Cosmetic Surgery Tips

4 years after breast reduction surgery

4 years after breast reduction surgery, I’m still in love with my new body

I can’t believe it’s been four years since I had my breast reduction surgery. It’s hard to believe it’s been that long, but I’m so grateful that I had the courage to take a step towards self-acceptance.

The surgery itself was pretty straightforward: under general anesthesia and in the operating room, my surgeon removed some of my breast tissue and reshaped my breasts to make them smaller—and then stitched me back together. It wasn’t as painful as I thought it would be—the worst part was probably just not being able to move for about two weeks afterwards! But I’m so glad I did it because now when I look down at myself, instead of feeling self-conscious about how big my breasts were before, now all I see is how beautiful they are now!

I’ve never felt more confident than ever before—and if you’re thinking about getting a breast reduction yourself but aren’t sure if it’s right for you, let me tell you: just do it! You won’t regret it!

4 years after breast reduction surgery


Temporary bruising, swelling and numbness are common the first night after surgery.  You may need to go to the bathroom frequently during the night because of the IV fluids you were given during your surgery. Drink a lot of fluids in order to keep up with this fluid loss. As your body begins to balance itself out, it will rid itself of this extra “water weight and everything will return back to normal. You should leave all of your bandages intact overnight including your Bra and elastic ACE wrap.


The next morning following your surgery, you will return to Dr Motykie’s office for your first post-operative visit. You should leave all bandages and dressings intact overnight and until you reach the office the following morning.  Upon arrival to the office you will be escorted to a private examination room where your dressings will be changed and your operative sites will be evaluated. After your examination, you will be placed back into your surgical brassiere and ACE compression wrap and you will be allowed to return back to your home. All of your questions will be answered and you will be given instructions for the following week that will include the following:

You may feel tired and sore for several days following the surgery.  Your breasts will be swollen and tender. The sensation/feeling in the areolas/nipples may also be diminished the immediate post-operative period and may take several months to return to normal. Specific instructions regarding exercise, bras, compression bandages/garments will also be provided. Strenuous activity, particularly utilizing the chest and arms, will be restricted for the first few weeks after surgery. You will most likely be able to return to work within a few days depending on your job. Patients may shower the next day after surgery with care taken to not soak the sticky tapes over the insertion site. Aerobic and impact cardio exercise should be avoided for one to two weeks post-operatively. Weight lifting should be avoided for 3-4 weeks post-operatively and chest exercise should not begin until 4-6 weeks post-operatively. The resumption of and amount of physical /athletic activity should be guided by the level of patient discomfort with “pain” being the ultimate guide.


For the first week after surgery, you will wear an elastic ACE bandage and your surgical bra over gauze dressings. The results of your surgery will typically be obscured by swelling and bruising at one week after surgery. In fact, you may even notice during the first week or two after your surgery that your breast appear slightly “too large”. Do not be alarmed, this is completely normal and is due to swelling from the surgery. If the breasts were the perfect size immediately after surgery, they would most likely end up being too small after the swelling resolves. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with your prescribed medications but most women say that a mastopexy surgery is almost “painless.” Some people can return to work after a few days and some after one week. Most patients can drive their vehicles within a few days after surgery, but plan on having someone drive you to your first few post-operative visits anyway. In regards to an exercise program, use common sense and use pain as your guide; if it hurts, simply don’t do it!  The majority of patients are allowed to return to light, low impact cardiovascular exercise after the first week of recovery. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades away as the swelling subsides over the several weeks or so.

During this time period, there may be some moderate pain, but it can typically be treated with your prescription pain medications. You may want to wear an athletic or support bra until the swelling has subsided (Bra information). Heavy lifting or straining should be avoided after surgery because this can cause the breasts to swell and increase pressure. You can typically return to work within a week and to full activity within a few weeks. Sensation in your nipples may be reduced temporarily, but should return to normal or become hypersensitive as your breasts heal.


If you are still feeling a bit tired during this time don’t worry because it will take you a few weeks or months to feel completely like yourself again. Depending on the amount of physical exertion required to perform your expected duties, you should already be back into your normal rhythm at work. Exercise and workout routines may begin at this point in your recovery process with pain as your ultimate guide. Any activity that causes discomfort and/or pain needs to be avoided until further along in your recovery process. When you return to the activity, start at half speed and increase to your normal routine as long as you do not feel any pain during and/or the day after your workout.  Although exercising will not adversely affect your end result, it may temporarily cause more swelling immediately after the exercise that will subside over the next few hours. The majority of my breast lift patients are back to their regular workout routine within 4-6 weeks after their surgery.

During this period, sensory changes of the nipples and breast are normal and only temporary. Typically, normal sensitivity will return slowly over time. Lastly, as sensation begins to return some patients experience a hypersentivity in the nipples and/or areolas. This is also completely normal and temporary, and is a sign that normal sensation is beginning to return to the breasts. Over the next several months many of the benefits of your breast lift surgery will begin to materialize and you will begin to enjoy the transformation you have received form your breast surgery.

  • Surgical Bra: At this point in time you are no longer required to be wearing any surgical compression garment. However, many patients choose to continue some sort of light compression clothing during this time period including spanks or similar spandex type clothing.
  • Healing Process: There are some procedures/ treatment modalities available that can support and/or may accelerate your healing process such as Endermologie, Ultrasound and/or Radiofrequency treatments. There are several scar therapies on the market and there are many different types of laser scar removal treatments that can be utilized at different times in the course of the overall healing process that were not available 5-10 years ago,


All patients vary in their ability and speed to recovery after surgery but most commonly you can expect the final result from surgery to be evident at six months after surgery.  By this point in time, your breasts should be close to their final shape and size and it is therefore the proper time to begin shopping for additional bras and swimwear.  If you become pregnant after the surgery, the operation should not affect your ability to breast-feed, since your milk ducts and nipples have been left intact. All breast lifting techniques require removal of excess skin which will create scars on the breast. However, most scars fade away to thin lines with time and they are strategically located in areas that are covered by bathing suites and clothing. Most patients find these scars to be very minimal in comparison to the improvement in the shape and size of their new breasts. In addition, there are now numerous way to treat breasts scarring during and after the healing process utilizing scar therapies and laser treatments if necessary.


Breast lift surgery corrects breast sagging using a combination of techniques that allows for the removal of excess breast skin, reshaping of the breast mound and repositioning of the nipple. A breast lift alone, however, may not provide sufficient upper breast mound fullness in patients that feel that their breasts have also “deflated” in addition to becoming droopy.  In this case, a breast implant can be inserted to add volume and upper pole fullness at the same time as the breasts lift surgery. Some surgeons may recommend breaking this surgery into two separate surgeries which ends up being much more expensive, stressful on the body and time consuming for a patient that needs to schedule additional time off from work. Dr Motykie, however, prefers to do both surgeries at the same time because it allows the surgery to be more affordable for my patients as well as having them undergo one anesthesia, one recovery process and one time period off from work.  Dr Motykie is very experienced in performing combined breast lift/augmentation procedures using both saline and silicone breast implants as well as being proficient in performing all the most current and effective breast lifting techniques. Lastly, since one of the most common reasons women seek breast lift surgery is a prior pregnancy/breast feeding that has led to deflated, droopy breasts, a breast lift surgery may be combined with other body contouring procedures such as liposuction and/or a tummy tuck which is commonly termed a “Mommy Makeover.”

Breast reduction is a common cosmetic surgical procedure. It aims not only at bringing down the size of the breast proportionate to the build of the individual, but also to overcome the discomfort caused by massive, ill-shaped and hanging breasts. The operative procedure has evolved from mere reduction of breast mass to enhanced aesthetic appeal with a minimum of scar load. The selection of technique needs to be individualised. Bilateral breast reduction is done most often. Haematoma, seroma, fat necrosis, skin loss, nipple loss and unsightly, painful scars can be the complications of any procedure on the breast. These may result from errors in judgement, wrong surgical plan and imprecise execution of the plan. Though a surfeit of studies are available on breast reduction, very few dwell upon its complications. The following article is a distillation of three decades of experience of the senior author (L.S.) in reduction mammoplasty. An effort is made to understand the reasons for unfavourable results. To conclude, most complications can be overcome with proper selection of procedure for the given patient and with gentle tissue handling.

KEY WORDS: Breast, complications, fat necrosis, reduction mammoplasty, seroma
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Reduction mammoplasty aims to create proportionate, youthful looking breasts with minimal scars, having the ability to breast feed and retain normal sensations. The plan of operation is straightforward. Two choices need to be made – what incision to be given and what pedicle to be used to retain the nipple and areola. Quadrants other than the pedicle are removed; the breast shaped and redundant skin excised. An entire array of techniques has been described to achieve the above-mentioned aims. Out of these, the Wise pattern[1,2] access with inferior pedicle breast reduction has been the most popular. However, the vertical pattern mammoplasty has its proponents too, after the works of Lassus,[3] Lejour,[4] and Hall-Findlay[5] amongst others. Benelli[6] has advocated the circumareolar access for the operation. Especially in cases of mild hypertrophy, liposuction of the breast achieves significant reduction. Amputation of the breast with free nipple-areolar graft[7] needs to be considered for a massive and ptotic gland.[8,9]

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An informational video prior to meeting the consultant is recommended.[10] Many Indian patients however, detest watching surgical steps.

The following details must be asked[11] for from all patients: Age,[12] upper body symptoms due to the pendulous breasts; history of breast cancer, pregnancy and breast feeding; smoking; hormonal or anticoagulant use;[13,14] diabetes;[14] submammary intertrigo; expectations to lose weight post-operatively; expected breast size post-operatively; requirement for other cosmetic surgeries (like abdominoplasty[15]) simultaneously.

A physical examination is necessary to choose the right technique. The following are noted:

Size of the breast; density of its parenchyma; ptosis[16]

Estimated amount of the breast tissue to be retained (this is more important than the amount to be resected)

Body mass index (BMI) (patients with BMI >35 must be encouraged to lose weight)[10,17,18]

Photography (from the front and sides).[11]

Whatever technique is chosen, the following steps have to be adhered to:

Marking of the patient in standing position

Midsternal line from suprasternal notch to the xiphisternum

Breast meridian: 7.5 cm from the suprasternal notch on the clavicle, a perpendicular line is drawn onto the breast mound, which usually passes through the nipple

The distance from the suprasternal notch to the nipple is measured

The inframammary crease is marked. The distance from the nipple to the crease is noted. The new nipple position is marked on the breast meridian[19] varying from 18 to 24 cm depending on the height of the individual. Err on marking the new nipple position too low, rather than too high[13]

The new location of the areola is marked with an areola diameter of 45 to 55 mm

Skin incision lines are marked depending on the technique chosen. The reader is referred to masterly articles[13,20] on the finer aspects of marking of incisions

An informed consent is taken.

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Technique evolves with time and during the course of a career. Out of the senior author’s personal experience of 468 breast reductions over the last 30 years, the inferior pedicle technique was used in the initial decade; vertical scar techniques for the next 15 years and a combination of liposuction and vertical scar in the last 5 years.

Inferior pedicle technique
The inferior pedicle technique, with a Wise pattern incision, has enjoyed universal appeal in the last half a century. It is the standard against which all other techniques are judged[11,20] [Figure 1]. The technique is reproducible across a range of breast sizes and with varying ptosis. It is easy to master; access to different quadrants is excellent and permits precision in shaping the retained parenchyma and the skin envelope.[20] The lengthy operating time, scar burden and bottoming out in the late follow-up period are the drawbacks of the procedure. Again, the technique relies on the redraped skin to shape the breast, rather than the retained parenchyma.[13]

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Figure 1
Left: 20 year follow-up of breast reduction with inferior pedicle and inverted T incision. Following the procedure, the lady begot three children and all were breast fed. Right: The axillary pad of fat was removed in a second sitting, 20 years after the breast reduction

Unfavourable results encountered with this technique are:

Flattened, boxy shape of breast lacking projection[20] and volume [Figure 2]

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Figure 2
Flattened breasts with loss of volume and projection. This unmarried lady presented for revision mammoplasty after undergoing reduction elsewhere

Dog-ears on both ends of the transverse scar with prominent lateral bulges

Loss of the nipple or delayed healing

Hypo pigmented patch of the nipple

Webbing of the presternal region [Figure 3].

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Figure 3
Left: Young girl who underwent a massive reduction. Right: Post-operative result. Note the presternal webbing

The shape of the breast can be maintained by keeping the pedicle at least 7.5-8 cm wide and keeping the glandular element slightly more than the estimate. The superior flaps are raised from the gland with the thickness of 2 cm and then raised up to the lateral extent of the gland to retain the conical shape of the breast.

The dog ears and lateral bulges can be avoided by taking measurements meticulously. For example, if the transverse inframammary length is 22 cm, the lateral segment should be 12 cm, the medial segment should be 10 cm. The suturing should be started from the lateral side.

Nipple loss can be avoided by keeping the pedicle in a pyramidal shape, not letting it fall forwards and supporting it all the time while excising the glandular element on the lateral and medial segments.[21]

The medial and the lateral flaps can be approximated along the inframammary crease after inserting drains. The nipple-areola opening is created by incising a circle of diameter 5 mm larger than the previously incised nipple-areola.

Superior or superomedial pedicle technique
It is a safe and a reliable technique consuming less surgical time with long-term consistent results. Extensive undermining of skin flaps is not required.[20] The shape and contour are well maintained with minimal scarring. After the basic markings of breast meridian the new nipple position is marked on it. The new areola is marked around it with a diameter ranging from 3.5 to 4.5 cm. The inferior limit of the excision should be 2-3 cm above the inframammary crease.

The pedicle can be superior or medial depending on the surgeon’s choice. Most of the breast tissue is resected, inferiorly, laterally and medially.[22] Scar if it is beyond the infra mammary fold becomes prominent and persistent. Under reduction may be the complication where the patient may still feel the size is big. This technique has proved to be reliable, but it is limited by increased difficulty in moving the nipple over longer distances.

Vertical mammoplasty
Lassus popularised vertical mammoplasty without the inframammary fold scar. It is characterised by en bloc resection of skin, fat and glandular tissue; transposition of the areola on a superiorly based flap, no undermining and a vertical scar. Reporting on 30 years of experience with vertical mammoplasty in 1350 breasts,[3] Lassus quoted zero necrosis when the nipple is transposed no more than 9 cm.

Lejour used undermining and often combined this with liposuction.[4] She advises against marking the nipple too high, to keep the lower most aspect of vertical resection at least 3-4 cm (in case of small and ptotic breast) and up to 6-7 cm (in hypertrophic, ptotic breast) above inframammary fold to avoid migration of the vertical scar down on to the chest wall [Figure 4].

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Figure 4
Left: Skin marking prior to vertical mammoplasty. Middle: Post-operative result. Right: Late follow-up. The vertical scar below the inframammary crease is still prominent

Circum areolar breast reduction
This procedure[6,23] can be chosen for mild hypertrophy of a tubular breast with enlarged areola (small volume reduction with mastopexy[20]). The incision is made around the areolar perimeter and the required size of areola is preserved. The rest of the areola is excised like a de-epithelised skin flap. The incision is deepened in the lower half of the areola and the required amount of breast tissue is excised. The wound is closed in three layers. The deeper suture is with a non-absorbable suture. The second suture layer is to reduce the gap further and skin is closed with interrupted sutures. This technique aims to avoid a visible stitch line. This procedure can be preceded by liposuction, which helps in reducing the volume [Figure 5].

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Figure 5
Left: 17-year-old girl with unequal tubular breasts. She underwent liposuction and circumareolar breast reduction. Right: Post-operative result

The unfavourable results of this procedure are:

Inadequate reduction of breast as there is limitation in exposure

Removal of excess skin via a periareolar route may result in a flat appearance[20]

The scar around the areola may become prominent, hypertrophic and may take a long time to settle.

Liposuction alone as a breast reduction procedure
This is very effective and useful in unmarried girls leaving no visible scar and no other morbidity such as haematoma, seroma and nipple necrosis. The ideal patient for such a procedure[24] is a young patient with juvenile fatty breast parenchyma with good skin elasticity and tone. For better assessment, a preoperative mammography may be of great help.

Moskovitz et al.[25] conducted a survey to know the outcome of the liposuction for breast reduction. The survey revealed that 80% were satisfied with the result and would go on to recommend it to a friend. Thus, it can be considered as an effective method of breast reduction.

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