Introduction Breast reduction is a procedure that can considerably improve the quality of life for patients who have excessively large breasts that are not proportionate to the rest of their anatomy. When this procedure is performed, the patient doesn’t only achieve a reduction of breast volume but also an improvement of the contours and shape of the breasts and a better position of the breasts on the chest wall. Moreover, the emotional, physical and psychological discomfort is alleviated, and the patient will have more freedom of movement, increased functionality, and the liberty to choose whatever clothing style she prefers. Breast reduction, also known as reduction mammoplasty, can be performed at any age, but the general recommendation of responsible plastic surgeons is to wait until the breasts are fully developed. Pregnancy and breastfeeding can affect the size, shape, and consistency of the breasts. This means that if you plan to get pregnant in the future, it is important to discuss this aspect with the plastic surgeon during the pre-operative consultation. During breast reduction, a part of the mammary gland tissue is removed. Many patients want to know what the implications of this are and how is the pain after reduction mammoplasty. In this article, we will discuss how breast reduction is performed, what to expect during the recovery period, and how is the pain after the procedure. Overview Breast reduction targets women with overly large, droopy breasts to reduce and elevate the breasts to a natural position on the chest wall. Breast reduction is performed with impressive results on patients all around the world and on a daily basis. It is not a new procedure, and you should also know that in some cases the cost can even be supported by health insurance. Reduction mammoplasty can be performed as a stand-alone or combined with other procedures to improve the overall appearance of the body. Breast reduction is often performed with liposuction on the sides and the back to make the whole area look better and to eliminate the unwanted fat deposits localized on the armpits and back. At the same time, for patients who have undergone considerable weight loss, breast reduction can be performed together with a tummy tuck. This is also the case for mothers who are left with overly large breasts and a saggy tummy after one or multiple pregnancies. To achieve a good symmetry of the breasts, the plastic surgeon will measure them during the initial consultation. During the procedure, the plastic surgeon will try to correct any imperfections of the breasts, but you have to be aware of the fact that perfect symmetry is not possible and it shouldn’t be a goal of breast reduction surgery. The breasts are sisters, not twins; keep this in mind when evaluating the results. Breast reduction is performed with the patient under general anesthesia, and the incisions are positioned so the scars are around the areolas, in the inframammary fold, and on a vertical line going from the inframammary fold towards the areolas. These incisions are necessary to reposition the areola, reduce the volume of the breasts, and reshape the breasts and improve their contours so the final result is as aesthetic as possible. If the patient has excessively large breasts, the plastic surgeon might decide to completely detach the areola in order to be able to move it to an anatomically correct position on the chest. This can result in an impossibility to breastfeed and also some changes in the sensitivity of the nipple and areola complex. The procedure can take between two to four hours, depending on the complexity of each case and if combined with other procedures in the same sitting. The patient isn’t required to stay in the hospital for long after waking up. In a vast majority of cases, hospitalization is between a few hours and a maximum 24 hours. Afterwards, the patient can return home. Recovery period after breast reduction After surgery, the breasts will be swollen and bruised. Possible complications such as excessive bleeding, seroma, hematoma, infections and skin necrosis are common to other surgeries but rarely occur. The patient can also be confronted with specific complications such as changes in breast sensitivity, the impossibility to breastfeed, an unaesthetic appearance of the scars, and breast asymmetries, among others. Most patients won’t be confronted with any complications after the procedure, aside from the normal side effects commonly associated with undergoing any type of surgical procedure. When leaving the medical facility, the patient must wear a special post-op bra that is mandatory to be worn for at least a few weeks non-stop and then a few more months during the day. The breasts need special support after the procedure, so a good quality sports bra or a special post-op bra is necessary. Pain after breast reduction After surgery, the patient can experience a state of generalized weakness and even pain on the chest. The pain is mostly experienced during sudden movements or when the patient is coughing, for example. This is a normal occurrence after breast reduction. Keep in mind that the plastic surgeon has removed a part of the mammary tissue and it takes time for the tissues to heal and for the surgical trauma to be overcome. Simple analgesic medication can be used to alleviate the pain and, if necessary, the plastic surgeon can prescribe stronger pills to help you manage the pain. However, keep in mind that the stronger the pill is, it can have other side effects. The pain is mostly present during the first few days after the surgery. However, some patients can experience pain and discomfort even a few weeks after the procedure, mostly due to not following the recommendations of the plastic surgeon to the letter. It is not uncommon for patients to feel pain, changes in breast sensitivity, and swelling of the breasts during the first menstrual cycle after surgery. Don’t worry, these are symptoms that will subside gradually without additional treatment being necessary. Intense physical activity should be avoided, as well as excessive movement of the upper body and the breasts. Generally speaking, the patient is advised to avoid running, jumping, sleeping on the tummy and even sexual intercourse for at least two to three weeks after the procedure. The idea is to avoid any kind of pressure, stimulation or rubbing on the breasts for three weeks or even a month. Not following these recommendations can cause unnecessary pain that could be quite intense. Another cause of pain after breast reduction could be an infection that has occurred at the surgical site. The common signs of infection are pus coming from the incisions, high fever, swollen breasts, and intense pain. It is important for you to be aware of what are the signs of infection as this condition requires immediate treatment, otherwise life-threatening complications can occur. In the case of an infection, the pain is intense and it can feel daggers in the breasts. Make sure to contact your plastic surgeon or doctor immediately if you notice any symptoms of infection after breast reduction surgery. Conclusion Breast reduction, also known as reduction mammoplasty, is a complex and complicated surgery performed with the aim of making the breasts more proportionate to the rest of the patient’s anatomy and eliminating the discomforts associated with having excessively large breasts. Most patients interested in undergoing reduction mammoplasty are concerned with the level of pain they are going to experience after the procedure, considering the fact that a part of the mammary gland is removed. Generally speaking, the pain after breast reduction is easily alleviated with pain medication prescribed by the plastic surgeon. The pain can be present for a few days or a few weeks, depending on the patient’s commitment to follow the instructions of the plastic surgeon for post-operative care. Complications that can occur after breast reduction such as infection could trigger intense pain. Pain medication is not enough when pain is caused by an infection, and the patient should seek immediate medical help to treat the infection.