Breast reduction is also called Reduction Mammoplasty. Overly large breasts have appropriately been described as an “affliction.” Terms have been derived, ranging from macromastia to gigantomastia which may not be etymologically correct but are certainly image-conjuring.

Among the reasons for wanting the reduction include:

• Aesthetic and psychological, for instance asymmetry, unable to wear desired clothes, self-image and self-esteem.
• Due to the weight of the breasts pulling the bra straps deep into the shoulders, causing postural change and backache, reducing pleasure in physical activities, interfering with breathing.
• Hygiene: despite every effort to control moisture, skin beneath the breast becomes chronically inflamed and infected (intertrigo).

The surgical technique of reduction will depend on the situation, the amount of reduction required, the preference of the patient and the decisions of the surgeon. To the extent possible, wherever the incision is placed, the nipples and areolae will be left attached to functioning breast tissue, thereby retaining normal sensation and the potential for breast feeding.

There are a variety of incisions employed in a reduction mammoplasty and these are generally the same as those used in a breast lift:

• Anchor incision: around the areola, vertically down to the inframammary fold, then transversely under the breast within the fold.
• Lollipop incision: around the areola and vertically down the center of the breast.
• Horizontal incision: along the inframammary line.

Once access to the breast has been gained, it is a matter of skilled judgement to determine the amount of tissue to be removed, yet at the same time leaving the areola-nipple-complex (NAC) intact, though it will probably in the reconstruction of the breast be placed higher up than its pre-operative status.

The free nipple graft technique potentially allows ease of access to a larger quantity of breast tissue, but even if the graft survives (which it may not) it has lost sensitivity and function.

Liposuction is appropriate when the breast is fatty, and not much needs to be removed, and although the incisions are small, so is the quantity of substance removed.