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Breast Reduction Surgery: Q&A with Dr. Joshua Fosnot

Plastic surgeon Dr. Joshua Fosnot sitting on window ledge

Sore shoulders, red marks from straining bra straps, and ill-fitting tops—having large breasts isn’t all it’s cracked up to be.

Women with large breasts often complain about these issues and more including neck and back pain. In many cases, breast reduction surgery may be the only option to correct a disproportionate bust line and relieve these discomforts. If you’re a healthy, non-smoker with large breasts and a whole lot of discomfort, this surgery might be for you.

What is a breast reduction?

Breast reduction surgery is a serious medical procedure that brings the typical risks associated with surgery, as well as some special considerations. The procedure includes a surgeon removing excess breast tissue (and preserving necessary blood supply) before lifting the remaining breast back into a natural position.

“Breast reduction surgery is a procedure that has been around for a long time because it offers a lot of benefit to patients,” explains Joshua Fosnot, MD, plastic surgeon at Penn Medicine. “Typical candidates have symptoms associated with their very large breasts, including neck or back pain, or rashes underneath the folds of their breasts.”

There are limitations to how far surgery can reduce breast size and still maintain a natural appearance. “The main goal of breast reduction is not to just change aesthetically how the patient looks, but to allow them to lead a healthier lifestyle,” explains Dr. Fosnot. “So, when people ask me what size is appropriate, I tell them that I think the answer is what's within the limits of what we can do surgically, and also one that aims for an overall balance with the rest of their body.”

Procedure and recovery

Breast reduction surgery lasts about two to three hours and is usually done as an outpatient case. Patients typically go home the same day. However, an overnight stay may be possible and will depend on the surgeon.

Following surgery, patients with have either a permanent "lollipop" scar around the nipple with a straight line down toward the crease under the breast (or a “boat anchor” scar, which also includes a scar along the lower breast fold). Initially, the scars will be red but will gradually fade over time. Pain or discomfort may linger for up to two weeks, but medications will be prescribed to manage the swelling and pain. Patients should avoid any form of heavy lifting or straining and take sufficient time off from work and other responsibilities to allow for a full recovery.

“Most patients are feeling fairly well after a week or two, and if they have a fairly sedentary job, I tell them they can probably expect go back to work two weeks after their operation,” Dr. Fosnot explains. “But if they have a physically demanding job, it might be closer to a month before they can resume their full activity.”

Breast reduction surgery side effects

For women considering breast reduction, it’s important to be aware of potential side effects associated with the surgery. Aside from the usual surgery risks of infection or undergoing general anesthesia, some women may experience scar tissue or numbness in the nipple. In fact many patients are concerned about nipple sensation. According to Dr. Fosnot, “It’s common for patients to have hyper-sensitivity in the short term, which gets better with time. It’s very rare, but possible, to completely lose nipple areolar sensation long term.”

For those of childbearing age, another common consideration is breastfeeding after surgery. The choice whether or not to breastfeed is a personal one, and it’s important to understand options before undergoing a reduction surgery.

“The data would suggest that not all women can breastfeed after reduction surgery, though not all women want to breastfeed.” Dr. Fosnot continues, “But it is possible that after a breast reduction, it could limit the patient’s ability to breastfeed.”

Breastfeeding may be negatively impacted if the surgery requires a large amount of breast tissue to be removed or the milk ducts are affected. There are many resources available for moms-to-be who undergo a breast reduction surgery and wish to breastfeed. Lactation consultants can provide more information.

Improved quality of life

Overall, women who undergo breast reduction surgery are generally very satisfied with their decision. The reduction not only improves the appearance of the breasts but also helps to improve quality of life by decreasing or eliminating shoulder, back and neck pain.

For women considering the procedure, it’s important to know that there will be scars and there is a recovery process with long-term changes. In most cases, the benefits outweigh the risks… something to consider when you’re shopping for next season’s most fashionable tops and want to feel like the best version of yourself.

In addition to breast reduction surgery, Dr. Fosnot also performs reconstructive microsurgery for cancer patients and an array of cosmetic procedures at the Plastic Surgery Philadelphia and Bryn Mawr offices.

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