Introduction Women who naturally have overly large breasts usually don’t consider themselves to be incredibly lucky as some might think. Having breasts too large compared to the patient’s anatomy can be more often associated with back, neck and shoulder pain as well as other daily discomforts and not with feeling sexy and desirable. Because it can be rather difficult to find clothes that actually fit well without looking trashy or baggy, it is rarely the case that these women can enjoy their breasts. This is the reason why breast reduction surgery is performed worldwide. Each year, women from countries all over the world choose to resort to plastic surgery to get smaller breasts. The procedure is called breast reduction and is often performed with the patient under general anesthetic. The procedure can take two hours or even more, depending on the complexity of each case. In this article, we will discuss more about the operative plan of breast reduction surgery and also whether drains are used for this procedure. Breast reduction Breast reduction can only be performed after the patient has at least one meeting with the plastic surgeon to play out the procedure. As a rule of thumb, we recommend getting advice and help only from an experienced, talented board-certified plastic surgeon. This way you can maximize the results and minimize the potential complications that can occur post-op. During the consultation for breast reduction, the plastic surgeon will ask about your medical history, current medication and allergies, as well as other lifestyle habits such as smoking. It is a well-known fact that smoking can interfere with the healing process and increases the risk of developing an infection and other complications such as wound dehiscence, delayed wound healing and fat tissue necrosis. This is the reason why the general recommendation is to avoid smoking for at least three to four weeks before the procedure and at least the same amount of time after the procedure. Moreover, not smoking will increase your chances to get scars that heal well and are barely visible after the cicatrization process is completed. It is essential to tell the plastic surgeon exactly how things are and the most important details about your medical history to allow him to develop the best surgical plan for your particular case. The surgeon will ask you to stop taking birth control medication a month before the procedure and also to avoid anti-inflammatory medication as well as natural supplements for two weeks prior to undergoing breast reduction surgery. These instructions have the role of preventing the formation of blood clots after surgery and also excessive bleeding. If you are taking medication that was not discussed with the plastic surgeon during the pre-operative consultation, make sure to contact him and let him know, so there are no surprises on the operating table. The procedure is performed with the patient under general anesthesia and can last up to two hours or more. Incisions are made in different areas of the breasts. The incision type, length, and number are determined by the amount of tissue to be removed, how severe is the breast ptosis, and also the preference of the plastic surgeon. When breast reduction is performed with other procedures or as a part of the Mommy Makeover package, the procedure can last much longer, even up to six hours. This is why it is essential to have an experienced, board-certified plastic surgeon performing the procedure as it is a rather complex one. After the incisions are made, the plastic surgeon will get access to the glandular tissue and eliminate the part that is in excess. This is a very important stage of the procedure and also a very delicate one. It is essential to remove the same or similar amounts of tissue from each breast to ensure satisfactory results. At the same time, breasts are never identical. This means that the plastic surgeon must carefully estimate how much tissue to remove from each breast so the breasts will look the same after the procedure. After the glandular tissue in excess has been eliminated, the remaining mammary gland is re-centered higher on the chest wall to get a perky appearance of the breasts. Also, the plastic surgeon will re-drape the skin envelope of the breasts over the remaining glandular tissue, ensuring there is enough tension in the skin for it to be smooth and the sagginess is eliminated. When a considerable part of the mammary gland is eliminated from the breasts, the plastic surgeon might decide to use drains. This means that after the surgical incisions are sutured, drain tubes are placed on each breast, close to the incision site. The drains can be necessary to help eliminate the fluids and blood that could otherwise accumulate at the incision site and create seromas and hematomas. The risk to develop a seroma or hematoma is present after any type of surgical procedure. There are procedures where the risk is increased such as the tummy tuck, but this is not usually the case with breast reduction surgery. However, the decision to use drain tubes or not will ultimately depend on the plastic surgeon performing the procedure. It is worth mentioning that even if they are used, the drain tubes are not left in the body for more than 24 to 48 hours. During the first day or two after the procedure, there will be fluids eliminated through the tubes. When there is no longer anything coming through the drain tubes, it means it is safe to remove them. There will be a follow-up consultation with the plastic surgeon the next day or after two days. During this consultation, the plastic surgeon will assess how the healing process is going, if there are any signs of infection, and if there is anything draining through the tubes. It is important not to try to remove the drain tubes on your own as this might trigger infections. Otherwise, the risk to contract an infection when the drain tubes are inserted are minimal. Conclusion Drains can be inserted after the patient has breast reduction surgery. This doesn’t happen in all cases; however, it can happen. The need to use drains is dictated by the amount of tissue that was removed from the breasts. If the plastic surgeon eliminated a significant amount of tissue, he might decide to use drains to avoid further complications. Drains are used to allow the elimination of the blood and fluids that could otherwise accumulate at the incision site and form seromas and hematomas. Seromas and hematomas of a small size can be easily reabsorbed by the body in the weeks and months to follow. However, if the fluid or blood accumulation is considerable, the plastic surgeon will have to suggest a treatment plan for the seromas or hematomas. In some cases, a syringe can be used to remove the liquid inside. In other cases, the plastic surgeon might decide to perform a small surgical procedure to excise the blood or fluid accumulation to avoid the formation of an infection in the area. If you notice any lumps or bumps on the breasts after breast reduction surgery, make sure to let the plastic surgeon know about this.