What is a breast reduction?
Reduction mammaplasty, the medical term for a breast reduction, treats macromastia: breasts so large and heavy that they cause chronic symptoms. Dr. Cat removes the excess breast tissue, fat and skin, reshapes the tissue that remains into a smaller, rounder breast, moves the nipple and areola up to the center of the new breast, and reduces an areola that has stretched. Every breast reduction is therefore also a breast lift; the difference is that volume comes out, so the breast is lighter as well as higher. Diet and exercise can shrink a breast that is mostly fat, as our post on how to reduce breast size without surgery explains, but not glandular tissue, and they cannot lift a breast that has dropped.
Symptoms a breast reduction relieves
- Back, neck and shoulder pain from the weight of the breasts, and poor posture
- Shoulder grooving from bra straps, and skin irritation or rashes in the fold under the breasts
- Difficulty exercising, sleeping comfortably and breathing freely, and clothes that never fit
- Self-consciousness about breasts out of proportion to the body, or one breast noticeably larger than the other (read about uneven breasts)
Who is a good candidate for a breast reduction?
Most of Dr. Cat's breast reduction patients have carried the weight for years. Some come after a significant weight loss with breasts that are still heavy and now low as well; some have one breast much larger than the other. Any size can qualify if the size causes you discomfort or unhappiness.
You may be a good candidate if
- Your breasts are large and heavy for your frame and cause back, neck or shoulder pain, grooving or skin irritation
- Physical activity is limited by your breasts, or you are self-conscious about their size or proportion
- One breast is significantly larger than the other and you want them balanced
- Your weight is stable, you are in good health, and you have realistic expectations
- You are not pregnant or breastfeeding, and you do not use nicotine
Not yet, or a different plan, if
- You are pregnant, breastfeeding or less than three months past weaning: Dr. Cat operates on the settled breast
- Your weight is still changing: significant weight gain after surgery can reverse the result
- You use nicotine and cannot stop; it restricts the blood supply the nipple and the incisions need
- Your breasts are low but a size you like: that is a lift rather than a reduction
- You want the reduction on the same day as a tummy tuck; Dr. Cat stages the two
Patients often arrive with a cup size in mind. Dr. Cat plans the amount removed around what you want and what your frame carries: one patient wants to be as small as she safely can, another wants lighter, perkier breasts without a dramatic change in size. Our post on going from a D cup to a B cup covers the options, and dense, glandular breasts that do not shrink with diet are the subject of our post on breast reduction for dense breasts.
Breast reduction incisions: lollipop or anchor
The pattern follows the amount of tissue coming out and the lifting the breast needs, and it decides the scar. Dr. Cat chooses the pattern that reaches the result with the least visible scarring, never a smaller one that would under-correct; our post on anchor vs lollipop breast reduction compares the two.
Vertical (lollipop) breast reduction
An incision around the areola and a vertical line down to the crease, with no incision along the fold. It suits moderate reductions with mild to moderate sagging and good skin, leaves two scars rather than three, and the vertical scar sits in the shadow beneath the breast.
Anchor (inverted-T) breast reduction
The same two incisions plus a third along the crease. It removes the most tissue and the most skin, so Dr. Cat uses it for large reductions, about three cup sizes or more, for breasts that have dropped a long way, and for the loose envelope left after major weight loss. The crease scar hides in the fold.
Areola reduction
A large breast stretches its areola, and every breast reduction reduces it with the incision that circles it, sized to the new breast. Dr. Cat also performs areola reduction on its own for patients whose breasts are the right size and position but whose areolas are wide, through an incision at the border of the pigmented skin.
How Dr. Cat does it
Dr. Cat is a board-certified plastic surgeon, trained in both head and neck surgery and plastic and reconstructive surgery, Harvard-educated and UCLA trained, and she has had breast surgery herself. Breast reduction is one of her favorite operations to perform, and she performs every step herself, from the markings to the last suture, with extreme attention to detail at each one.
Reducing, then reshaping
Under general anesthesia with a numbing solution in the breast, Dr. Cat first removes the excess fat and breast tissue, making the breast smaller, lighter and firmer. Then the sculpting: in her view creating a round shape is as important as removing volume, so the tissue that remains is shaped into a full, natural teardrop and the skin tailored over it without tension.
The lift: the nipple raised on its own blood supply
Once the size is right, the operation continues as a lift. The nipple and areola stay attached to the breast tissue and the blood vessels beneath them and move up to the center of the new breast on that tissue, which is why sensation and the ability to breastfeed are often preserved; a free nipple graft, with the nipple removed and reattached, is reserved for the very largest reductions.
Symmetry
Few women have two breasts of the same size, and in many of Dr. Cat's reduction patients the difference is large. She measures each side and removes a different amount from each so the breasts finish level; when asymmetry is the main complaint, one breast may be reduced more than the other or the smaller side only lifted, as in cases BRR-0040 and BRR-0676 below.
A minimal-scar closure
Dr. Cat is known for minimal-scar breast reduction, and the closure gets the time it needs. The incision around the areola sits at the border of the pigmented skin, where the change in color hides it; the vertical line and, when needed, the crease line are closed in meticulous layers without tension, because tension is what stretches a scar. Silicone strips start at two weeks, then silicone gel.
Surgery day: one major surgery per surgical day
A breast reduction takes about two to four hours, depending on the amount removed, under general anesthesia with a board-certified physician anesthesiologist, in Dr. Cat's QUAD A accredited surgery center on Rodeo Drive, with one major surgery scheduled that day and nothing else. You wake in a support bra that her team measures for you, with small drains that clear the fluid from the space the tissue left, and spend the first night in a plastic surgery aftercare center.
Breast reduction with other procedures
Breast reduction and lift
Patients ask whether they need a breast reduction and a lift, and a reduction already is one: the tissue is removed, then the nipple is raised, the areola reduced and the breast reshaped through the same lollipop or anchor pattern. What separates the two operations is weight: a breast that is low but a size you like needs a lift; a breast that is heavy as well as low needs a reduction, or the sag returns under its own weight. Our comparison of a breast lift vs augmentation covers the patient whose problem is emptiness rather than weight.
Revision breast reduction
Dr. Cat revises breast reductions and lifts performed elsewhere: breasts still too large or uneven, a boxy or flat shape, nipples too high or too low, areolas that stretched again, or scars that healed wide. Tissue is removed and the lift redone through an anchor incision, working through the scar tissue of the first surgery, which is why a breast reduction revision takes longer and costs more. A previous lift that did not hold, with no volume to remove, is a revision breast lift.
Mommy makeover
In a mommy makeover the breast reduction has its own surgical day. Dr. Cat never performs breast surgery on the same day as a tummy tuck: the anesthesia would be very long, and after a tummy tuck you use your arms to get out of bed, which breast surgery does not allow for two weeks.
Breast reduction recovery timeline
Here is what recovery looks like for most of Dr. Cat's breast reduction patients: little pain, a support bra, and the arms kept quiet for two weeks.
- The night of surgeryYou wake in your support bra with little pain and are up and walking within a few hours, then go to a plastic surgery aftercare center, where nurses check your drains, give your medication and see you through the first night.
- Day oneThe aftercare center brings you to our office. Dr. Cat checks the incisions and the drains and reviews the instructions with you and your caretaker. Most patients have soreness and swelling rather than pain and manage with Tylenol.
- One weekDr. Cat removes the drains. Most patients feel back to normal and are back at a desk, but the arms stay below shoulder height and there is no exercise for two weeks, however good you feel.
- Two weeksDr. Cat checks the incisions and starts silicone scar care, and the arm restriction ends. Moderate exercise such as walking or a stationary bike can begin.
- One monthDr. Cat clears most patients for vigorous exercise: jogging, aerobics and the gym.
- Two monthsThe support bra comes off after at least two months. Dr. Cat sees you at three months, when the shape is close to final.
- Four to six monthsThe tissues settle into their final shape and position and the result is fully visible. The scars keep fading for up to a year.
Results: what changes, and what can change them
The relief is physical first: the weight is gone, the shoulders unload, and posture and exercise get easier. Then the shape: a smaller, rounder, lifted breast with a proportionate areola, and the two sides matched. In Dr. Cat's experience breast reduction produces some of the most dramatic results of all breast surgeries, because the body feels better and looks in proportion, and clothes fit.
The tissue removed does not come back, but the breast can enlarge again with significant weight gain, pregnancy or hormonal changes; our post on breast growth after reduction surgery explains when and what can be done. Changes in nipple sensation usually settle over the first months; our post on lost feeling in the nipples after breast reduction covers the causes.
Risks and safety
Every surgery carries risk, and Dr. Cat would rather you understand the risks of a breast reduction clearly than hear only about results.
What can go wrong
- A fluid collection (seroma) or a blood collection (hematoma) in the first days, or infection at an incision or a drain
- Delayed healing or a small opening of the incision, most often where the vertical and crease lines meet
- Changes in nipple or breast sensation, usually temporary; rarely, partial or total loss of nipple sensation
- Loss of blood supply to part of the nipple or areola: rare, and the risk rises sharply in smokers and with very large reductions
- Firm lumps where fat lost its blood supply (fat necrosis), which usually soften over months
- A scar that heals wider, raised or darker than expected, including keloids in patients prone to them
- Asymmetry, a shape or size that needs a touch-up, and sag that returns with weight gain or pregnancy
- Difficulty breastfeeding, anesthesia risks, and a blood clot in the leg, rare and serious
How Dr. Cat reduces these risks
- Careful patient selection: a non-smoker, a stable weight, three months since breastfeeding, a review of your medical history and medications, and medical clearance and lab work
- The nipple and areola kept on their blood supply, a pattern chosen for the amount removed, and a meticulous layered closure without tension
- A gentle technique with minimal bleeding, drains for the fluid, and a support bra measured for you
- A QUAD A accredited facility, a board-certified physician anesthesiologist, and one major surgery that day
- The aftercare night, walking within hours of surgery, two weeks of arm restrictions, silicone scar care, and follow-up visits at one day, one week, two weeks, one month and three months
How much does a breast reduction cost in Beverly Hills?
Dr. Cat's surgeon's fee for a breast reduction is $50,000 to $70,000. The operating room and the board-certified physician anesthesiologist are quoted at your consultation, once Dr. Cat has examined you and set the operating time your surgery needs: operating time varies with your anatomy and with the areas treated together, so it is set by her, not by a price list. Surgeon's fees are typical ranges: a more complex case can cost more, and your fee is set at your consultation and is final only in your written quote. The quote is itemized in writing with your support bra and your follow-up visits. Where your fee lands in that range depends on the amount of tissue removed, the pattern and the asymmetry; the operating time sets the operating room quote. A revision of a breast reduction or lift performed elsewhere, with tissue removed and the lift redone through an anchor incision, is $75,000 to $79,000 in surgeon's fees; areola reduction on its own is $12,500. The first night in a plastic surgery aftercare center is arranged for every breast reduction patient.
The quote reflects one surgeon who performs every step herself, one major surgery per surgical day, a physician anesthesiologist for the whole case and an accredited facility on Rodeo Drive. Please do not fall for cheap or fast breast surgery: a reduction that left the breast boxy or the nipples too high is revised through scar tissue, at a cost above the original surgery done well. Our plastic surgery cost guides explain what a quote is made of.
Insurance, consultation fee and financing
Dr. Cat's practice does not accept insurance: a breast reduction with her is self-pay, and the office provides the paperwork to submit a claim to your insurer after surgery, without verifying coverage or billing on your behalf. A consultation with Dr. Cat is $500, or $1,500 for a revision consultation, credited in full toward your surgery. The practice partners with Cherry, its primary financing partner, and also accepts CareCredit and Alphaeon Credit; see financing and payment plans.
Your consultation with Dr. Cat
It starts with a free 15-minute discovery call with our Patient Concierge, who books your consultation. At the consultation, in person on Rodeo Drive or, for out-of-town patients, by private video consultation through OnPatient, the HIPAA-secure patient portal, Dr. Cat listens first: how much smaller you want to be, what hurts, whether you plan to breastfeed. Then she measures each breast, the nipple against the fold, the width of the areola and the difference between the two sides, and builds the plan: how much tissue comes out of each side, the lollipop or the anchor pattern, and the recovery. You leave with an itemized written quote.
