Large breasts can be painful — here's when to consider breast reduction surgery

• Breast reduction surgery can help people whose qualify of life is impacted by their breast size.
• In 2020, the average cost of a breast reduction was nearly $6,000 and insurance may not cover it.
• While rare, risks from the surgery include loss of feeling in the nipples and irregular breasts.
• Visit Insider's Health Reference library for more advice.

Breast reduction surgery, known as a reduction mammaplasty, is a surgical procedure that removes fat and tissue from the chest, resulting in smaller breasts. 

People get breast reduction for cosmetic and medical reasons, says Smita R. Ramanadham, MD, a plastic surgeon with a New Jersey practice. 

Some people with large breasts are self-conscious, have difficulty with activities like running, or have trouble finding clothes. Others have pain in their neck or back, severe bra strap grooving on their shoulders, or rashes under their breasts. 

If you're considering breast reduction surgery, here's what to expect and the side effects and risks associated with this procedure.

Who qualifies for breast reduction surgery?

"Anyone with larger breasts than what they desire qualifies for breast reduction surgery," says Jordan D. Frey, MD, a plastic surgeon with ECMC Hospital. 

It's best to do surgery after breast development has stopped, usually around 18. Most surgeons ask patients to wait until they haven't experienced any additional breast growth for at least six months, Ramanadhan says. However, in some cases where there is a medical reason like back pain, a breast reduction can be performed on teenagers, she said. 

In order to have insurance pay for the procedure, patients need to demonstrate a medical reason that has not been treated through other means like physical therapy. Even with insurance, most patients have some out-of-pocket costs. 

The average 2020 cost of a breast reduction was nearly $6,000, which does not include any of the anesthesia or hospital fees. 

What to expect during surgery

Breast reduction is typically an outpatient surgery that takes 1.5 to three hours and is performed under general anesthesia, Ramanadham says.

Before surgery, you'll talk with your doctor about your goals, including what size breasts you would like. Most people opt for breasts that are more proportional to the rest of their body, and a C cup is a popular size, says Frey. 

Pregnancy, breastfeeding and weight loss can all affect the size and shape of the breasts. Because of that, some doctors may recommend waiting until after these events to get a lasting result from breast reduction surgery. 

You'll also need a pre-operation physical and blood work to make sure that you are healthy enough for surgery, says Stafford Broumand, MD, a plastic surgeon at 740 Park Plastic Surgery. 

During surgery, an incision is made, usually on the underside of the breast. The nipple and areola are left attached in order to preserve blood flow and nerve endings, Ramanadham says. In rare cases, including reducing very large breasts, the nipple may have to be removed and reattached. 

Tissue is removed from the breast, and the breast is re-shaped and contoured by adjusting the skin around the areola. In some cases, doctors may also reshape the areola to better suit the smaller breast.

Recovery and side effects

After surgery, you'll be sent home wearing a special surgical bra and likely be on pain medication for a few days, Ramanadham says. 

"This surgery is generally very well tolerated with minimal pain or discomfort," Ramanadham says. 

Light exercise like walking are encouraged immediately, but you should avoid any heavy lifting for two weeks and can resume normal activities, like running, within six weeks. 

You'll see your doctor within one to two weeks of surgery to check up and remove drains. 

Most people will have a visible scar on their breasts at the site of insertion that should become less noticeable with time. 

"The surgery is a trade for smaller and more lifted breasts and the cost of that trade is scars on your breasts," says Frey. "For just about all of the women that I have helped with breast reduction surgery, they tell me the trade off is very well worth it."

In most cases, breast reduction does not affect the nipple or milk ducts, Broumand says, so most people who choose to can breastfeed after a reduction. 

If you hope to breastfeed, tell your doctor before surgery, since certain techniques, including leaving the nipple attached — which is the most common type of procedure these days — are less likely to interfere with lactation. 

Risks

A breast reduction has the same risks as other surgeries, including blood loss, bruising, swelling, and infection, says Broumand. 

Many people worry about losing nipple sensation, but that is very rare, especially with surgical advances designed to preserve sensation. 

There are also cosmetic risks. Some people may experience prominent scarring or asymmetrical breasts, Ramanadham says. Asymmetry is rare and only occurs in about 1% of cases. 

Other risks include:

• Damage to tissue including muscle or the lungs
• Abnormally firm breasts
• Skin discoloration
• Blood clots
• Lingering pain in the breasts

Insider's takeaway

A breast reduction is an outpatient procedure that removes tissue from the breasts, resulting in a cup size that is more proportional to a person's body. 

The procedure has some risks, including the likelihood of permanent scarring and soreness for a few weeks after the surgery. Still, doctors say that the surgery is usually a positive experience. 

"The majority of patients are thrilled after their breast reduction surgery," Ramanadham says. "They feel more confident, can do the activities and sports they like, can wear the clothes they desire, and may have improved back pain or discomfort."