Medical Encyclopaedia › Breast reduction (short definition)
In brief: In breast reduction (reduction mammoplasty), glandular tissue, fatty tissue and skin of the breast are removed and the breast is lifted at the same time. The nipple is moved higher in the process. Many of those affected seek the procedure not for aesthetic reasons but because of physical complaints caused by very large, heavy breasts. Scars are unavoidable.
When may breast reduction be considered?
Very large breasts (macromastia) can cause neck, shoulder and back pain, grooves from bra straps, skin inflammation in the inframammary fold and limitations in sport. Psychological distress is also common. It must be clarified whether the complaints really come from the breasts or whether other causes such as posture problems or overweight predominate. Good prerequisites are a stable body weight, not smoking and an unremarkable breast examination. Depending on age, a mammogram or ultrasound is recommended beforehand. In men with enlarged breast glands, this is called gynaecomastia; its treatment is different.
Procedure and techniques
The procedure is performed under general anaesthesia and usually takes two to four hours. The nipple usually remains connected via a tissue pedicle with blood vessels and nerves and is moved upwards. Depending on the amount of tissue to be removed, the result is a scar around the areola with a vertical scar to the inframammary fold, or additionally a scar in the inframammary fold (T-incision). With very large breasts, it may be necessary to graft the nipple freely; sensation and the ability to breastfeed are then lost. Liposuction of the lateral parts of the breast is sometimes performed in addition. The removed tissue is examined histologically.
Healing and course
After the operation, a support bra is worn for several weeks. Swelling and a feeling of tightness subside within weeks; the final shape becomes apparent after a few months. Light activities are often possible again after one to two weeks, sport and heavy lifting only after medical clearance. In studies, many of those affected report significant relief of their complaints and a better quality of life. The scars remain visible but usually fade over one to two years. Weight gain, pregnancies and ageing can change the breasts again later.
Risks and complications
- wound-healing problems, especially where the incisions meet; more common in smokers and in people with diabetes or overweight
- secondary bleeding, haematomas, infections, seromas
- widened or raised scars
- reduced or altered sensation of the nipples
- circulatory disorders of the nipple or fatty tissue up to tissue loss (fat necrosis), rarely
- asymmetries and corrective procedures
- restricted or absent ability to breastfeed
- general surgical risks such as thrombosis
Costs and health insurance
Unlike many aesthetic procedures, breast reduction can be covered by German statutory health insurance if there are physical complaints. A prerequisite is an application before the operation; the insurer usually has the case assessed by the Medical Service. As a rule, proof is required that the complaints are due to breast size and that other measures such as physiotherapy, suitable bras or weight loss have not helped sufficiently. According to case law, purely psychological or aesthetic reasons are generally not sufficient. If the application is rejected, an objection is possible.
Important to know
Before deciding, there should be detailed counselling by a specialist in plastic and aesthetic surgery, questions about scar position, breast size after the procedure and the wish to breastfeed, and an appropriate time to reflect. If family planning is not complete, this should be taken into account. Alternatives are targeted back exercises, well-fitting sports and support bras and, if overweight, weight reduction.
Related terms in the encyclopaedia
Mastopexy, Augmentation mammoplasty, Gynaecomastia, Intertrigo, Back pain, Scar, Breastfeeding, Mammography, Liposuction
Sources
- Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC): Patienteninformationen zur Brustverkleinerung
- American Society of Plastic Surgeons (ASPS): Breast Reduction – Patient Information
- Sozialgesetzbuch Fünftes Buch (SGB V), § 27 Krankenbehandlung
- AWMF-S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE)
Note: This article is for general information and does not replace advice, diagnosis or treatment from a doctor, dentist or pharmacist. Last updated: October 2026.