Breast reduction

Female breast reduction, also known as reduction mammoplasty, is an operation to reduce the weight and volume of the breasts.

During the procedure, fat, glandular tissue and skin are removed from the breasts, which are then reshaped and the nipples repositioned.

Breast size is determined by genes, hormones, body frame and weight. For most women, breast size is proportionate to the body, but for some women the breasts are particularly large.

Breasts are sensitive to the hormone oestrogen. They can grow during adolescence or later in life after the menopause, or because of the use of hormone replacement therapy (HRT). Some women also develop a noticeable asymmetry (difference in size or shape) between their breasts.

Breast reduction surgery can help women who are unhappy with the shape, weight or droop of their breasts by making them smaller and more lifted. However, breast size alters with body weight, so your breasts may increase in size if you put on weight or become pregnant even after surgery.

Men can also have breast reduction surgery to treat enlarged breasts, known as gynaecomastia. Read more about male breast reduction.

Availability on the NHS

Availability of breast reduction surgery on the NHS can be variable depending on the policy of your local clinical commissioning group (CCG).

If breast reduction is done to improve appearance rather than for health reasons, it is not normally available on the NHS. Instead, you will need to pay for private treatment.

To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will need to have a consultation with a breast or plastic surgeon and possibly an assessment by a psychiatrist or psychologist. They will consider whether there is enough social, psychological or physical benefit to justify surgery – for example, if your breasts are causing you significant pain or mental health problems.

The final decision is usually made by a cosmetic exclusion panel of your local CCG, which will take into account the information from your assessments and review your individual case.

Read more about the availability of cosmetic surgery.

Breast reduction on the NHS

You may be considered for a breast reduction operation on the NHS if you have physical discomfort from having large breasts, such as:

• backache 
• neck pain
• skin irritation
• poor posture
• excessive sweating, rashes and skin infections under the breasts
• grooves on the shoulders from bra straps
• an inability to exercise or take part in sports

Large breasts can also cause psychological distress. Common complaints from women with large breasts include not being able to wear fashionable clothes and finding it difficult to take part in active sports. Psychological distress may also include unwanted attention or harassment, self-consciousness and depression.

Some CCGs may also have specific eligibility criteria for breast reduction on the NHS that can include the size of your breasts, your weight, whether you smoke, and whether other options – such as wearing professionally fitted bras – have been tried but have not helped.

Before having surgery

It is important to discuss your problems and options with your GP and an appropriately qualified surgeon before going ahead with a breast reduction. This will help you to get a clear idea of what changes you can expect to see and to ensure you are aware of any risks involved.

Any type of surgery carries risks. The potential complications specific to breast surgery include:

• scarring 
• unevenly shaped breasts or nipples
• wound healing problems 
• loss of nipple sensation
• being permanently unable to breastfeed

Read more about things to consider before breast reduction surgery and the risks of breast reduction surgery.

The operation

Bilateral breast reduction surgery (reduction of both breasts) takes two to four hours under general anaesthetic. You will usually need to stay in hospital for one to two nights afterwards.

There are several techniques the surgeon could use. The most appropriate method for you will depend on the size of your breasts and the desired result.

You will need to take it easy for two to six weeks while you recover from the operation, but recovery time depends on your age and general fitness. It is likely you will have sore breasts for a few weeks.

The final appearance of your breasts may not be obvious for several weeks or months after the operation.

Read more about how breast reduction surgery is performed and recovering from breast reduction surgery.