Medical Indications
Breast reduction (reduction mammaplasty) is performed for both medical and cosmetic indications. Medical indications for insurance coverage typically require documentation of: chronic neck, back, or shoulder pain attributable to breast weight; skin rashes or ulceration in the inframammary fold; nerve symptoms (brachial plexopathy from strap pressure); and failure of conservative measures. Most insurance programmes in the US require removal of a minimum grams of tissue per side (typically 300–500g minimum in smaller patients) to qualify as medically necessary.
Surgical Techniques
Several reduction techniques exist, differing primarily in pattern of incision and method of nipple transposition. The inferior pedicle technique (Wise pattern) is the most widely used, providing reliable nipple blood supply via a tissue bridge from the lower breast. The vertical scar technique (Lollipop) produces less scarring at the cost of greater technical complexity. The free nipple graft technique is used for very large reductions where standard pedicles cannot reliably supply the nipple — nipple sensation and breastfeeding capacity are sacrificed in exchange for safe nipple positioning.
What Is Removed
Both glandular tissue and fat are removed, plus excess skin. The proportion varies by patient. In patients with high fat-to-gland ratios, liposuction-assisted reduction can supplement or partially replace excision. The nipple-areola complex is typically reduced in diameter and repositioned superiorly to correspond to the new breast shape.
Evidence for Outcomes
Breast reduction has some of the highest patient satisfaction rates of any elective surgery — consistently above 90% in long-term follow-up studies. Pain relief outcomes are among the most robust in plastic surgery: multiple systematic reviews demonstrate significant reduction in neck, back, and shoulder pain, headaches, and quality-of-life impairment. Breastfeeding capacity is reduced but not eliminated in most techniques.
