Patients with overly large breasts that cause back pain and dermatological condition at the level of the inframammary fold usually want to have the breast reduction procedure done as soon as possible so they can get relief from the pain and discomfort. But is it recommended to have the intervention performed before or after having kids?The disadvantages of having overly large breastsJust like very small breasts, overly large breasts can have negative effects on the emotional condition of the patient, creating complexes and frustration. If women with small breasts are led to believe that pills, creams, and massages might create an augmentation (although this is just myth and false advertising), there is not much to be done about overly large breasts. No physical exercises, diets or creams can reduce the volume of your breasts. Of course, if you lose a considerable amount of weight, your breasts might lose volume too, but the skin envelope will be just as big and sagging on the chest.Due to their weight, the breasts put pressure on the spine, hence affecting the patient’s posture and causing back, neck and shoulder pain, sometimes on a daily basis. Moreover, it can be very difficult to find suitable clothing and lingerie that will offer you much-needed support.It is not uncommon for patients with overly large breasts to experience recurring dermatological condition such as rashes, irritation, and inflammation at the level of the inframammary fold due to the lack of air flow in the area. The breast reduction procedure is the only method offered by plastic surgery that will provide relief from the pain.About the breast reduction surgeryReduction mammoplasty is a surgical intervention performed under general anesthesia. Aside from the obvious aesthetic benefits, it can provide comfort for patients confronted with back and neck pain, difficulty in breathing, among other things. The procedure can take up to two or three hours, depending on the complexity of each case and the desired shape of the breasts that need to be achieved.The intervention can start with the plastic surgeon performing an anchor-shaped incision that will follow the natural contours of the breasts. According to the pre-operative marks, the plastic surgeon will excise the surplus skin and the nipple and areola are moved to a more elevated position. The mammary gland is detached from the pectoral muscle, and the excess glandular tissue and fat is removed as well. The breasts are fixed into the new position with sutures. With the help of liposuction, the plastic surgeon can also eliminate the adipose tissue at the level of the axilla to provide an improved aesthetic result.The scars after breast reduction are around the areola, vertically towards the inframammary fold and horizontally in the inframammary fold. Hospitalization can be necessary for a period of 24-48 hours during which antibiotics will be administered. It is important to wear the elastic bandages and a supportive sports bra as your breasts will be swollen and need the additional support.Breast reduction and pregnancyBecause this procedure can be performed on very young patients due to the nature of the discomfort and health issues associated with it, we need to answer the question as to when it would be a good time to have it. The general recommendation is to wait until you are done having kids before scheduling your breast reduction procedure. The reasons behind this indication are several.First, we need to mention the aesthetic results. These can be negatively impacted if a new pregnancy occurs as the breast’s skin envelope will stretch again to accommodate enlarged breasts that are caused by the milk ducts preparing for lactation. Once breastfeeding is over, the patient might find herself in the situation of having what looks like deflated, sagging breasts.Then, there is also breastfeeding. As mentioned, a part of the mammary gland is excised during surgery. This means the breastfeeding ability of the patient will be reduced. If the new pregnancy occurs within a short time after the breast reduction surgery (within a year or so), the patient might not be able to breastfeed at all as the milk ducts have been sectioned or a part of them even removed. I always advise my patients to wait until they are done having children, especially if breastfeeding is important to them.However, if the discomforts caused by the overly large breasts are putting a mark on the quality of life or prevents the patient from pursuing a passion or activity, then the procedure should be performed at the earliest convenience of the patient. Of course, the condition is to wait until the mammary gland is fully developed.There is no simple answer to the question, and each patient must discuss with the plastic surgeon the characteristics and make the best decision for her. The plastic surgeon can make recommendations and suggestions, but ultimately, it is the patient’s choice when she wants to proceed with the intervention.ConclusionBreast reduction surgery can significantly improve the quality of the patient’s life by allowing her to do physical activities that otherwise be uncomfortable and alleviate back, neck and shoulder pain. Patients with overly large breasts often experience a dermatological condition that can create further discomfort.The breast reduction procedure can be performed after the breasts are fully developed, and it is recommended to avoid an ulterior pregnancy as it might alter the aesthetic results. However, if the discomforts are too much for the patient to deal with until the family is complete, the procedure can be performed before the patient has any kids. In this case, it is important to keep in mind that breastfeeding might be difficult and even impossible for some patients.