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Breast Reduction Surgery: Your Guide to a Perfect Result and Recovery

This is Dr Beldholm and in this article I will discuss a range of topics related to breast reduction surgery (the other names for this procedure is reduction mammoplasty or sometimes also reduction mammaplasty, I will use these terms more or less interchangeably in this article).

Breast reduction can be a life changing operation. I see the full range of patients coming for breast reduction surgery. Every patient has a different expectation of the surgery and what result they want to achieve. The most common request that I get is to make their breasts as small as possible.

In this article we will go through a range of important topics:

  • How does medicare work and how much does the surgery cost
  • Measuring cup size
  • How do we decide on how much to remove to get you the perfect result
  • 3D imaging to show you the final result after surgery
  • How my extensive experience in breast reduction surgery makes a huge difference in the results
  • How the surgery is performed (Warning: There are some graphic photos of surgery being done by Dr Beldholm in this article.)
  • What to expect after your surgery
  • Breast Reduction cases

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Breast Reduction

This woman came in to see me for a breast reduction surgery. She was an E cup and had several issues with her big breasts. She was getting rashes under the breasts. As you can see from this photo she also had bra strap indentations and was quite uncomfortable in a bra. She also had trouble exercising. She still wanted to be in proportion and we were aiming for a C cup in size. The after photos is taken around 3 months post op. As you can see she has a very nice perky shape to the breasts. The scars are still a little bit red. I routinely do liposuction on the side of the breasts, the so called axillary tail area. You can notice that on the after photo, she is quite flat in this area which is an additional bonus.

How does Medicare work and how much does the surgery cost?

Breast reduction is covered by a Medicare item number. If you have health fund that covers you for the operation, then you will not need to pay for the hospital and you will get a rebate back for the surgical fee and the anaesthetic fee.

The item number for this operation is: 45520

You can find out more information from the Medicare Benefits Schedule ( this is part of the Australian government department of health website).

The description for this item number is:
“REDUCTION MAMMOPLASTY (unilateral) with surgical repositioning of nipple
Multiple Services Rule”

Fee: $900.45 Benefit: 75% = $675.35

Our surgical fee is: $7000 (depending on your health fund, you should get around $2000 back)

If you do not have Health cover then our all inclusive package price is (you will get a small amount of money back from medicare): $13990

You can find out more information about our pricing on our breast reduction page.

What is breast cup size and how do we measure it?

It is important to say that there is a difference between measuring the cup size for the purpose of getting a good fitting bra and for the purpose of having breast reduction surgery. There are a lot of different websites that will go through in detail how you can measure yourself. Check out the article on Bra Necessities, they have a nice little video as well showing you how to do the measure.

From a surgical point of view, it is important to realise that the same cup size across different women is not the same. So the volume difference between different women having for example an E cup can be quite significant.

This is how I measure the cup size when you come to see me for your breast reduction surgery.

Breast measurement

First I measure you in your own bra and measure across the nipples.

Breast Measurement

Second I measure you under your breasts.

I will then take the first measure minus the second measure in centimeters. I use a little table that I have developed over the years that I have found to be quite accurate.

  • A cup if you are flat
  • B cup measure more than 2.5 cm difference
  • C cup measure more than 5.1 cm difference
  • D cup measure more than 7.6 cm difference
  • DD cup measure more than 10.2 cm difference
  • E cup measure more than 12.7 cm difference
  • EE cup measure more than 15.2 cm difference
  • F cup measure more than 17.8 cm difference
  • FF cup measure more than 20.3 cm difference
  • G cup measure more than 22.9 cm difference
  • FF cup measure more than 25.4 cm difference
  • H cup measure more than 27.9 cm difference

It is important to know that after a D cup in size, the bra sizes from different manufacturers differs. For example, an F cup sized bra from one manufacturer may be equal to an EEE cup in another one.

How many grams do we need to remove to give you the cup size that you want?

Next step is to estimate how many grams of breast tissue I need to remove to give you the cup size that you want. Most women that I see for reduction mammoplasty usually want around the B or C cup in size.

In a lot of ways this is both an artform and is based on experience. However, it is important to do some initial calculations and measurements to get a starting point on how much to remove. This can than be modified with all the factors such as:

  • Where is the volume in the breast
  • How droopy are the breasts
  • How much liposuction do we need to do to get a good result
  • What pedicle is being used

I based my initial measures on an article in 2004 that I have found being very accurate.

It is quite complicated and I use a table to do this during your consultation that I have created and tweaked over the years.

Here’s an example of the process:

  • The first step is to decide what the final result should be. Let’s say that you want to be a C cup.
  • Then we count how many cup sizes down this is from your current cup size. For example, if you are currently an F cup, this means that we are reducing you by 5 cup sizes.
  • Then I use a table that tells me how many grams each cup size is in your band circumference (see the table below). For example if your band circumference under the bra is 102cm, then each cup size is 315grams and 5 cup sizes down would be 1475 grams. This is for both breasts and does not include the liposuction that I normally do.
  • The final step is to modify this according to how uneven your breasts are. For example, if one breast is a cup size bigger then we would take 315 grams more on that breast.

Table of band circumference and how much to remove for different measurements.

Under breast band circumference/Cup size difference

breast_reduction_table

3D imaging for breast reduction

I routinely do 3D imaging for my patients. This is a great tool to be able to show you the expected result. It is also helpful in refining how much to remove from each breast. However, I have found that the predicted volumes to remove using the 3D imaging is not as accurate as the method that I use above. Combining the 3D imaging with the measures that I take and based on my experience in adjusting how much we take out, I have found that I rarely get the final cup size wrong.

This video shows a comparison of the 3D result that I showed the patient in the room and her actual surgical results. As you can see, the 3D visualization is not perfect. However, it is quite good at predicting the final result. The main issue with the 3D imaging when you have really large and droopy breasts is that it struggles to recreate the breast fold as this is hidden. So many times the simulation for breast reduction surgery is not as accurate as when I do similar simulation for breast augmentation patients.

This video shows the actual before and after results for this patient. As you can see, the left breast is significantly bigger than the right and we have been able to even out her breasts remarkably. This is a 6 months post op result and you can note that there is still some redness left in the scars.

Transcript of video where Dr Beldholm is discussing breast reduction techniques

breast reduction

To be able to give you a more accurate idea of what all these terms mean I’m going to use one of my recent patients for illustrative purposes. This lady came to see me with very large breasts. She had been suffering for years with bad back ache, bra strap indentation, rashes under her breasts. The left breast is slightly bigger than her right breast and as you can see, she has a visible bra strap indentation on the left side.

There are many, many, many different ways of doing a breast reduction. The main thing that determines the result is the pedicle that we use. Where does the blood supply come to the nipple?

You can have inferior pedicle, when the blood supply comes from the bottom up. You can have a superior pedicle, where it comes from the top down, or you can have various side blood flows. You can have a medial-pedicle, you can have a lateral-pedicle, or you can have a combination of all of these.

breast reduction

In this woman, we did a superior pedicle, to give you an idea about this picture. As you are looking at it, on the left side is the head of the patient. The nipple where my arm is, is towards the belly button. The part that I’m holding with my right hand is where the blood supply comes from to the nipple. I like the superior pedicle as it preserves volume in the upper part of the breast. If you look at the before photo you can see that even though she has large breasts, there is very little volume in the upper part of her breasts. My aim is always to give you smaller breasts but still perky and a nice shape.

Now, it all depends on how far the nipple-areolar complex needs to travel. If you have a really, really low set breast, very hangy, very saggy, I usually do a medial-pedicle because that can swing the nipple-areolar way up. If you only have a little bit of distance to go, then a superior pedicle is really good because it preserves the upper fullness. The inferior pedicle is an old fashion pedicle that’s been down for many, many years, 30 years plus, and is associated with a wise pattern excision, which I’ll explain in a moment.

The inferior pedicle, the problem with that one is that all the tissue is on the bottom, so over time you actually get more sagginess. I prefer using the superior or the medial-pedicle. However, at times if you’re having a revision and you had the previous inferior-pedicle, we would go with this one for your revision surgery. 

It is all tailored made to your breasts. The excision pattern is very different from the pedicle. The first thing you decide is, how long does the nipple-areolar need to travel? Then, you do your blood supply, where does it comes from, and then you decide on how to do the excision pattern. The excision pattern just means basically how much skin you cut out and how you do it. If you get a tiny bit of skin then you really only need around the nipple straight down, if you had a lot of excess skin, then you need to cut a horizontal excess out as well.

If you have a lot of skin down the side of your breasts, then you will need an extended cut down the side. Again, it’s all tailored, custom made, it’s not cookie cutter solutions. I do this on each and every breast, it’s slightly different because everyone is different and unique. I will tailor it so that you get the best possible result and for each and every person. Sometimes, each and every person is different too, so you can have a breast that has less sagginess and more sagginess on the other side, and you do different techniques to even them out.

breast reduction

In this photo we are creating the new opening for the nipple areolar complex. I’m making strips and we de-epithelialize the area. This means that we are taking the top of the skin but leaving what is called the dermal matrix (this is where all the blood runs just deep to the skin) this preserves blood flow to the nipple.

The result you get depends on a number of factors. I decide on how much to remove based on your measurements and what type of breasts you have, and also what you want afterwards. Some women have very, very large breasts, but they want the reasonable size breast afterwards, so they’re after a D cup for example. We will decide on exactly how much to remove to get you to that cup size. Sometimes, you want less, you want a C cup or even a B cup, so the amount that we remove will depend on what you want and what breasts you have now.

I based the amount that I remove on personal experience because experience is really, really important. I’ve done a lot of breast reductions, so I can tell how much to remove from just looking at your breasts, but, I also base it on extensive research, and I have a little scale that I follow, that gives me an indication on how much to remove. I measure your breasts and that will give me your current cup size, and then I follow the scale with your height and weight and we decide on exactly how much to remove.

Now, I will adjust this based on my experience in operation to make sure that you get the result that you want.

breast reduction surgery

This show the end result after 4 hours of doing her reduction mammoplasty. Note the little plastic tubes in the middle of the picture, these are drains. All my stitching is absorbable so she will not need anything taken out. We have managed to get her quite perky and much smaller. On the initial consultation, she requested a B cup in size. Post op, she ended up with a large B to C cup and she was extremely happy with the result.

Transcript of Dr Beldholm taking about how breast reduction can reduce the risk of breast cancer

You can also find more information about this topic in one of our other blog articles:

Breast Reduction Surgery: How it Can Decrease Your Risk for Breast Cancer

If you have very large breasts, there’s also a lot of breast tissue. There are some studies showing that if you reduce the breast tissue, it will reduce the breast cancer risk. The percentage is very hard to pick because everyone’s different. Everyone gets different breast reduction amount, but there is certainly studies out there showing that you reduce your breast cancer risk by having a breast reduction.

Breast cancer screening before your reduction or any sort of breast surgery is really really important. Why? Well, when we do a breast reduction, we are rearranging everything in your breast, so we’re cutting tissue down in the bottom. We are putting the nipple areola complex higher, and we’re doing pillars that we’re stitching together, so we’re basically rearranging all the breast tissue in your breast when we’re doing a breast reduction.

What does it mean? Well, if you did have a cancer and we cut through the cancer, and then we rearranged everything around it, it would mean that we would have a very very hard time to know exactly where that cancer is. It’s better to know if you have a cancer beforehand. Deal with the cancer, and then do the breast reduction because once you’ve cut through the cancer and you’ve done a breast reduction, it basically means you need a mastectomy because we can’t be sure exactly where the cancer is located in your breast afterwards.

Now, even if you had breast cancer screening beforehand, we always send off the breast tissue. I had a recent patient just a couple of weeks ago that we did a breast reduction for, and she had screening. She had everything done beforehand. It was all clear, and when we sent off the breast tissue, she actually came back as a breast cancer and actually a poorly differentiated breast cancer, but the lucky thing in her is that we completely cut it out. She doesn’t need any more treatments. She’s being sent off for an oncologist for further opinions about chemotherapy and other things. This shows how important it is to send off the tissue because even if we do cut cancer out fully, you still need further treatment such as chemo, radiation and other treatments. It is very, very important especially if you’re approaching the 40’s plus mark where the breast cancer risk does increase.

Transcript of Dr Beldholm talking about going back to work after a reduction mammoplasty

This is Dr. Bernard Beldholm. Today we are talking about going back to exercise and work after your breast reduction surgery. What can you expect after your breast reduction? When we do a breast reduction we’re obviously removing tissue around the breast. We’re doing liposuction usually on the side of the chest wall and we’re lifting the nipple to a higher position. Your breast is going to be smaller. You’re going to be taped up after to support everything and you’re gonna have a support bra afterwards. A lot of times you stay overnight. You can go home the same day but most of my patients tend to stay overnight and they go home the next day. You will be able to have a shower the next day. It’s not gonna be that major bulky dressings. It’s gonna be just in a nice firm surgical bra and you can put on your normal clothes. It’s usually not that different from afterwards. The main difference is obviously you’re gonna be a lot smaller, so probably afterwards you’re gonna be more comfortable. If you have back pains, bra strap pains, these are going to be reduced almost immediately afterwards.

Going back to work after your breast reduction will depend on a number of factors. It obviously depends on how active at work you are, how much running around you do, if you’re doing heavy lifting, if you’re driving and that sort of thing. If you have a desk-type job, if you’re in front of the computer and not doing that much active work, you can probably go back in about a week. Remember, you do have drains after most of the time and we take the drains out usually the next day but some does a couple of days. If you really want to go back quickly to work, aim for about a week if you’re not doing too much activity at work.

If you’re doing a lot of running around, if you’re doing heavy lifting, if you’re bending over, that sort of work, then you definitely need to stay a couple of more weeks off work. You’re looking at probably about three to four weeks afterwards.

If we talk about exercise, again there’s a whole range of different exercises. There’s the mild exercises, just walking, which you can do straight after your operation pretty much. To more heavy aerobics, heavy lifting, gym exercise, squatting, that sort of thing. It’s all a range. The walking starts straightaway, running or very, very mild running or jogging you can probably start about three weeks after. From four weeks onward, you can start doing a little but more aerobic type exercise. Heavy lifting, weights, squatting, that sort of thing, leave it for a bit more longer than that so probably five to six weeks. At six weeks onward you should be good to go. Whatever you want to do. The scars will be nicely healed. You will most likely find that you’ll be a lot more comfortable than you were before your operation because you don’t have that heavy weight from the breast to contend with. A lot of women get rashes underneath when they exercise or rubbing, so this is all gone after your operation. You’ll find that in effect, you’re gonna feel a lot more comfortable doing exercise. A lot of my patients start doing a lot of more exercise because they’re more comfortable.

CASE studies to review

Surgery for uneven large breasts

Patient 3040

We showed this patient previously when demonstrating the use of 3D imaging. As with most of my patients, she came in to get her breasts reduced and also evened out. She had been thinking about having breast reduction for around 20 years.

She had many of the common symptoms for large breasts:

  • Neck pain
  • Sore back
  • Rashes under the breasts

The left breast was nearly 2 cup sizes bigger than the right breast. She was well and truly over the discomfort and wanted them made as small as possible. We talked about the different options for her. We settled on aiming to give her a B cup.

Her reduction mammoplasty went well. I removed 383 grams of breast tissue on the right side and 660 grams of breast tissue on the left side. In addition to this, we did liposuction on each side and removed 400 grams of fat in total. I put in drains and she stayed overnight in the hospital. When I saw her in the morning, there was minimal fluid in the drains so I removed these and she went home. She had 6 treatments of LED lights at our office. She has a Large B cup or small C cup depending on the bra that she uses. Her discomfort and pain from having large breasts settled almost overnight.

She was a very happy woman!

Smaller breast reductions

Patient 3039

Not everyone is the same. Most women that I see for breast reduction have large breasts and very commonly say, get me as small as possible.

However, sometimes, women come to me and say I have large and droopy breasts, and I just want them a little smaller and perkier and not so droopy anymore. This is what this patient told me.

She had been thinking about a breast reduction since 2012. She had a hysterectomy in 2012 and have noticed that she has got a lot bigger from then.

She had had a range of the usual symptoms from larger breasts:

  • Shoulder pain
  • Bra strap indentations
  • Discomfort and pain when exercising
  • Back ache
  • Skin irritation
  • Sweat rashes
  • Restricted movement

We talked about the options and what result she wanted. We were aiming for a C-D Cup in size.

I did a Medial pedicle breast reduction for her with a wise pattern skin excision. I removed

402 grams of breast tissue on the right side and 358 grams of breast tissue on the left side. I also did my routine liposuction on the breast rolls. And we removed 402 grams of fat from the right side and 358 grams of fat from the left side.

She had a successful recovery and went home on the day after surgery.

The final result is a nice perky D cup and she was very happy with this.

Very large breast reductions

Patient 3035

I commonly get women with very large breasts.

This woman has 3 grown up children in their 20’s. She had been struggling with the common symptoms from large breasts mainly shoulder and neck pain. She had a G to H cup in size but was not sure as she could not find any bras that fit her.

She wanted to go down to a C-D cup in size. She had uneven breasts and wanted this corrected as well.

I did a medial pedicle reduction mammaplasty for her. On the right side we removed 922 grams of breast tissue and on the left side we removed 758 grams of breast tissue. I removed 1 liter of fat from the side of her chest, the so called lateral breast roll. I used drains and these stayed in overnight. She spent one night in the hospital.

She had a very good result with a nice C cup and was extremely happy with this.

in conclusion

I hope that you have found this article useful about breast reduction surgery. This is one of my expert areas and if you are suffering from all the symptoms from large breasts, the surgical treatments for this are very good. The pain is minimal usually in my experience and most of the time you can get back to daily activities quickly.

Time for a consult?

Keen to book an appointment ASAP? Using our Make An Appointment Make An Appointment online booking system is simple and takes just a minute! You can also give us a call at (02) 4934 5700.

Article citations

AJ Turner, DG Dujon, “Predicting cup size after reduction mammaplasty”, British journal of plastic surgery, Volume 58, Issue 3, April 2005, Pages 290–298.