Breast Reduction / Macromastia
What is Macromastia?
Macromastia, also called breast hypertrophy, occurs when a woman’s breasts are disproportionately large or heavy in relation to her body frame. This can cause a wide variety of physical issues including significant neck and back pain, poor posture, inability to exercise and difficulty with weight management. It can also contribute to psycho-social problems such as bullying, unwanted sexual attention, poor self-image, depression and many other issues.
What causes overly large breasts in adolescents?
The exact cause of macromastia in teenagers is often unknown, but it is influenced by a combination of hormonal changes during puberty, genetics, and sometimes body weight. In most cases, it occurs as an isolated condition without an underlying medical issue. Less commonly, rapid and excessive growth (known as juvenile gigantomastia) can happen shortly after the onset of puberty.
What problems can overly large breasts cause?
Patients with macromastia often experience a range of physical and emotional challenges, including:
- Chronic neck, back, and shoulder pain
- Shoulder grooving from bra straps
- Skin irritation or rashes under the breasts
- Poor posture and difficulty participating in sports or physical activities
- Limitations in finding properly fitting clothes
- Emotional distress, lowered self-esteem, and social anxiety
These symptoms can significantly impact daily life, but they are often greatly improved with appropriate treatment.
How is macromastia diagnosed in adolescents?
Diagnosis begins with a thorough physical examination by a pediatric plastic surgeon. A patient's medical history, breast development timeline, and symptoms will be reviewed. Additional laboratory or imaging tests are rarely needed unless there are unusual findings. In some cases, consultation with an endocrinologist or adolescent medicine specialist may be recommended to rule out rare hormonal causes.
What are the treatment options?
Treatment is tailored to the severity of symptoms and each patient's individual needs. Options include:
- Non-surgical management: Supportive bras, physical therapy, pain management, and weight stabilization can help milder cases, though they often provide only temporary relief.
- Surgical reduction: Breast reduction surgery is the most effective long-term solution for significant symptoms. The procedure removes excess breast tissue, fat, and skin while reshaping the breasts to a more proportionate size. The nipple and areola are typically repositioned for a natural appearance.
What is breast reduction?
Adolescent breast reduction, also known as reduction mammaplasty, is a surgical procedure designed to reduce the size and weight of overly large breasts in teenage girls. During this procedure, excess skin, fat and breast tissue is removed and the breast is reshaped to better fit the patient’s body. This nipple is often repositioned as a part of this procedure. There are several techniques that can be used depending on each individuals breast size or shape. These are often named by the scar they leave and the most common ones include:
- Vertical (“Paddle”) – Leaves a scar around the nipple and from the nipple down to the fold under the breast
- Wise (“Anchor”) – Similar scars to the vertical but with the addition of a curved scar in the fold beneath the breast
When should surgery be performed?
The ideal timing for breast reduction is when breast growth has stabilized, typically after breasts have remained the same size for at least 12 months. This often occurs in the late teens, but surgery can be considered earlier if symptoms are severe and impacting daily life. Your healthcare team will evaluate physical and emotional maturity to determine the best timing for your daughter.
What can I expect after treatment?
Recovery varies, but most adolescents do very well:
- Hospital stay: A majority of patients are able to go home the same day of surgery, though rarely a 1-night stay may be indicated.
- Postoperative care: A supportive dressing or surgical bra will be placed after surgery. Discomfort is managed with over-the counter medications and typically largely resolves within 3-4 days after surger.
- Recovery timeline: Most girls return to school in 1 week and resume full activities, including sports, in 4-6 weeks.
- Long-term results: Improved posture, reduced pain, enhanced self-confidence, and a more proportionate figure.
Regular follow-up appointments will monitor healing and breast development.
Are there any potential complications?
As with any surgery, there are risks, though serious complications are uncommon in healthy adolescents. Possible issues may include:
- Scarring (which typically fades over time and can be hidden in natural contours)
- Changes in nipple sensation
- Minor wound healing issues
- Asymmetry or need for minor revision
- Small risk of breast regrowth (more common if surgery is performed very early)
Dr. Daggett will discuss these in detail and take steps to minimize risks. The vast majority of patients experience excellent outcomes with high satisfaction.
Support and Resources for Families
Navigating macromastia can be challenging for both teens and parents. Connecting with support groups, speaking with a counselor, or consulting specialized adolescent health teams can provide valuable emotional support. You and your daughter are not alone—many families have successfully gone through this journey with positive results. Reach out to our team for compassionate, individualized guidance.
Information for Breast Reduction Patients
For breast reduction referrals, we will only take patients ages 17 1/2 years or younger. For patients older than our 17 1/2 year cut off, your doctor can refer you to an adult provider in the community.
Post-Operative Course
Day of Surgery:
- Plan to spend the first night in the hospital after your surgery. However some patients may be able to go home the same day.
- You will go home wrapped up in gauze bandaging and an Ace bandage. If the Ace becomes loose or uncomfortable, it is okay to adjust it as needed but do not remove it completely. Your breasts may look bruised and this is expected. It will resolve with time.
- You can take ibuprofen (Motrin) and acetaminophen (Tylenol) as needed for pain.
- You will need to make an appointment to be seen in the office at 1 week after your surgery. Call the office for an appointment: 865-824-4939.
Post-op Days 2-7:
- Leave dressings in place with the Ace wrap. May adjust as needed.
- Sponge baths for now.
- Sleep with head and chest elevated (wedge, recliner, etc.)
- No lifting up arms and keep activity light.
- May continue Motrin or Tylenol for pain. Most patients experience improvement in pain by day 3.
- Purchase a front zip soft bra with no underwire and bring this with you to your 1 week post-op appointment.
Follow Up Appointments and Timeline
1 week post-op appointment:
- Bring your soft front zip bra with no underwire to this appointment.
- Bandaging will be removed.
- Re-measure and take post op photos.
For the next 5 weeks:
- No underwire bras.
- May shower per usual.
- No lifting anything heavier than a gal of milk.
- You may notice skin glue feeling off and this is normal. Do not pick off the glue, just trim back the loose pieces.
- Patients with dark pigmented skin may noticed sloughing pink skin on their nipples. This is normal. The skin will return to its normal color once everything is healed.
- May lift arms and have light activity, light going for a walk or riding a stationary bike. No impact or bouncing activity (jogging, jumping jacks, etc.)
- You can go back to school. You will need to use a rolling back pack or carry 1 book at a time.
- You will come back in 5 weeks for your 6 week postop recheck.
6 week post-op appointment:
- Re-measure and take photos.
- Ensure that you are continuing to heal well.
- You may go back to all levels of activity.
- You may now wear an underwire bra.
6 month post-op appointment:
- Re-measure and take photos.
1 year post-op appointment:
This will be your last office visit. We will re-measure and take 1 last set of photos. If you are agreeable, we may ask you to sign a photo release so we can share your surgery journey in pictures with new patients.
Please know that you can always call the office for any questions or concerns: 865-824-4939.
Breast Reduction Supplies
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Front zip bra with no underwire |
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Over the counter antibiotic ointment (bacitracin) |
