Breast Reduction

A breast reduction procedure surgically creates smaller, lighter and firmer breasts by removing fat, glandular tissue and skin from the breast. Incisions will be placed around the areola, extending from the areola down to the breast crease. This surgery achieves a breast size in proportion with your body and alleviates a variety of medical problems associated with large, pendulous breasts.


Breast reduction reduces your breast size and reshapes your breast and removes extra skin and breast tissue while lifting your nipple/areola. Breast reduction surgery not only resizes the breast, but it reshapes the breast, so they are proportionate with your body and relieve your symptoms. If you have back pain, neck pain, grooving in your shoulders, rashes under your breasts, difficulty finding bras that fit, and difficulty with everyday activities then breast reduction surgery can help you. Breast reduction is as known as reduction mammoplasty.

Breast Reduction Etiology

Large breasts often run in the family but other factors such as pregnancy and obesity may contribute to large breasts. In addition to being large, the breasts may be uneven in size or have large nipple/areolas. Large breasts not only cause physical symptoms, can often cause emotional distress and self-consciousness as well.

Breast Reduction Candidates

Beast reduction patients usually seek surgical correction for their large breasts after they have tried to manage the physical symptoms with conservative treatment. Many patients experience back pain, neck pain, shoulder grooving from bra straps, skin rashes, difficulty breathing when lying flat, and poor posture resulting in numbness. Breast reduction patients may also have difficulty finding clothes that fit properly and may have trouble exercising from their large breasts. Good candidates for surgery are healthy, don’t have severe obesity, don’t smoke, have a normal mammogram, and have realistic expectations. Breast reduction candidates should consider couple of things before they proceed with surgery such as the scars after surgery, the fact that they may lose sensation in the breast or nipple/areola complex, and that they may not be able to breastfeed after surgery. Discuss future plans to become pregnant with Dr. DiFrancesco, as pregnancy may change your results.

Breast Reduction Consultation

During your consultation, Dr. DiFrancesco will evaluate the current shape and size of your breasts, the quality of your breast tissue, and the skin envelope and the placement of your nipple/ areola complex. You will discuss your expectations after your breast reduction procedure. Breast reduction will reduce the size of the breast as well as lift the breast and shape it.

Breast Reduction Surgery

Breast reduction surgery is typically an outpatient procedure and performed under general anesthesia. Breast reduction can be performed through several different incisions and with different types of pedicles. During your consultation, Dr. DiFrancesco will discuss which breast reduction technique is right for you.

Wise Pattern Breast Reduction

Wise pattern, commonly known as an anchor incision, describes an incision which borders the areola, extends vertically to the inframammary fold, and horizontally along the inframammary fold. Wise pattern breast reduction can be used with several different types of pedicles. A pedicle describes the blood flow to the nipple areola. The wise pattern breast reduction is usually used in patients with very large breasts or patients who have severe sagging or ptosis of their breasts were the nipple/ areola needs to be moved superiorly.

Wise Pattern Breast Reduction- Inferior Pedicle

The inferior pedicle is one of the most common used today. The inferior pedicle breast reduction has the greatest chance of preserving sensation to the nipple/areola complex and breastfeeding after breast reduction.

Wise Pattern Breast Reduction-Superior Pedicle

The superior pedicle breast reduction is for patients with smaller volume breast reductions. The superior pedicle has a more reliable blood supply compared to the inferior pedicle.

Wise Pattern Breast Reduction- Superomedial Pedicle

This breast reduction procedure combines the advantages of using the inferior pedicle and the superior pedicle. The superomedial breast reduction avoids the boxy appearance of the breast and long-term bottoming out seen with other techniques. Dr. DiFrancesco uses this technique for very large breasts or breasts with a lot of loose skin. The wise pattern superomedial pedicle gives the best shape and size with long term results.

Wise Pattern Breast Reduction- Other Pedicles

There are many different types of breast reduction pedicles including bi-pedicle, lateral pedicle, medial pedicle, and superolateral pedicle.

Vertical Breast Reduction

A vertical breast reduction describes a technique which uses a lollipop incision which borders the nipple/areola and extends vertically to the inframammary fold. The vertical breast reduction is optimal for small breast volumes in patients with good quality skin.

Vertical Breast Reduction-Superior Pedicle

The superior pedicle was first popularized in France. This technique is great for smaller volume breast reductions with good quality skin. The scarring is minimal with the lollipop scar.

Vertical Breast Reduction-Superomedial pedicle

This technique with popularized in Canada and allows larger breast reductions to be performed with a minimal scar. The superomedial pedicle breast reduction technique avoids the long-term bottoming out seen with other techniques and gives the breast a superior shape with a lot of upper pole fullness. Dr. DiFrancesco often combines this technique with liposuction of the lateral breast and axilla to correct the under-arm fullness present with large breasts. The final scarring is the lollipop scar.

Horizontal Breast Reduction

The horizontal breast reduction uses a horizontal incision along the inframammary fold and an incision bordering the nipple/areola complex. There is no vertical incision as seen used in the wise pattern and vertical breast reductions. Horizontal breast reductions use an inferiorly based pedicle. This technique is used with patients who have very loose skin. The disadvantage of the horizontal breast reduction is it leaves the breasts with a boxy appearance.

Massive Weight Loss Patients- Breast Reduction

Massive weight loss patients often have very loose skin and deflated breast tissue. A wise pattern breast reduction technique is used to address to lose skin and shape the breast. In patients with weight loss greater than 75 pounds, they may lose the fullness in the upper pole of their breast. An implant may be needed to restore the cleavage as breast tissue alone may not be enough.

Liposuction- Breast Reduction

Liposuction is best when combined with another breast reduction technique. It is commonly used to contour the lateral breast and axilla to prevent that “side boob” patients complaint of. Liposuction alone will remove breast tissue making the breast smaller, but it cannot shape the breast. Therefore, the breasts are left sagging.

Free Nipple Graft Breast Reduction

Breast Reduction with free nipple graft is for patients with a very large breasts and a very low nipple/areola complex. The pedicle would be too long for reliable blood flow and the nipple/areola complex will not survive. The solution is to remove the nipple/areola and reposition it on the breast mound after it has been reduced and shaped. The result will be a smaller, perkier breast. This technique may cause some hypopigmentation in the nipple /areola complex and will eliminate the ability to breastfeed. The free nipple graft may be the only safe technique for breast reduction in our morbidly obese and very large breasted patients.

Breast Reduction FAQ

Who is a good candidate for breast reduction?Healthy women between he ages of 18 and 65 may benefit from breast reduction surgery.
How do I get insurance to cover the procedure?Not all insurance policies cover breast reduction, to ensure your policy does check with your insurance company to see if they cover the breast reduction code or CPT code 19318.
My insurance company covers breast reduction, what next?Your insurance company will require their criteria of medical necessity is met before they pre authorize your breast reduction. This criteria may include a note from your primary care doctor stating your procedure is medically necessary, back or neck pain caused from large breasts.
How do I move forward with a breast reduction?Schedule a consultation with Dr. DiFrancesco -a board certified plastic surgeon today!
What is the recovery like?Most patients feel immediate relief from their symptoms of back and neck pain. They return to everyday activities in 1 to 2 weeks and return to the gym in 4 to 6 weeeks.

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