Breast Reduction

A Breast Reduction is performed to both reduce the size of the breast as well as to restore a more natural, beautiful and perky shape to the breast, and restoring the nipple position to resemble a more youthful breast.

This procedure is for women who have large breasts and wish to address the following symptoms:

  • Pain that may occur in the back, neck, shoulders or the breasts themselves
  • Heaviness of the breasts that causes
    • Bra straps to dig into the shoulders
    • Difficulty sleeping or getting comfortable at night
    • The need to use arms to lift the breasts
  • Maceration or rashes of the skin under the breasts, especially in warmer weather

Alternatively women seek the procedure to improve:

  • Correct the sagging of their breasts (called breast ptosis).

A = indicates a mild degree of ptosis where the nipple sits at the fold of the breast.

B and C = indicate a more severe degree of ptosis where the nipple sits below the fold of the breast.

  • Improve the size and shape of the breast to be in proportion with the rest of their body

While patients of any age can have this surgery, it is best to wait until all breast growth has been completed.

Patients who may not be suitable for breast reduction include those:

  • Who are very overweight (especially where BMI > 35)
  • Have significant previous scars on the breast
  • Recently or are currently breast feeding
  • There is a suspicion for breast cancer
  • Have had radiation to the breast
  • Have a bleeding disorder
  • Have a lot of medical problems including diabetes
  • Are currently smoking

If you fit into the above categories it does not mean you cannot have breast reduction surgery and you are best to discuss your concerns with Dr Aggarwal.

At MODE, Dr Aggarwal will guide you through the planning of surgery and help decide which procedure is best suited to achieve your goals.

Procedure Snapshot
  • Anaesthetic: GA by accredited anaesthetist
  • Time: 3 hours
  • Duration of stay: Overnight or day stay procedure
  • Hospital: Offered at a private hospital where Dr Aggarwal works
  • Medicare/Health fund rebate: Yes. A referral is required and you will need to have adequate private health insurance cover.
  • Recovery: Most people can do most things at the end of the first week. Upper body exercise is disallowed for 6 weeks and strenuous exercise for 3 months. Avoid swimming in a pool or beach for 2 weeks.
  • Results: Breast Reduction Patients are some of our most satisfied patients. The scars initially however are obvious are bright pink, and take at least 3-6 months to settle down and fade. Similarly the shape of the breast can look a little odd initially, but it settles into its final shape over 3-6 months. It is important to remember this time frame and final results vary from patient to patient

Cosmetic Concerns

  • This is generally unwise – while it is easy to feel this way with your current breast size, you will regret being too small later.
  • It is important to end up with a result that is in proportion to the rest of your body.
  • From a surgical point of view, a breast reduction operation removes parts of the breast gland and fat while keeping tissues behind the nipple to maintain the blood and nerve supply to the nipple. The breast is then reshaped into a more pleasing, beautiful shape. The more tissue that is removed the more the blood supply to the nipple can be threatened – there is therefore a limit to how small we can make you, safely, during a breast reduction procedure.
  • You require a breast lift rather than a reduction.
  • Breasts deflate with weight loss and also the effects of pregnancy and breastfeeding, leading to loss of volume and shape.
  • A breast lift restores the shape of the breast while repositioning the nipples to a more appropriate position.
  • For more information please read the section of this website on Breast Lift.
  • A breast reduction is your ideal operation – read more about the procedure in this section.
  • The procedure is very similar to a breast lift, and the scars are also similar. However during the procedure parts of the breast tissue and fat are excised to achieve a reduction in volume and improvement in shape.
  • The decision of which scar will be employed depends on the amount of reduction required and the amount of loose skin that must be removed at the lower part of the breast.
  • In general Dr Aggarwal at Mode, prefers the lollipop or vertical pattern for most breast reductions. It is important to remember however that with this technique a certain amount of loose skin will initially be present at the lower part of the breast.
  • This loose skin takes up over a period of 3-6 months but in some patients it does not go away completely, and may need a minor excision down the track. If this is required a small horizontal scar will be placed in the fold of the breast and the length of this scar is less than what it would have been had the skin been excised in the first stage. Often this removal of skin can be undertaken under local anaesthesia in rooms.
  • An anchor scar is necessary for patients who require a large reduction, or require a large of amount of skin to be removed. In these patients too much loose skin would be present at the lower part of the breast if the lollipop scar was employed.
  • Dr Aggarwal will be able to guide you during the pre-operative consultation process as to which scar will be best for your breast reduction.

Procedure Information

The procedure is always performed under general anaesthesia given by an accredited anaesthetist in a fully accredited and licensed facility (usually one of the North Shore’s premier private hospitals). The procedure takes three hours and patients will be discharged either the same day or stay overnight.

  • Before any surgery on your breast Dr Aggarwal will refer you for a mammogram and ultrasound to ensure the breast is clear of any pathology.
  • A scar has to be placed on the breast to achieve a breast reduction. In general the scars can be of two different types:

Lollipop Scar (Vertical Breast Reduction Scar)

  • This incision is placed around the nipple and areola, as well as vertically down from the areola to the fold of the breast

The advantage of this scar are:

  • Allows excellent shaping of the breast, with the vertical scar allowing removal of excess skin on the breast, and allowing the breast to become more ‘perky’
  • Allows resizing the areola to a more appropriate size
  • The vertical scar takes tension off the nipple and areola reducing the chances of it widening over time

The disadvantages are few but include:

  • There can also be some redundant loose skin left at the inferior part of the breast – this takes up over the first few months and rarely needs a small revision. If it needs to be excised the scar is often shorter than it would have been had it been removed at the time of the original operation.
  • Suitable for small reductions only

Anchor scar (Wise pattern Breast Reduction Scar)

  • This incision is placed around the nipple and areola, as well as vertically down from the areola to the fold of the breast, and a horizontal incision in the fold of the breast.

The advantage of this scar are:

  • Allows excellent shaping of the breast, with the vertical and horizontal scars allowing removal of excess skin on the breast, and allowing the breast to become more ‘perky’
  • Allows resizing the areola to a more appropriate size
  • The vertical scar takes tension off the nipple and areola reducing the chances of it widening over time

The disadvantages are few but mainly that there are extra scars compared to the lollipop approaches. In general, we find that these scars heal well become more inconspicuous over time. Due to the T shaped scar, sometimes there is slower healing at the T junction.

  • In general drains are avoided during a breast reduction procedure allowing patients to go home the same day
  • The exceptions are patients:
    • Having very large reductions
    • Also having removal of old implants and capsulectomy (removal of the layer of tissue surrounding the implants)
    • On blood thinning medications
    • If unexpected bleeding or alternative situation that could increase the risk of seroma (fluid collection) is found during the operation.
  • If a drain is inserted you may need to stay in hospital overnight
  • Dr Aggarwal will place waterproof dressings over the incisions.
  • You should wear a compressive sports bra or crop top for the first 6 weeks. This helps to reduce swelling, pain and discomfort in the early post-operative period as the area heals.
  • You will be able to get the area wet after 48 hours and go back into your crop top or sports bra after your shower. You will not be allowed to swim in a pool or beach for at least 2 weeks after surgery. This could be a little longer is there are wounds that are slower to heal.
  • You will be given a script for antibiotics by Dr Aggarwal which you must continue until the box runs out
  • You will also be given pain relief medications although most patients only report minor amounts of post-operative pain that is responsive to simple oral analgesia.
  • You will not be allowed to go back home on your own – you must have someone accompany you home, and it is best to have someone look after you for the first few days as you recover. You should not drive for at least 24 hours after having an anaesthetic nor operate heavy machinery.
  • While most sedentary activities can be resumed in the first week, you must not do any exercise for the first few days after surgery that could raise your blood pressure. You will also not be allowed to do any heavy lifting or upper body exercises for the first 6 weeks.
  • Dr Aggarwal will see you a week after your procedure to inspect how the wound is healing. You will be given instructions how to look after the wound as it continues to heal. You will be able to ask questions about what you can and cannot do. Generally we will see you at 1 week, 3 weeks, 6 weeks, 3 month, 6 months and 1 year post surgery.

Risks & Complications

Every surgery carries risks, and therefore one must consider if risks outweigh the benefits for your own personal situation. If they do then the surgery may be well worth it. Dr Aggarwal will discuss the pros and cons of surgery with you during your consultation.

  • Risks of anaesthetic – there are general risks of going under an anaesthetic such as a mild stress on the heart and lungs, risk of reaction to anaesthetic drugs and risk of blotting in the legs. These risks are generally low in patients who are otherwise fit and healthy.
  • Bleeding (1-2%) – any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. If this occurs it will necessitate a return to theatre to control the bleeding.
  • Seroma (2%) – after any injury to the body the area swells. Part of the fluid that enters the area sends cells to the area that help the area heal. However excess fluid can create a fluid collection called a seroma, which can then create the risk of infection. Insertion of a drain during surgery can help reduce incidence of a seroma. Wearing compressive garments and reducing activity post-surgery also helps mitigate this risk.
  • Infection (<1%) – this is very rare. However you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.
  • Poor Wound Healing (5%) – Occasionally absorbable sutures used under the skin can be rejected by the body forming a small pustule where the suture spits out. These issues usually resolve with removing the suture and dressings.
  • Nipple compromise – this is a rare but most significant complication in a breast reduction procedure. When the breast is reshaped the aim is to keep a block of breast tissue behind the nipple intact. This block of breast tissue contains the blood supply that keeps the nipple alive as well as the nerves that supply sensation to the nipple.
    • There can be problems with the blood supply of the nipple, and if there has been previous surgery to the breast.
    • Arterial problem – this is when there is a problem with the blood coming to the nipple and it therefore turns white. This may require the nipple to be removed and placed back as a nipple graft.
    • Venous problem – this is where there is a problem with the blood returning to the body from the nipple. It gets to the nipple, and pools there therefore turning the nipple blue. This may require manoeuvres to reduce the tension on the nipple, and sometimes other adjunctive techniques to increase the blood draining from the nipple.
    • The risk of these complications are much higher in patients who smoke or who are diabetic.
  • Change in nipple sensation – a third of women preoperatively have reduced sensation to their nipples, a third have normal sensation and a third have more than normal sensation (hypersensitivity). Literature indicates that these ratios are unchanged following breast lift/reduction surgery.
    • However we believe that it is possible to reduce the sensation to the nipple following any breast surgery.
    • In most cases this should be transient and returns to normal, a process that takes up to 12 months.
  • Change in the ability to lactate or breast feed: a third of normal women (who have not had surgery) have normal ability to breast feed, a third have reduced capacity (i.e. will need to supplement their feeds with formula to their infant), and a third have no capacity to breast feed. Literature indicates that these ratios are unchanged following breast lift/reduction surgery.
    • However we believe that it is possible to reduce the ability to breast feed following any breast surgery.
    • If this is of great significance to you, you should either not have breast lift/reduction surgery or postpone it to when you have completed having your family.
  • Widening of the nipple-areola complex – this can be a problem with a periareolar mastopexy. The most effective way of preventing this complication is to place a vertical scar in addition to the scar around the nipple (lollipop) which takes the tension off the nipple and areola.
  • Asymmetrical scars – There can be a difference in how each breast behaves to the underlying implant, and can produce an asymmetry to the scars, albeit the aim is to get them as symmetrical as possible.
  • Hypertrophic or poor scars – How one’s body behaves to scarring is individual and largely genetic. Some types of skin are more prone to hypertrophic or keloid scarring, and some individuals and families are more prone to this. We will routinely advise you on how to improve the quality of scars over time. You should also discuss any history of abnormal scarring with Dr Aggarwal preoperatively.
  • Asymmetrical nipple position and shape – due to scars on the breast, and native asymmetry of every woman’s breasts there can be a difference in how each breast behaves to the surgery, and this can produce an asymmetry to the nipple size and shape, albeit the aim is to get them as symmetrical as possible.
  • Nipples too high or too low – in general at the end of a breast reduction procedure the aim will always be to have the nipples sit a little low. This is because as the breast settles, and scars relax the nipples will move up. The aim is to avoid the nipples looking too high as this can be an extremely difficult problem to correct. If long term nipples are too low this can be easily addressed though a crescenteric skin excision of skin just above the nipples, which can be performed under local in rooms.
  • Unusual breast shape – it is common for the initial shape of the breast to be unusual as lower part of the breast gland and skin is tightened making the upper part look fuller and the lower part look tight. This settles as the scars relax and the breast settles. This can take approximately 3 to 6 months.
  • Asymmetry
    • Most women’s breasts are asymmetrical
    • The aim during breast reduction is to get them more symmetrical – if required this may involve removing more tissue from one side than the other
    • However there can be small asymmetries in the final breast shape.

Procedure FAQs

  • It is advisable to obtain a referral for breast lift/reduction as it is possible to claim a Medicare rebate of approximately $73 for the consultation if you have a referral
  • It is also possible that a Medicare/Health Fund rebate may apply to you depending on what procedure you need, and having a referral allows you to claim this reducing out of pocket costs substantially.
  • You can see us at our main practice at Gordon, or at our other locations at Hornsby, Hunters Hill or Camperdown.
  • Please scroll to the bottom of the page to find out more information about these locations.
  • Any of the hospitals where Dr Aggarwal works – i.e. Sydney Adventist Hospital, SAN Day Surgery, Hunters Hill Private or Castlecrag Private hospitals
  • Cease fish oil, and other supplements such as Ginkgo, Ginseng.
  • Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.
  • If you are smoking you need to cease this well in advance of surgery as the risks of nipple compromise and poor wound healing significantly increase in smokers.
  • No but Dr Aggarwal recommends that you purchase a crop top or sports bra which you should wear for at least 6 weeks.
  • You should not wear any bras with an underwire during this period
  • You should not do any exercise that raises your blood pressure for at least 72 hours after surgery to avoid the risk of an unexpected bleed
  • Heavy upper body exercise should be avoided for 6 weeks
  • Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.
  • Not usually.
  • Occasionally we may undertake scar revision in a private hospital or under local anaesthesia in rooms. For instance this can be to remove loose skin that did not disappear completely after a vertical pattern breast lift.
  • Most patients are extremely satisfied following breast reduction surgery and will not require any additional surgery.
  • Yes
  • However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.
  • You may swim in a pool or beach after 2 weeks as this is the time it takes for the incision to heal.
  • It is best to not drive for several days and up to 1 week after surgery.
  • No
  • You will require a general anaesthetic in an accredited private hospital.
  • It is usually a day surgery procedure but you will need someone to pick you up and accompany you home after the procedure
  • If a drain is used you may need to stay overnight
  • A third of women preoperatively have reduced sensation to their nipples, a third have normal sensation and a third have more than normal sensation (hypersensitivity). Literature indicates that these ratios are unchanged following breast lift/reduction surgery.
  • However we believe that it is possible to reduce the sensation to the nipple following any breast surgery. In most cases this should be transient and returns to normal, a process that takes up to 12 months.
  • Permanent loss of sensation to the nipple is rare.
  • If this is of significant concern to you, you should not have surgery on your breast.
  • Even in the normal population (women who have not had breast surgery) up to a third of women cannot breast feed at all, and a third require additional supplementation for their infant. The remaining third of women can breast feed normally. These proportions of women are unchanged after breast lift/reduction surgery.
    • However we believe that it is possible to reduce the ability to breast feed following any breast surgery.
    • If this is of great significance to you, you should either not have breast lift/reduction surgery or postpone it to when you have completed having your family.
  • Yes
  • However the additional scarring within the breast can make breast mammogram and ultrasound more difficult to interpret by radiologists.
  • It is therefore important that prior to undergoing surgery you have imaging of the breast – it makes sure there is nothing of concern in the breast tissue, and also forms a baseline against which a post-surgery mammogram can be compared.
  • It is important for you to participate in regular screening as you would have otherwise done for breast cancer based on your age and family history, after having surgery
  • No.
  • However any tissue removed during surgery is sent for histopathological examination meaning it is examined by experts under a microscope. This is to ensure there is no evidence of suspicious pathology in that tissue.
  • Despite having preoperative imaging, it is possible for an occult breast cancer to be detected by having surgery. The rate of this is much less than 1%.
  • It is important for you to participate in regular screening as you would have otherwise done for breast cancer based on your age and family history, after having surgery
  • In Australia it is recommended for women who reach the age of 50 to undergo 2nd yearly mammography for breast cancer screening in the absence of other significant family history – if you have a strong family history you may be required to start breast cancer screening earlier
  • Minor breast reduction can be performed with liposuction alone
  • However this results in looser skin and makes the breast sag more
  • It also means that the tissue removed cannot be sent for histopathological examination
  • We therefore reserve liposuction alone for minor revisions where small adjustment of breast size may be needed to achieve symmetry.

Procedure Pricing

  • The price for breast reduction, without insurance or health fund cover, is approximately $12000-13000 all inclusive, which includes
    • Surgical fees
    • Hospital fees (additional fees apply for overnight or 2 night stay)
    • Anaesthetist fees
    • Follow up
  • A Medicare item number usually applies to breast reduction surgery, and if you have appropriate health insurance cover, the out of pocket cost reduce to around $6000-7000.
    • You must confirm with your health fund that you are covered for item number 45520
    • We cannot take responsibility for health funds rejecting claims for coverage of surgeon/anaesthetist or hospital fees.
  • Please note that the above price does not include
    • Preoperative consultation fees – which are $280 for the initial consult and $140 for additional preoperative consultations
  • Public patients
    • Please note that this is becoming increasingly more difficult to offer at public hospitals; due to extremely strict criteria which is hard to meet.
    • Only in very extreme cases can we wait list you for a public hospital procedure
    • This requires special approval via preoperative photographs from the Department of Plastic Surgery at the hospital which must then be agreed to by the Head of Surgery.
    • If approved you will be placed on a 12 month waiting list for the procedure.
    • See our section on ‘what does it mean to be a public patient’ for more information.

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Meet Dr Aggarwal

Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.

What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at two of Sydney’s most prestigious public hospital campuses (RPA and POWH/RHW), and operates privately on the North Shore.

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New Consulting Locations

In addition to our Hornsby and Camperdown locations, in 2018 we bring you:

  • Hunters Hill (Lower North Shore) – conventiently located near one of Dr Aggarwal’s operative locations at Hunters Hill Private Hospital, Hunters Hill offers the convenience of accessing Dr Aggarwal in the lower north shore.
  • Gordon (North Shore) – set to be our primary practice, our flagship rooms will be open for trading in August 2018. Follow our blog to see an update on progress.
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Consulting Locations

Gordon (Flagship)

Suite 13, Level 3, 924 Pacific Highway, Gordon NSW 2072

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Hornsby

85 Burdett St, Hornsby NSW 2077

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Camperdown

Level 2, Clinic D, Chris O’Brien Lifehouse, Camperdown NSW 2050

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Hunters Hill

Level 1, 6 Ryde Road, Hunters Hill NSW 2110

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Phone:

1300 80 9000

info@modeplasticsurgery.com.au

Suite 13, 924 Pacific Highway
Gordon NSW 2072, Australia

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