Breast Reduction: The Complexities and Regrets
All plastic surgery procedures can have a transformative impact on a patient, and breast reduction is often among the most life-altering. "I can't find the words to express the confidence I've gained after the breast reduction," states one RealSelf reviewer. "The physical, emotional, and mental influence it has had on me is tremendous." With such feedback, it's no shock that the surgery has a 97% Worth It Rating; a study reveals that this procedure brings high patient contentment. However, there remains a small group of patients who aren't satisfied with the results – and in reality, some even end up lamenting having undergone the procedure. Despite its rarity, breast reduction regret is a genuine phenomenon.
We noticed that the majority of patients who labeled breast reduction surgery as "Not Worth It" faced some major complications – specifically, tissue necrosis of the nipple. This study of 338 breast reduction patients indicated that only one patient experienced this complication. By now, you surely understand how crucial it is to select your provider carefully, as your choice of surgeon can determine the success or failure of your procedure. "The ideal way to prevent breast reduction remorse is to visit a plastic surgeon who is board certified, conducts a significant number of these procedures, and with whom the patient feels at ease," remarks Dr. Evan Garfein, a board-certified plastic surgeon and the chief of plastic and reconstructive surgery at Montefiore Einstein Advanced Care in New York City.
That being said, there is still a portion of patients who regret breast reduction even with a safe outcome. To assist in preventing dissatisfaction with your own surgery, read on – with the assistance of three plastic surgeons, we dissect several aspects of this specialized procedure that can lead to breast reduction regret.
Breast Reduction Regret #1: Scarring
There are several distinct incision techniques employed when performing a breast reduction, with the most common ones being periareolar (around the nipple); lollipop (around the nipple, with another incision extending vertically downward from it); and an anchor incision, which is similar to the lollipop technique but includes an additional horizontal incision. According to Dr. Garfein, the incision utilized typically depends on the amount of skin that needs to be removed. "The incision pattern is often discussed in detail before the procedure, so it doesn't come as a surprise," explains Dr. Catherine Chang, a board-certified plastic surgeon in Beverly Hills, California.
How the scars turn out largely depends on patients' genetics. If you have a tendency to develop keloids, you likely are aware of this, and you have a higher risk of significant scarring after the procedure; it truly depends on chance. "I've had patients whose scars, after one year, appear thin, light in color, and hardly noticeable," says Dr. Michele Koo, a board-certified plastic surgeon in St. Louis. "I've also had patients form thick, rope-like, dark scars that itch for up to one to two years after surgery." Scars can also expand, especially with weight gain.
Breast Reduction Regret #2: Size
While it can be startling to suddenly have smaller breasts – and some patients might regret breast reduction surgery because they went too small, it's more common to regret not having gone even smaller. That said, the shock related to the size of one's new breasts after the procedure can be lessened during the consultation. "It's common and a good practice to bring pictures of your 'ideal breasts' to your plastic surgeon to avoid any misunderstandings," says Dr. Koo. "This also forces my patients to select a size and mentally prepare for their future body proportions after the surgery." Dr. Chang notes that some surgeons might also offer 3D imaging to provide patients with a better understanding of their new appearance.
The most important aspects to consider when choosing your post-procedure size are the degree of change and the proportions of the rest of your body. "Drastic changes in breast size – from very large to very small – or a mismatch in the size of the breast in relation to the patient's size are more disruptive to a patient's self-image than a more subtle change," cautions Dr. Garfein. "Whenever possible, it's better to design a reduction that keeps the breasts in harmony with the rest of the patient's body." Working closely with your provider on a plan for your new size and shape can significantly reduce the likelihood of breast reduction regret.
Breast Reduction Regret #3: Regrowth
It's uncommon but possible: breast tissue can grow back after a breast reduction. This frequently occurs due to weight gain – if you're someone who tends to gain weight in your breasts, you might be at a higher risk of regrowth. Other causes include pregnancy (which causes hormonal changes that can prompt the breasts to increase in size) and having breast reduction surgery too early in life, before your breasts have completed their growth. "This is one reason to delay having a breast reduction until your weight is stable or until you've finished having children," says Dr. Garfein, although he realizes this might not be ideal for all patients.
If the breasts were to regrow, a revision might be necessary to reduce the breast and improve its shape, says Dr. Chang. While it's understandable that needing to undergo the same procedure twice could cause breast reduction regret, that doesn't mean it's not worthwhile. "Although breasts can grow back to near their original size, this does not nullify the procedure," insists Dr. Koo. "I've had a few patients come back for a second breast reduction after having children and breastfeeding. They didn't regret it the first time and definitely not the second time."
Breast Reduction Regret #4: No Improvement in Back Pain
Even less common than breast regrowth is no improvement in back pain. "I have never – and doctors rarely ever say never – had a patient claim that they didn't obtain relief from upper back pain, shoulder grooving, and neck pain," says Dr. Koo. This comes with a caveat: patients with almost immediate relief have had their breasts lifted above the inframammary fold and have removed at least 500 grams (about one pound) of tissue from each breast. Simply having lighter breasts doesn't guarantee a reduction in discomfort, says Dr. Garfein: "There are numerous reasons for back pain – large breasts are certainly not the sole reason."
However, if you have another condition causing your back pain, such as a problem with a disc in your neck or a shoulder impingement, you might not experience relief. You might also require support. "It can take time for the muscles to adjust and strengthen," says Dr. Chang. "For some, physical therapy might still be necessary after breast reduction surgery to help improve posture and strengthen certain muscles." Strength training might also be easier after the surgery. "It's the relief of the weight on your shoulders and neck that might have prevented you from going for a jog or exercising," says Dr. Koo, who discovers that this procedure typically inspires her patients to lead a healthier and more active lifestyle.
Breast Reduction Regret #5: No Change in Self-Esteem
For many, the improvement in one's mental health is the most significant advantage of undergoing a breast reduction. "The psychological boost of being able to wear a swimsuit, exercise comfortably – [even something] as simple as easily buying a bra is truly remarkable," says Dr. Koo. "The relief from sweaty rashes under the breasts on the abdomen is astonishing; the freedom of removing 2 to 10 pounds of breast tissue from your shoulders is beyond description for almost 100% of my patients." There's also the liberation from leering gazes, the value of which cannot be overemphasized for many with large breasts. Studies show that in the majority of cases, breast reduction surgery can alleviate depression and anxiety as well as enhance quality of life and self-esteem.
However, for those who have pre-existing body image issues that aren't resolved through this surgery, undergoing breast reduction can result in regret. "Pre-existing body image issues are extremely important to clarify, not only for breast surgery but for all aesthetic and reconstructive surgery," says Dr. Garfein. "It is one of the most significant duties of the plastic surgeon to explore pre-existing body image issues, as they not only won't be improved after surgery but can be unintentionally worsened by it." Your provider should spend ample time with you to not only understand what you desire from the surgery's outcome but also the primary reason for pursuing it in the first place. "If I sense that the reason can't be addressed with the surgery, I will make it a point to discuss this with the patient so that they understand that the surgery won't solve those issues," says Dr. Chang.
What to Do if You Regret Your Breast Reduction?
If you haven't undergone this surgery and are cautious about potential regret, let us stress that the majority of patients who undergo breast reduction surgery are highly satisfied with the results. In fact, the providers we interviewed for this article have almost never encountered a patient who regretted their breast reduction; don't let rare cases dissuade you from conducting your own research and finding a reputable provider with whom you can discuss your fears. "Have an honest and open conversation with your plastic surgeon to understand the limitations of the procedure," says Dr. Chang. "Therapy and coaching can be very beneficial for patients who have concerns about their expectations for the procedure." Understanding the limitations of a breast reduction and providing your provider with visual reference points for your desired outcome can also help you avoid breast reduction regret.
Those who have undergone and regret breast reduction surgery typically feel regretful around the 6- to 12-week mark, after observing the scar or breast size as the swelling subsides, says Dr. Koo. If you're regretting your choice, contact your provider immediately – but also be kind to yourself. You'll still be recovering from your procedure, and it's somewhat normal to question the decision to have plastic surgery during the recovery period, especially when you're uncomfortable. "Breast surgery typically takes six months to a year to fully heal," says Dr. Chang. "Often, patients who initially feel regretful end up being satisfied with their results once their body has had a chance to recover."
If you've fully recovered and determine that you do, in fact, regret your breast reduction, you have options. "When any patient has regrets after any cosmetic or reconstructive surgery, the most important thing for the surgeon to do is to be available to listen to the patient, provide reassurance when appropriate, and offer a revision when appropriate," says Dr. Garfein. If you decide you want to enlarge your breasts with an augmentation surgery, your breasts' weight, size, and shape should be stable for at least one year before scheduling a new procedure.
Breast augmentation after a breast reduction is not particularly common, but it's not unheard of. Dr. Koo usually sees this from patients who have lost a significant amount of weight, either through lifestyle changes or bariatric surgery; Dr. Garfein occasionally sees it from patients who feel they were overly reduced or regret their overall decision to have breast reduction. "In these patients, fat grafting is a possibility – although typically, the placement of an implant yields better cosmetic results," he says. "Having had a previous reduction should not affect the likelihood of a successful outcome for the second operation."
