Introduction When it comes to the breasts, many women dream of having breasts as big as watermelons and think they would be happier if this dream would come true. However, the reality is that it is very difficult to be happy when the size of the breasts is excessive, whether the breasts are natural or made by the hands of a talented plastic surgeon. This is the reason why so many celebrities who had plastic surgery and got big implants end up having revision surgery to get smaller implants. Day-to-day life with excessively large breasts is a constant struggle. Moreover, there are issues associated with having overly large breasts that are known only to women dealing with this issue. In this article, we will discuss the only solution to reduce the size of the breasts and also whether it should be performed with liposuction or not. When you know you need a breast reduction Breast reduction is a procedure developed to help women with an excess of glandular tissue to get a more proportionate size of the breasts. There are multiple discomforts associated with the excessive size of the breasts, such as: – Difficulties in breathing when sleeping on the back or when performing certain physical activities. There are activities normal and simple for anyone, but they can be associated with pain and discomfort for women with overly large breasts. For example, when running or jogging even short distances, women can find themselves with a shortness of breath that is caused by the pressure put by the breasts on the lungs. – Dermatological conditions on the inframammary fold When the volume of the breasts is normal and the breasts are in a normal position on the chest wall, most of the glandular tissue should be positioned over the inframammary fold. There must be good air flow on the inframammary fold, and this only happens when the breasts are of a normal size and not affected by breast ptosis. However, when the breasts are excessively large, the early onset of breast ptosis is almost a given. This means that the breasts will be sagging on the chest wall, even on patients who are rather young. When the majority of the breast tissue is under the inframammary fold, it means that there is an almost complete lack of proper oxygenation here. Hence, dermatological conditions can occur that can be difficult and even impossible to treat exactly because the area is never completely dry. – Damage on the spine and an abnormal body posture It is common for women suffering from an overdevelopment of the mammary gland starting from their teen years to develop an abnormal body posture. This body posture is characterized by the pulling of the shoulders to the front in an attempt to hide the breasts, arching the spine. Kyphosis and scoliosis are often associated with overly large breasts, especially if they occur early in the patient’s life. We have patients as young as 12 years old suffering from breast hypertrophy. If the hypertrophy is severe and not corrected in time, it can lead to permanent deformations of the spine that might be irreversible. This means that the damage that can occur on the spine might be difficult or impossible to correct later on in life. This is why it is important to see a plastic surgeon as soon as possible if the breasts are excessively large. – Difficulties in finding clothing and supportive bras While this issue might seem trivial compared to permanent deformation on the spine, it can be a rather significant discomfort, considering the fact that women deal with this problem every day. Finding clothes that actually fit without looking baggy or making the person look like she is severely obese is a real struggle when it comes to overly large breasts. Also, finding a good bra that could actually support excessively large breasts is an adventure in itself, if at all possible. Breast reduction addresses women who suffer from an excessive size of the breasts. The procedure is performed with the patient under general anesthesia, so the comfort and lack of pain is ensured during the operation. Moreover, the patient can get rid of the excess glandular tissue and get more proportionate breasts in a matter of a few hours, depending on the complexity of each case. Each breast reduction surgery is different and customized to resolve the needs of each patient. Some patients will want to get a full C bra cup, while others will be happy even with a D after undergoing breast reduction surgery. It is important for the plastic surgeon-patient communication to be effective, open, and honest so the patient can get her expectations out of this surgery. The hospitalization period is of a few hours, and if no complications occur, patients are discharged from the hospital on the same day. The recovery period is about two weeks. There is not a lot of pain associated with the recovery after breast reduction surgery; however, to minimize the risks and to accelerate the healing process, patients are advised to avoid smoking and sleeping on the tummy for a minimum of three weeks post-op and also to not lift any heavy objects for about four weeks post-op. When you know you need lipo with breast reduction There are patients confronted with breast hypertrophy and breast ptosis that come to our office in the hopes of getting onlu liposuction that will correct the issues of the breasts. There are also patients who understand that breast reduction surgery is necessary but also think they need liposuction. It is important for everyone to understand that in the case of overly large breasts, it is almost never the case that their volume is mainly fat. Generally speaking, the overdevelopment of the breasts is caused by an overdevelopment of glandular tissue. In other words, patients have an excess of glandular tissue and not of fat. And because the surplus is glandular tissue, it can’t be removed with liposuction, and it needs to be removed during a breast reduction procedure. Liposuction can only be performed when we are talking about an excess of adipose tissue. It is rare that liposuction is performed on the breasts. However, if the patient desires a more considerable improvement of the body at the same time, the plastic surgeon might recommend getting liposuction on the sides of the body starting with the axilla and up to the flanks, on the abdominal wall, and even on the back. Because women with overly large breasts find it difficult and even painful to exercise, it is not uncommon for them to be confronted with unwanted adipose tissue in different areas of the body. These adipose tissues can be successfully addressed with liposuction during breast reduction surgery. When liposuction is performed on the sides, abdominal wall, and the back, the upper part of the body might look completely changed and improved when the final results occur. Patients should know that after undergoing breast reduction with lipo, it is mandatory to wear a girdle or compression garments on the areas treated with liposuction, as well as the special post-op bra. The compression clothing is important to help reduce the swelling that can naturally occur after a surgical trauma and refine the results furthermore. Keep in mind that there are multiple benefits associated with undergoing combined procedures, including reduced costs. Conclusion Breast reduction surgery is the only efficient and safe method to reduce the size of overly large breasts. Breast hypertrophy or gigantomastia is due to the overdevelopment of the glandular tissue. This means that the patient doesn’t have overly large breasts not because there is a lot of fat in the breasts, but because there is a considerable amount of glandular tissue. This is the reason why the breasts are not reduced considerably when the patient loses weight. Breast reduction can be performed on one or both breasts, and also as a stand-alone procedure or with other procedures such as liposuction. In some cases, the plastic surgeon might recommend liposuction on the tummy, back, and sides to create a more beautiful overall appearance of the body after the procedure. However, liposuction is usually not performed on the breasts.