Breast surgery

Breast reduction removes some tissue, a lift changes position and shape, and implants add volume. Gynecomastia surgery in men requires a separate investigation into the cause of enlargement.

The surgeon assesses anatomy, skin and breast tissue, previous surgery and overall health. Before surgery, discuss incisions, scars, possible changes in sensation, effects on breastfeeding and realistic outcomes.

• A wish to change volumeSmall volume or loss of fullness after pregnancy, breastfeeding or weight changes can be a reason to discuss augmentation. Significant drooping may also need a lift.
• Asymmetry or changes in shapeThe surgeon assesses differences in volume, nipple position, skin quality and the realistic limits of correction.
• Physical discomfort from large breastsNeck, back and shoulder pain, rubbing beneath the breasts and difficulty with activity can be reasons to discuss reduction. Other causes of pain should also be assessed.
• Breast droopingWith weight changes, ageing or breastfeeding, skin can lose elasticity. A lift changes shape and tissue position but does not always add volume.
• Reconstruction after treatmentAfter tissue removal for cancer, the possibility and timing of reconstruction are agreed with the oncology team.
• Male breast enlargementFor gynecomastia, the cause is investigated first: glandular tissue, fat or a combination need different approaches.

The decision should be your own and informed, rather than a response to someone else's idea of the right size or shape.

Elective surgery is postponed with active infection, inflammation, a flare-up of illness, pregnancy or breastfeeding. Minors require a separate medical and legal assessment. Clotting disorders, diabetes, heart, kidney and other organ conditions, a history of cancer and medication affecting bleeding are assessed individually. Uninvestigated breast changes are checked before surgery.

Possible complications include bleeding, infection, asymmetry, changes in sensation and healing problems. For implants, capsular contracture, rupture, rare implant-associated tumours and future follow-up are discussed separately.

The surgeon takes a medical history, examines and measures the breasts, clarifies your goals and explains the techniques. The anaesthetist assesses overall health. Blood tests, ECG, ultrasound or mammography depend on age, medical history and the surgical plan; the same set is not appropriate for everyone.

The team discusses smoking, alcohol, medication and supplements in advance. Do not stop prescribed medication yourself, including drugs affecting clotting. Individual instructions cover food and drink before anaesthesia, hygiene and arrival at the clinic.