1. A Round Shape
While the concept of breast reduction often implies a simple downsizing, plastic surgeons are highly strategic in reducing the breasts to make them not only smaller but also more shapely and elevated. Dr. Chang points out that they aim to avoid creating a "widened, flattened look," which is a common issue she notices when reviewing other surgeons' breast reduction outcomes on various platforms.
"I constantly tell patients to view a breast reduction as a breast lift combined with tissue removal," remarks Dr. Amaka Nwubah, a certified plastic surgeon in Nashville, Tennessee. She emphasizes that the discomfort associated with large breasts isn't solely due to their weight but also their droopiness, or what doctors term as ptosis – the extent to which the breasts hang from the sternum. Addressing both these factors is crucial. "I typically remove excess weight from the bottom and sides of the breasts, maintaining volume at the top and middle to prevent a sunken appearance and achieve a pleasant, round shape," she states. "I also lift the breasts and nipples on the chest wall, keeping the nipple attached in most cases and simply moving it upward."
Although creating upper-pole fullness – a term used by surgeons for cleavage – is a goal in almost every breast surgery, it isn't always achievable through reduction alone, as noted by board-certified New York City plastic surgeon Dr. Melissa Doft. Creating those curves often requires firmer breast tissue, which not all women possess. The thought of adding fat or even a small implant might seem counterintuitive when the aim is to minimize the breasts, but sometimes it's the only way to achieve the push-up-bra effect many patients desire.
2. Symmetry
You've likely heard that breasts are like sisters, not twins, meaning they don't look exactly the same in all respects. And as Dr. Doft explains, "The breasts never start identically, and they won't end up being precisely the same after reduction – but the surgeon should come close." Specifically, you should anticipate leaving the operating room with breasts of the same cup size and round or oval nipples of coordinating proportions and at the same height.
See the before and after
According to Dr. Chang, "The key to a symmetrical outcome is making careful preoperative markings and being precise about both the nipple-areolar positioning and the distance between the bottom of the areola and the inframammary fold [the crease at the lower border of the breast]." She also highlights the importance of weighing the excised breast tissue to compare the amounts removed from each side. Additionally, before final sutures are placed, the surgeon should assess their work with the patient in an upright position on the surgical table to ensure the shape and size of the breasts are closely matched.
3. A Youthful Nipple-Areolar Position
During a breast reduction, each incision has a specific purpose. For instance, the cut around the nipple-areolar complex, as explained by Dr. Chang, "reduces the size of the areola and enables it to be relocated to a higher, more centralized position on the breast." Ultimately, the dimensions of the areolas should be appropriate for the breasts they rest on.
While patients sometimes have special requests for their new nipples (such as a slightly upturned position), Dr. Doft tells us that the ideal placement is "at the point of the inframammary fold, projected onto the breast" – meaning level with the breast crease. She adds that for a reduction, it's not unusual for the nipple-areola area to be slightly south of the center.
When examining before-and-after photos, "you should look at the nipple position in the lateral or side view to see if the nipple is at the most protruding part of the breast," adds Dr. Nwubah. "When looking at the breast result directly, check if the nipples appear aesthetically in a good position."
See the before and after
4. Thin, Hidden Scars
For both doctors and patients, inconspicuous scars are always a priority, regardless of the type of surgery. This is particularly true for breast reductions because the incisions are so prominent. "A good scar appearance is crucial for the overall look of the breast," says Dr. Chang. "Dark, raised, and prominent scarring can detract from even the most perfectly shaped breast reduction."
As mentioned earlier, every incision serves a surgical purpose. Surgeons make cuts around the areolas to resize and relocate the nipples. They also make a vertical slice from below the center of the areola down to the breast fold "to tighten and remove the excess skin, thereby narrowing and rounding out the breast base and allowing for a lift of the remaining tissue," explains Dr. Chang. These two incisions – around the areola and vertically through the breast – create what is known as a lollipop scar. For larger breasts, a third incision along the breast fold is often necessary to remove additional tissue. This line combines with the previous two to form an anchor pattern. When a patient's anatomy requires this more extensive procedure, "I keep the scar on the breast and do not extend it to under the arm, ensuring the bottom of the anchor is largely hidden from view," says Dr. Doft.
See the before and after
Beyond careful incision placement, Dr. Chang adds that "meticulous closures using nonreactive suture material and minimizing tension on the incision" are prerequisites for thin, nearly invisible scars. All our surgeons also manage breast reduction scars for several months postoperatively with a personalized regime of massage, silicone gels and sheets, laser treatments (to reduce redness), and occasional steroid injections to flatten raised scars.
5. Proportionality
When analyzing an "after" image, Dr. Nwubah suggests asking yourself: Is the result proportional to the patient's overall physique? "This is one of the delicate aspects of breast reduction," she adds. "The breasts should not seem disproportionate to the rest of the body."
As a final tip, Dr. Nwubah urges patients to request prospective surgeons to show long-term before-and-after photos – pictures of patients who are at least three months post-breast reduction surgery. "Be cautious not to be enticed by early, immediate post-operative results that don't reveal the true long-term appearance," she cautions.
