Introduction Breast reduction is a surgical procedure used to reduce the volume of overly large breasts. The first procedure was performed in the 8th century as research shows, and nowadays it is one of the most commonly performed plastic surgery procedures. Breast reduction is one of the plastic surgery procedures performed not for aesthetic purposes, but also for health and functional purposes. The weight and size of the breasts can be reduced by using a variety of surgical techniques. The main differences between them are the location of the incisions, the scars that are left after the procedure, and the amount of mammary tissue that remains after the tissue in excess is removed. In this article, we will discuss some important details about breast reduction that patients should be aware of before undergoing the procedure. Purpose of breast reduction Reduction mammoplasty is the medical term used for breast reduction. The procedure improves the proportions, position, and the appearance of the breasts, contributing to the harmony of the overall body figure of the patient. Moreover, the removal of the mammary gland tissue that is in excess contributes to the improvement of the quality of life of the patient by making the symptoms associated with overly large breasts disappear and increasing mobility. It is very common for patients with excessively large breasts to be confronted with neck, back and shoulder pain due to the pressure put by the weight of the breasts on the chest. Moreover, the patient will often avoid significant movements of the upper body and to engage in physical exercises due to the burden and discomfort of having big breasts. Just like any plastic surgery procedure, it is very important for the patient to know exactly what she wants to achieve with breast reduction and her expectations to be in line with the surgical possibilities. During the pre-operative consultation, you will discuss all the details of breast reduction with the plastic surgeon, as well as your motivations to undergo surgery and what are the expected results after the procedure. Generally speaking, breast reduction is performed with the aim: – To reduce the volume of overly large breasts – To position the breasts on a natural position on the chest wall and correct mammary ptosis – To reduce the dimensions of the areola and reposition it according to the new shape and size of the breasts – To get a local symmetry and a beautiful appearance of the breasts that are proportionate to the rest of the patient’s anatomy. What to do before breast reduction surgery A respectable and responsible plastic surgeon will tell you that the preparation stage is very important for the success of your procedure and also to help you avoid unwanted complications that can occur. There are a few pre-operative medical tests that need to be taken before the procedure, such as: – Blood tests: Routine investigations that will reveal the health condition of the patient before surgery. – Mammary echography: Often recommended for patients who are young while the mammography is the preferred imagistic test for patients over 40 years old. The tests that the patient should take will be recommended by the plastic surgeon during the pre-operative consultation During this initial meeting, the plastic surgeon will also perform a medical examination to check the condition of the breast tissues. During this examination, he will evaluate the shape and size of the breasts in relation to the thorax dimensions and the ideal proportions. Also, the surgeon will palpate the breasts and the axilla to evaluate the consistency of the tissues and the potential presence of tumor formations. After this, the surgeon will evaluate the level of mammary ptosis, as well as the position and dimensions of the areolas. In a vast majority of cases, patients with overly large breasts also have enlarged areolas. The surgeon will continue the examination with checking the shape, size and position, asymmetries, and also evaluate the skin quality and tonus. If there are dermatological conditions on the inframammary fold, he will evaluate those as well. Pictures and exact measurements of the breast will be taken. Moreover, the plastic surgeon will also evaluate the overall health condition of the patient and will ask about medical history. Before leaving the consultation, you will receive a list with dos and don’ts before and after the procedure. When is breast reduction recommended? Breast reduction is a highly customized procedure, so it can’t be performed to get breasts that look like just the ones of your favorite celebrity or your friend. The plastic surgeon will take into consideration the desires and expectations when deciding what the optimal treatment plan is. Many times this procedure has medical indications, especially when the patient is confronted with daily and persistent pain on the back, neck, and shoulders. But there are also cases when the procedure is done for purely aesthetic purposes or to enhance the functionality of patients who are active in sports, for example. The ideal patient for breast reduction is a woman in good health and emotional condition, who has a weight close to normal, and doesn’t smoke or take other medications that are contraindicated for the procedure. Breast reduction surgery can be performed when: – The breasts are overly heavy and cause back, neck and shoulder pain as well as deformations of the spine and dermatological conditions on the inframammary fold, difficulties in breathing, etc. – The patient finds it difficult to get clothing that can accommodate the volume of the breasts and give them proper support. – The patient has realistic expectations from the surgery. When is breast reduction not recommended? While there are no firm contraindications to undergoing breast reduction, the procedure should be avoided or postponed if the patient is not in good health or emotional condition. Moreover, if the patient wants to have more children and breastfeed in the future, breast reduction should be postponed until after breastfeeding stops. One of the long-term consequences possible after breast reduction is difficulty or an impossibility to breastfeed. This is the reason why the recommendation is not to undergo the procedure if you want to breastfeed in the future. The incomplete development of the mammary gland is another situation when breast reduction is not recommended. While theoretically speaking the procedure can be performed on patients of any age, the advice is to wait until the breast tissues are fully developed before removing a part of the mammary gland. Otherwise, the results might be altered due to the further development of the mammary gland. Breast reduction shouldn’t be performed on patients who haven’t stopped breastfeeding or have stopped less than six months ago. After breastfeeding stops, the breasts need at least six months (preferably more) to get back to a neutral shape and size. Undergoing surgery before the breasts reach a balance is not advised as the results of the procedure might not be long-term or permanent. The procedure should also be avoided by people who are taking anti-inflammatory medication or birth control medication that can’t be stopped. The general recommendation is to stop these medications a month before the procedure or at least two weeks in advance. Conclusion Breast reduction is a procedure that is popular and commonly performed nowadays as it provides relief from the daily struggles associated with having excessively large breasts. Patients looking to undergo breast reduction should be aware of the details of the operative plan and also what needs to be done in preparation before and after the procedure. The important details about breast reduction should be discussed with the plastic surgeon during the pre-operative consultation. Make sure to ask about the surgical plan, as well as what medication to avoid before and after the procedure, and when is a good time to undergo the procedure.