Breast modification and reduction

Author: MUDr. Josef Hrbatý

Breast plastic surgery is the most popular and well-known type of plastic surgery. Reasons for a surgical change of shape or size of breasts are not only aesthetic but also medical. Shape, symmetry and the size of breasts can affect a woman psychically and can even influence how they are perceived by others. Large breasts can cause back or vertebral pain. How does breast plastic surgery work and what can a patient expect following it?

Getting ready for vertical mammoplasty

First the surgeon will take measurements in order to find out specific distances (see below) so the breasts will have as close to the same shape and size after the surgery. Complete symmetry can never be achieved.

We usually measure the following distances:

1. nipple - jugulum (the pit on the upper edge of the breast bone)

2. further distance nipple - middle line

3. nipple - inframammary fold

4. the incision is then set according to the drawings

Next, the surgeon sets the position level of the areolas so the breasts are of an adequate height based on the patient’s figure, shape of her chest and also according to the planned size of the breasts after surgery (in a breast reduction). The areolas must be well positioned on the breasts. The shift of the areolas is not done through cutting and then suturing on the elevated breasts. The areolas are only shifted up together with the gland.

The breast surgery process

For the actual surgery, first we make the incisions according to the drawings, make incisions around the areolas, remove the extra skin and eventually any extra breast tissue (for reduction). Breast reduction is performed by removing the wedge on the lower half of the breasts. The wedge can be moved differently depending on where the most tissue is. We also reduce the so-called breast basis, which is the part of the breast connected to the muscle. It shortens the breast’s projection, i.e. how the breast protrudes forward. We sew the breasts and form them with absorbable material.

The fixation of the gland to the muscle in specific heights is to prevent its early and excessive droop after the surgery and therefore sagging breasts as well. Absorbable as well as non-absorbable material is used. Then the skin is sutured and so-called sucking drains are inserted. The wounds are covered with gauze and the breasts are bandaged with elastic bandages.

After thebreast lift or breast reduction

The drains are kept in for 2 to 3 days on average, depending on the bleeding. The patient uses a bandage bra for approximately 2 weeks. After the largest swellings fade, normally in 2 to 3 weeks, patients can use a normal bra, a so-called push-up is not recommended. It is necessary to wear a bra for a longer time during the day until the scars around the gland are so firm that the breasts do no sag at all or minimally. Such a period usually lasts around nine months. In general, the larger the breast, the longer the time needed to wear a bra after surgery. It can be even one year.


Usually pressure massages are recommended for minimizing scars, although it is not necessary. The pressure of the breast against the bra is an optimal permanent pressure massage. It can eventually be completed with a local application of ointment with silicone (Prosil, Dermatos and others). It is necessary to emphasize that the most significant factor in softening the scars are pressure massages.

Sometimes a slight deformation of an areola might occur, which changes its round shape to ellipse in some time. It is caused by the tension of the scars and the drooping of the breasts. Scars on the edge of the areola do not look good. In these cases we recommend considering a correction of the slightly deformed areolas and eventually perhaps camouflaging them through tattooing.

Every surgeon will proceed with specific differences; he/she has had different experiences. The important thing is that the client is satisfied with the result of the surgery and as we say all the ways lead to Rome.

The author of this article is Josef Hrbaty, M.D., a plastic surgeon at LAUREA Clinic in Brno.

Updated: 2008-05-28

MUDr. Josef Hrbatý

Discussion to topic

Shortystoys7  |  visitor  |  California
  • 4 answers
I need this done Ian in allot of pain
Maya Aesthetic  |  Basic member  |  Médecine esthétique  |  Istanbul
  • 37 answers
We are sorry to hear that.
please provide us with your contact information and we will find a solution as soon as possible.
Shortystoys7  |  visitor  |  California
  • 4 answers
I am 5.0 and 40d
Dr. Jiménez Toribio Plastic Surgeon  |  Basic member  |  Plastic surgery  |  Santo Domingo
  • 600 answers
Hi, How you doing!

Please, Please send me your photos, on the right and left and back.

Dr. Jimenez Toribio
Dr. Serban Porumb  |  Basic member  |  Oradea
  • 253 answers
You may send some pictures with front and sides views, and see some of our postop results, to our clinic web page, Estetis Clinic. You will receive more detailed information from there.

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