Breast Reduction for Enlarged Breast

Aesthetic breasts are covered by crisp and elastic skin devoid of wrinkles, occupy an optimal position on the chest wall and are of proportionate size. There is a good volume distribution between the upper and lower poles, and this confers a pleasing silhouette when viewed from the front and the sides. When viewed from the side, the upper pole of the breast is a gentle slope rising from the upper chest wall, and the lower pole is convex in shape ending in the inframammary fold (IMF). Beautiful breasts project the image of youth, confidence, elegance and femininity.

How Does It Manifest?

Excessively large breasts (macromastia) may appear disproportionate in relation to an individual’s height or body and are often source of chronic discomfort. Due to their weight, they may become droopy (breast ptosis) and make the individual appear matronly. Obtaining an appropriately sized brassiere for support may be difficult. The undergarment transfers the weight of the breast to the body resulting in chronic pain in the neck, shoulders and upper back.

Droopy breasts may result in accumulation of perspiration in the skin folds beneath the breasts (the inframammary fold, or IMF), and leading to problems such as fungal infections, skin inflammation and malodour. Individuals with macromastia may also experience difficulty in finding clothing that fits them. Social functioning may be adversely affected in individuals with macromastia.



How does it arise?

Most cases of macromastia are developmental and occur without known cause. They often affect both sides, with one side more severely affected. Some cases are associated with obesity, pregnancy and/or breastfeeding. Cases of unilateral macromastia are uncommon and require investigations to exclude breast cancer. There are uncommon developmental illnesses that may cause adolescents to have enlarged breasts.


treatment - Breast reduction surgery

Reduction mammaplasty reduces the breasts to an appropriate size, corrects droopiness and keeps the scars in inconspicuous locations. Breast reduction often delivers immense satisfaction to affected individuals. Successful outcomes improve the individual’s self-confidence and social functioning. In many cases, it may be performed as an outpatient procedure under intravenous sedation or a short general anesthesia.

The following individuals may consider breast reduction surgery:

  • Individuals with chronic pain (neck, shoulder, back) or skin symptoms at the IMF (skin irritation, fungal infections, malodor)
  • Individuals with breast ptosis (droopiness). Individuals whose breast glands and/or nipple-areola complexes lie below the level of the IMF
  • Individuals with benign breast lesions requiring removal and desiring for breast reduction (managed in conjunction with partnering breast surgeons)
  • Individuals who have undergone significant weight loss but with significant residual macromastia, with or without breast ptosis, in order to restore proportionality

Breast reduction surgery restores breasts to their youthful, pre-macromastia state. Reduction mammaplasty surgery achieves the following:

  • Create breasts that are symmetrical, appropriately positioned on the chest wall and are proportionately sized. Individuals with ptosis will have the breasts elevated to an appropriate level on the chest wall during this surgery
  • Maximally preserve nipple and areolar sensation and preservation of future ability to breastfeed (if applicable)
  • Maximally preserve nipple and areolar blood supply
  • Relocate the nipple-areola complex to an aesthetically pleasing position on the breast mound and reduction to a normative size (if applicable)
  • Minimize the scar length and restricting scars to inconspicuous locations

Individualizing the surgical approach produces natural-looking, elegant, and bespoke outcomes.

In individuals aged 40 and above, breast cancer screening is performed prior to the reduction as a routine precaution. This may be in the form of mammography or MRI scan. Individuals are advised to stop herbal supplements and traditional medicine, and start special medications 7 days prior to surgery to minimize bruising and swelling.

There are many different possible incisions and breast reduction techniques available. The common skin incisions used include:

  • The periareolar (doughnut) incision. This technique is appropriate for small volume reduction and minimal elevation of the nipple-areola complex. The incision is made around the areola only
  • The circumvertical (lollipop) incision. This technique is appropriate for moderate volume breast reduction, nipple-areola complex elevation and resection of horizontal skin excess. The incision is made around the areola, and a vertical line connecting the bottom of the areola to the IMF
  • The J- or L- incision. This technique is appropriate for moderate volume reduction, nipple-areola complex elevation and resection of vertical and horizontal skin excess. This incision is similar to the lollipop incision with a slight extension toward the side
  • The inverted T incision. This technique permits large volume breast reduction and significant elevation, complete resuspension of the breast onto the chest wall and a large amount of skin resection where necessary.

Reduction mammaplasty is a fine art that aims to strike a balance between removing an appropriate amount of breast tissue for symptom relief whilst preserving the feminine identity, and maintaining optimal blood circulation and nerve sensation to the overlying nipple-areola complex.

A small minority of individuals undergoing breast reductions will require insertion of drainage tubes to prevent accumulation of blood and fluid. These are typically removed on the 1st or 2nd postoperative day. Mild bruising and swelling is expected after surgery, which will mostly resolve by the 10th postoperative day. Return to work is possible for most individuals after the 7th postoperative day.


Showering is possible from the 2nd postoperative day onwards. Stitch removal is usually not required as they are self-dissolving. Individuals may require wearing of a postoperative support brassiere to reduce swelling and facilitate wound healing. Strenuous physical activity is avoided for the first 2 weeks postoperatively to minimize swelling and bruising.

Breastfeeding is a physiological process possible in most (but not all) women. There is usually mild transient reduction of sensation of the nipple-areola complex following breast reduction. Studies have shown that the proportion of females who successfully breastfeed following reduction mammaplasty is not significantly different from the general (unaugmented) population.

Most postoperative individuals are advised to undergo mammography between 3 to 6 months postoperatively, as this mammogram will be used as a basis for comparison for future breast cancer screening mammograms.

As a routine, breast reduction specimens are sent for histopathological examination following excision. An incidental finding of cancer is exceedingly rare and occurs in about 0.14% of all cases. Such cases will be managed with a partnering breast surgeon.


The Picasso Advantage

Reduction mammaplasty is a less commonly performed procedure in Asia. Dr Yeo is experienced in breast reductions because of his work and surgeries for post-weight loss patients.

Our clinic has an en suite operating facility that has MOH certification as an Ambulatory Surgical Center (ASC). This assures your maximal privacy and convenience while keeping facility and equipment costs contained.