Introduction Having breasts that are excessively large can be a real functional, physical and psychological handicap. Due to the disproportion of the breast volume and weight in relation to their anatomy, patients frequently experience discomfort when performing physical activities, back, shoulder and neck pain, not to mention the difficulties encountered in finding suitable clothing and lingerie. Breast reduction surgery is the procedure performed with the aim of harmonizing the size and volume of the breasts with the rest of the patient’s anatomy. The procedure is a complex and difficult one, and this is why the recommendation is to have it performed only by an experienced and talented board-certified plastic surgeon in a medical facility with all the safety regulations in place. Like any other plastic surgery procedure, there is a risk of getting unsatisfactory results after breast reduction. After the procedure, the patient can be left with asymmetries or breasts that are still too big or too small. In this article, we will discuss how to avoid getting unsatisfactory results after plastic surgery, namely breasts that are too small and what can be done if this happens. Breast reduction surgery The only way to correct the excessive size and volume of the breasts is to undergo breast reduction surgery. The procedure will result in breasts that are more in line with the rest of your anatomy, smaller in size, and with a beautiful shape and a good position on the chest wall. The potential sagginess of the breasts will also be corrected. Before scheduling your breast reduction procedure, it is necessary to decide upon the most suitable plastic surgeon who will perform your procedure. After selecting the plastic surgeon, you will need to schedule a pre-operative consultation with him to allow him to examine your morphology and recommend the right surgical plan to be followed. A mammography is mandatory to be taken before the procedure for women over 40 years old while younger women can take a breast echography. This is necessary to find out if there are potential issues with the mammary gland tissue as they would need to be addressed before the surgery is performed. Another consultation with the anesthesiologist will be scheduled a few days before the procedure. Depending on the amount of mammary tissue to be excised, the surgical procedure can last up to two hours or more if it is performed with liposuction on the back and under the arms. This combination of procedures is often preferred by patients who present an excess of adipose tissue in the surrounding areas as it will maximize the results and improve the overall appearance of the patient. There are different surgical plans that can be followed when breast reduction surgery is performed. The plastic surgeon will decide upon the best surgical approach after the medical examination that takes place during the pre-operative consultation. The factors that are taken into consideration when deciding the operative plan are: – The presence of breast sagginess – The tonus and elasticity of the skin envelope of the breasts – The level of hypertrophy After the general anesthesia is administered, the plastic surgeon will make incisions. The glandular tissue that was in excess will be removed, and the remaining part of the mammary gland is remodeled to get a beautiful shape of the breasts. The excess of fat and skin tissue are also removed, and the nipple and areola complex are repositioned and their dimensions are reduced, if necessary. The incisions are then sutured and elastic dressings are applied over the operated area. The post-operative period after breast reduction surgery is not associated with intense pain and the recovery often takes less than two weeks. There are potential complications that can occur after such a complex procedure such as infections, excessive bleeding, seromas, and hematomas, among others. Keep in mind that it is essential to follow the recommendations of the plastic surgeon for pre-operative preparation and post-operative care to minimize the risks that are normally associated with breast reduction surgery. The immediate results of the procedure are visible immediately, but the final results can take up to one year to be properly assessed. How to avoid unsatisfactory results after breast reduction As soon as the procedure is done, the patient will have smaller breasts and many of the discomforts associated with overly large breasts will disappear straight away. However, the breasts will be swollen and bruised. This is normal and natural, so the patient is advised to wait before evaluating the results. Sometimes the patient will feel that the breasts are too small. Keep in mind that due to the swelling that naturally occurs, the breasts might actually look a bit bigger than they will be three months down the line when the swelling will subside completely. In order to avoid unsatisfactory results, the patient needs to make sure that she selected a board-certified experienced plastic surgeon that she can talk to openly and honestly. Also, it is important to make sure that the plastic surgeon understood what you want to achieve in terms of the final size of the breasts. Otherwise, it is possible for the plastic surgeon to deliver you with what he considers to be a satisfactory result for your particular case. Sometimes it can help to bring pictures to the pre-operative consultation to illustrate the goals you have. After such a complex procedure and having overly large breasts for many years, it is normal for the patient to feel that the breasts might be a little on the small side. When trying to assess the results, make sure that you remember the discussion you had with the plastic surgeon during the pre-operative consultation. Are the breasts the size you discussed or are they really smaller? If the breasts are indeed smaller and you want them to be a little bigger again, you can choose to undergo an additional plastic surgery procedure. What to do in case you get unsatisfactory results after breast reduction Waiting a period of at least three to six months before evaluating the results of breast reduction surgery is essential. During this time, patients might get used to the new size of the breasts and decide they are happy with it. In other cases, patients might decide they want to undergo an additional plastic surgery procedure to get the size of the breasts they desire. Even in this case, it is important to wait at least six months to allow the breasts to recover and heal from the initial surgical trauma. Ideally, the patient should wait a year before undergoing another procedure. To increase the size of the breasts after getting breasts that are too small with breast reduction surgery, the patient can opt for breast augmentation with implants. The size of the breasts is easy to estimate when using implants as they have a fixed volume. Most often, the insertion of implants will be done using the same incisions you had for breast reduction surgery, so no new scars will be left on the breasts. There are patients who choose to undergo breast implant surgery after undergoing breast reduction as it also allows for a more complex remodeling of the shape of the breasts. The only way to get upper pole fullness is by using implants with a certain profile. Conclusion Breast reduction surgery, also known under the term of reduction mammoplasty, is the only effective method to reduce the weight and volume of overly large breasts that can have a negative impact on the quality of the life of the patient. The procedure is often performed in less than two hours, but the duration of the procedure depends on the level of breast hypertrophy and mammary ptosis as well as if other procedures are performed with it or not. Getting unsatisfactory results after plastic surgery is one of the risks that are always to be considered when undergoing such a procedure, especially one as complex as breast reduction. The patient can consider the breasts to be too small after the procedure. This can be just an impression and the patient will get used to the size of the breasts in time, or the plastic surgeon might have reduced the volume with a larger quantity of tissue than discussed during the pre-operative consultation. To increase the size of the breasts again, a breast implant surgery can be performed.