Breast reduction is a complex and major surgery as it entails the removal of excess glandular tissue, as well as the associated fat and skin tissue. The procedure is often performed with the patient under general anesthesia and can take up to five hours, especially if it is combined with liposuction. When seeing the plastic surgeon for the first time, many patients ask how difficult breast reduction surgery is. It is important for the plastic surgeon to answer this question and also to give the full details of the operative plan to be followed to help the patient better understand what to expect. Breast reduction surgery starts with the plastic surgeon making incisions on the breasts. The incisions can have different shapes depending on the technique used by the plastic surgeon and the amount of glandular tissue to be removed. Generally speaking, an incision will be positioned around the areola, another one vertically from the areola to the fold under the breasts, and another one in the fold under the breasts. Using these incisions, the plastic surgeon will detach the skin and fat tissue from the breasts and then eliminate the excess of mammary gland tissue. This is a delicate part of the procedure, especially if the amount of tissue to be removed is larger than the part of mammary gland that will remain. This means that the plastic surgeon should pay special attention when making the excision to preserve the symmetry of the breasts. This is why it is important to have an experienced, board-certified plastic surgeon to perform your breast reduction. Otherwise, asymmetries can occur. If this is the case, a revision procedure should be performed to correct the asymmetry. After the removal of the excess of the mammary gland, the plastic surgeon will re-center the mammary gland to a natural position on the chest wall as often, overly large breasts also suffer from a certain level of breast ptosis. After this step is completed, the plastic surgeon will re-drape the skin on the breasts and remove the excess of skin and fat tissue. The nipple and areola complex will also be repositioned and even have their dimensions reduced if the patient had enlarged areolas. When the procedure is completed, the breasts should have approximately the same volume, with the nipple and areola complex in harmony with the rest of the breasts and in a good position on the chest wall. Breast reduction surgery is quite a difficult procedure. Some might say it is one of the most difficult, if not the most complex one because it affects the breasts that are an important part of a woman’s anatomy. Moreover, the procedure is difficult also because there are two breasts to be operated on and the results need to reflect symmetry.