Breast reduction — it removes tissue and skin and moves the nipple up, and it leaves a scar

Breast reduction removes both tissue and skin and moves the nipple and areola to a new position higher up.

It is not the opposite of breast augmentation. Augmentation places an implant; reduction takes tissue away and rearranges what is left. The difficulty and the character of the scarring are different.

The first thing to write about this operation is the scar.

Remove tissue and skin is left over. Shaping means reducing that skin, and reducing it means cutting. Where the incisions go depends on the technique.

• around the areola only — the least scarring, but limits how much can be removed
• around the areola plus a vertical line down (lollipop) — the most common
• plus a horizontal line along the fold beneath the breast (anchor) — when a lot has to come off

These scars fade but do not disappear. Unlike the other operations on this site, there is no 'inside the hairline' or 'inside the mouth' for them to hide in.

And this operation is not always performed for appearance alone. Neck, shoulder and back pain, posture, bra-strap grooving, skin problems in the fold beneath the breast can all be part of it. That judgement belongs in a consultation, and this site does not make it for you.

There will be a scar. Its length depends on the technique, but it is a line on the skin. It takes one to two years to fade, and in some people becomes a hypertrophic scar or a keloid. Then something like intralesional corticosteroid becomes a separate matter to deal with.

Breastfeeding can become difficult. The connection between the ducts and the nipple is affected differently by different techniques. If you may want to breastfeed later, say so at the consultation before anything else. It changes which technique is chosen.

Nipple and areola sensation can change — duller or more sensitive, and some of it can be permanent.

Rarely, blood supply to the nipple and areola suffers. Moved tissue that does not survive can partly necrose, and smoking raises that risk substantially.

The two sides will not come out identical, particularly if they differed to begin with.

Wounds can open where the incision lines meet.

Large weight changes change the result.

Say first whether you may want to breastfeed. It is the single piece of information that most shapes the choice of technique here. Saying it later cannot undo anything.

Ask to see the incision pattern drawn out. What 'areola only', 'plus a vertical line' and 'plus a horizontal line' each look like, and why that one is being proposed. How much comes off and how long the scar is are traded against each other.

Not smoking matters. This operation moves the nipple and areola, and blood supply decides the result. Smoking is especially dangerous here.

Do it at a stable weight. If a large weight change is coming, afterwards is better.

Wear the support bra as instructed for the weeks afterwards. It takes a direct part in how the shape settles.

Put off heavy arm use and exercise for as long as you are told.

Scar care begins once healing is done. Settle the timing and the method in consultation.

It cannot be undone. Removed tissue does not come back, and the scar stays.

Whether you can accept the scar is the central question of this operation. Unlike the facial operations on this site, there is nowhere here for a scar to hide. People who are happy with the result still have the scar.

If you may want to breastfeed, the timing is worth rethinking. Having it after breastfeeding is an option. But this site does not decide when for you.

If functional reasons are part of it, make them explicit at the consultation. Neck and shoulder pain or postural problems can change the plan.

Breasts keep changing with age and with weight. This operation sets things once; it does not stop them.

Whether to have it is decided in consultation, and it is better not to decide from one clinic's account.