What is breast reduction surgery, and how is it decided if it is right for someone?
Breast reduction surgery, also called reduction mammoplasty, is a consultant-led procedure that reduces breast size, shape, and weight. It can ease symptoms caused by breast hypertrophy, including shoulder discomfort, restricted movement, and recurring skin irritation. The surgery removes glandular tissue, fat, and skin, and reshapes the breast. If needed, the nipple is repositioned to suit the new shape. A consultant assesses a person’s suitability through clinical examination, medical risk factors, body volume distribution, and personal goals.
Pro Tip: Keep a symptom diary of discomfort, skin irritation, or mobility issues to provide your surgeon with clear context.
A calm look at the concern
Many people want to know exactly what breast reduction surgery involves, whether it suits their situation, and how surgeons make decisions about it.
This guide explains the process clearly, in the same way an experienced consultant would. Rather than focusing on cup sizes, it explores body proportion and volume asymmetry. It outlines the clinical assessment process and describes how the operation works. Dr D B Ghosh, Consultant Breast Surgeon in Harley Street, London, follows this approach in both breast reduction and broader breast care. Shared decision-making and informed consent are key aspects of this consultant-led care.
What breast reduction surgery is (and what it isn’t)
What changes during breast reduction?
Breast reduction involves removing excess gland, fat, and skin. The remaining tissue is reshaped to improve support, comfort, and overall breast contour. The nipple–areola complex is often repositioned to match the new breast shape and balance.
Because the skin must fit the new volume, reshaping requires incisions that lead to scarring as part of the healing process.
What it isn’t
Breast reduction is not a cup-size promise. Bra sizes are inconsistent and do not guide surgical planning. It is not only cosmetic. Many patients seek help due to physical discomfort, postural strain, or musculoskeletal factors. It is also not an excuse to skip breast checks. Clinical and, where necessary, imaging assessments are part of every case.
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Who breast reduction tends to help (in clinical terms)
When breast size contributes to symptoms
People often seek breast reduction if they experience constant heaviness or shoulder strain, rashes, intertrigo, or friction-related irritation beneath the breasts, bra strap grooving, difficulty exercising or moving freely, or challenges finding supportive clothing. These symptoms typically relate to symptomatic breast hypertrophy or macromastia.
When symptoms come from more than one cause
Not all discomfort is caused solely by breast size. Upper back or neck pain may be influenced by posture, musculoskeletal strain, or lifestyle factors. An experienced consultant determines whether breast reduction is likely to provide meaningful relief.
How the decision is made: a consultant’s checklist
What shapes the surgical plan?
Symptoms and aims
Identify which daily activities or movements are causing discomfort.
Clarify which issues would benefit most from tissue reduction.
Anatomy and proportion
Assess breast footprint and projection.
Evaluate degree of ptosis (droop).
Check skin quality and elasticity.
Examine symmetry between breasts and volume distribution.
Measure nipple position relative to the inframammary fold.
Planning based on proportion
Focus on body balance, support, and comfort rather than cup size.
Use photos or visual examples to communicate shape preferences when helpful.
Safety and recovery considerations
Review smoking, nicotine use, and overall BMI.
Consider previous breast surgery or radiotherapy.
Identify health conditions affecting healing, such as diabetes.
Technical approach
Choose a pedicle technique to preserve nipple blood supply and sensation.
Determine incision pattern based on individual anatomy and desired reshaping.
Pro Tip: Bring photos of desired breast shape to your consultation to help guide proportional planning.
Breast health assessment before surgery
What’s included in a breast assessment?
The triple assessment method ensures safe planning:
Clinical examination by the consultant.
Imaging, such as a mammogram or ultrasound, depending on age and risk factors.
Biopsy if findings require further analysis.
Why is tissue sent for histology?
All removed tissue is routinely examined in a lab. This standard step ensures safety and thoroughness and does not indicate that any abnormalities are expected.
What happens during the operation?
A step-by-step breakdown
Patient is placed under general anaesthetic.
Planned incisions are made according to the surgical approach.
Glandular tissue, fat, and skin are removed.
Remaining tissue is reshaped to improve support, symmetry, and overall contour.
Nipple is repositioned using a pedicle technique to maintain blood supply and sensation.
The area is closed with sutures and dressed.
Drains may be used in selected cases.
All decisions are pre-planned; nothing is improvised in theatre.
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Safety, trade-offs, and optimisation
How risks are managed
Breast reduction carries risks, including wound healing issues (dehiscence), infection, changes in nipple sensation, and slow healing or fluid accumulation. Patients who smoke or have a higher BMI may face increased risk. Surgeons may recommend optimisation measures before surgery to support healing and long-term outcomes.
Where techniques overlap with cancer surgery
Some breast reduction techniques are used in therapeutic mammoplasty, where tissue removal for tumour clearance is combined with reshaping. Although the goals differ, the technical principles are similar: safe tissue handling, balance, and support.
What to think about next
Before a consultation:
Note your symptoms or discomfort.
Consider how you would like your breast shape, comfort, and support to improve.
Bring example images if helpful.
Be ready to discuss goals, safety, and the plan for surgery.
Consultations with Dr D B Ghosh are unhurried and focused on understanding your needs. Decisions are consultant-led, guided by anatomy, safety, and proportion.
Clear explanations and shared decision-making are fundamental in breast reduction. This approach helps patients make informed, confident choices about their care.
