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Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight--from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.

Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

The surgery itself takes between 2 and 3 hours under a general anesthetic. Possible complications, although rare, include loss of the nipple, infection, severe scarring, loss of nipple erectile ability and nipple numbness. Nipple numbness has been known to be permanent and this could hamper future ability to breast feed.

Postoperative discomfort is minimal. The sutures dissolve; dressings are removed in l0 to 14 days. Patients may shower and bathe in 5 to 7 days, and they may drive in 4 or 5 days. Physical activity, including lifting, must be restricted for approximately 2 weeks, and active sports for 2 to 4 weeks. Three to 4 postoperative visits are required.

Men

Breast reduction for gynecomastia allows the surgeon to remove the excess tissue that may develop in the breast in some males at puberty is usually done with an incision around the nipple. If the enlargement is diffuse it is very difficult to achieve a smooth chest so there may be some ridges at the edges of the areas resected. The use of suction lipectomy has lessened this problem. Sometimes enlarged breasts in males are a result of health or drug problems and correction of these difficulties may reverse the process.

Surgery is performed under local or general anesthesia and takes about 1 and half hours. The scar is usually made just at the areolar or in the axilla and is usually not noticeable even in someone with little hair on the chest. The dressings and drains are removed in the office after a week. Patients must be careful to avoid strenuous physical activity for about a month. Complications may include excessive scarring, hematoma formation, or infection. Patients may drive after 4 to 5 days, and lifting may be resumed after a month.