Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight, from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman breast feeding feel extremely self-conscious.

Breast reduction, technically known as reduction mammaplasty, is designed for such women. The surgical procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better shaped breasts in proportion with the rest of her body.

The best candidates for breast reduction

Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort.

The best candidates are those who are mature enough to fully understand the surgical procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.

All surgery carries some uncertainty and risk
Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia.

Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.

The surgical procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples.

Future breast feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)