantly improve over time. Aesthetic plastic surgeons make every effort to hide and minimize scars, with the goal of achieving the desired results with the shortest possible scar. Special tissue handling and suture techniques further minimize scars. To get a better idea of breast reduction incisions, read How is a breast reduction performed?

      • This common anchor incision follows the breast’s natural contours and defines the new location for the nipple.
      •  Once breast tissue, fat and skin are removed, the skin is brought down and together to reshape the breast.
      • Large breasts that sag can cause back pain and other physical and emotional discomfort.
      • After surgery, breasts will be in proportion to your body and scars will fade over time.