A breast reduction (reduction mammaplasty) removes breast tissue, fat and skin to make the breasts smaller, lighter and higher. Most of Dr Kumar’s patients come for relief of neck, shoulder and back pain, and many come after major weight loss.
In short: A breast reduction removes tissue and skin, lifts the breast and moves the nipple higher, leaving a scar around the areola and down to the breast fold, often with a scar along the fold. It takes 2 to 3 hours under general anaesthetic, as a day case or with one night in hospital. Most people take about two weeks off desk-based work and are cleared for full activity at about 12 weeks. Medicare item 45523 can apply when the breasts are large for your frame and cause neck or shoulder pain. A GP referral is needed, and the first consultation is $400 with a Medicare rebate of about $88.
- Who it is for
- Am I suitable?
- Reduction or lift?
- The operation
- Recovery
- Scars and sensation
- Risks
- Cost and Medicare
- Questions
Who a breast reduction is for
Pain and discomfort. Large, heavy breasts can cause neck, shoulder and back pain, grooves from bra straps, and headaches. These are the symptoms that bring most patients to Dr Kumar, and they are what the Medicare item is designed for.
Skin and everyday life. Rashes and skin breakdown in the breast fold, difficulty exercising, and trouble finding clothes and bras that fit are common reasons too.
After major weight loss. Weight loss often leaves the breasts lower and emptier, with skin that has lost its elasticity. Women who still have large, heavy breasts are well suited to a reduction; others need a breast lift, with or without added volume. Read more about breast surgery after weight loss.
Men. Enlarged breast tissue in men is treated differently. Read about gynaecomastia and male chest surgery.
Am I suitable?
- Breasts large or heavy for your frame
- Neck, shoulder or back pain, or bra-strap grooves
- Rashes or irritation in the breast fold
- Weight stable, ideally for at least three months
- No nicotine in any form, or ready to stop: six weeks before and after surgery, eight weeks after major weight loss
- Diabetes and other conditions well controlled
- Comfortable that breastfeeding may be affected
- Realistic expectations about the scars and recovery
Dr Kumar assesses your breast size and shape, the position of the nipple, your symptoms and your general health, and explains whether a reduction suits you and whether the Medicare item is likely to apply. Breast screening should be up to date before surgery, and a mammogram or ultrasound may be arranged depending on your age and history.
Not sure whether you need a reduction or a lift?
Dr Kumar’s nursing team can review photos with Dr Kumar before you book, or you can arrange a consultation in Westmead, Penrith or Orange. A GP referral is needed.
Breast reduction or breast lift?
The difference is whether breast tissue needs to be removed, or only lifted and reshaped.
| Operation | Main aim | Volume | Medicare item when criteria are met |
|---|---|---|---|
| Breast reduction | Smaller, lighter, higher breasts | Reduced | 45523 |
| Breast lift | Lift and reshape without changing size much | Little change | 45558 |
| Breast lift with implants | Lift and add volume | Added with an implant | None |
| Breast lift with fat grafting | Lift and add modest volume | Added with your own fat | 45558 may apply to the lift |
Read more in breast lift or breast reduction?
What the operation involves
- Marking. The new position of the nipple and the incisions are marked with you standing, so that the breasts sit evenly.
- The incision pattern. A vertical (lollipop) pattern goes around the areola and down to the fold, and suits smaller reductions. An anchor (inverted T) pattern adds a scar along the fold, and suits larger reductions and most patients after major weight loss.
- Removing tissue. Under general anaesthetic, excess breast tissue, fat and skin are removed. The nipple and areola stay attached to the tissue beneath them to keep their blood supply, and are moved higher. The areola is usually made smaller.
- Shaping. The remaining tissue is shaped into a higher, rounder breast, and liposuction is used to refine the sides of the chest where needed.
- Closing. The wounds are closed in layers, drains are placed where needed, and Prineo and Micropore dressings are applied.
The tissue removed is sent to a pathologist for examination, as a routine part of the operation.
Recovery, week by week
| Time after surgery | What to expect |
|---|---|
| Day of surgery | Home the same day or the next morning. A compression garment or support bra is fitted before you leave. |
| Weeks 1 to 2 | Soreness, swelling and tightness across the chest. Walk daily and avoid lifting or reaching overhead. Sleep on your back. Drains, where used, are removed by Dr Kumar’s nurses once the drainage has settled. First review at about one week. |
| Weeks 2 to 6 | Most people return to desk-based work from about two weeks, then gradually to most everyday activities. Compression garment day and night. No heavy lifting. Drive once you can do so comfortably and safely. |
| Week 6 | Dressings and garment come off at the six-week review. Exercise is built up gradually from here. No underwire bra until Dr Kumar’s team clears you. |
| Week 12 | Most patients are cleared for full activity. |
| 3 to 12 months | Swelling settles, the breasts soften into their final shape and the scars mature. Reviews at six months and 12 months. |
Dr Kumar’s patients have ongoing contact and care from his team after surgery, with reviews at one week, six weeks, 12 weeks, six months and 12 months, and as often as needed in between. Read more about breast reduction recovery, compression garments and time off work.
Scars, sensation and breastfeeding
The scars sit around the areola and run down to the breast fold, often with a scar along the fold that is hidden under the breast. They are reddest and firmest at around three months, then soften and fade, and are pale and flat in most patients by 12 months. No nicotine, no heavy lifting for six weeks, silicone and sun protection all help. Read more about breast reduction scars.
Nipple sensation can be reduced or, less often, increased, and usually improves over months, though changes can be permanent. A breast reduction can affect the ability to breastfeed; some women breastfeed afterwards, but this cannot be guaranteed. Read about breast reduction and breastfeeding.
Risks
Every operation carries risk. Risks of a breast reduction include:
- Bleeding and haematoma
- Infection
- Delayed wound healing, often where the scars meet, and more likely with smoking or diabetes
- Thickened, widened or uneven scars
- Changes in nipple or breast sensation, which may be permanent
- Loss of part or all of the nipple and areola (rare)
- Fat necrosis (firm areas in the breast)
- Asymmetry of size, shape or nipple position
- Effects on breastfeeding
- Blood clots in the legs or lungs
- Risks of general anaesthesia
- The need for further surgery
A breast reduction is not a way of preventing breast cancer, and it changes how the breasts look on imaging, so a new baseline mammogram may be recommended afterwards and routine screening continues. Dr Kumar discusses the risks that apply to you at consultation. Read the risks and considerations of surgery.
Cost and Medicare
Fee guide: Breast reduction has a surgical and aftercare fee from $14,000. If you are self-funded, the anaesthetist is $2,600 and the hospital $2,000–$5,000, for an indicative total from $18,600. Fees include GST where it applies, and a Medicare item and your health fund can reduce what you pay. Your written, itemised quote after consultation confirms the figure. See all fees.
There are no package prices, because the cost depends on the operation, its length, the hospital and whether a Medicare item applies. After consultation you receive a written, itemised quote listing the surgeon’s fee, the anaesthetist, the surgical assistant, the hospital, garments and your aftercare, with the Medicare item numbers expected to apply.
| Medicare item | When it can apply |
|---|---|
| 45523 | Reduction of both breasts with repositioning of the nipple, for breasts that are large for your frame (macromastia) and causing pain in the neck or shoulder region, without an implant |
| 45520 | Reduction of one breast with repositioning of the nipple, after breast cancer or for a developmental abnormality of the breast |
The descriptor for item 45523 does not set a minimum weight of tissue to be removed or require physiotherapy first; whether it applies is assessed at consultation. When a Medicare item applies and your hospital cover includes plastic and reconstructive surgery, your health fund contributes to the hospital’s charges and part of the doctors’ fees, and the operation is GST-free. A reduction performed only to change appearance has no Medicare item: health funds do not contribute and GST is charged.
A deposit is paid when you book, after the cooling-off period, and the balance one month before surgery; if you book up to six months ahead, you can pay in interest-free instalments arranged directly with the practice. Breast reduction is offered in only a small number of public hospitals, with long waiting lists, so most are performed privately. Read more about breast reduction cost, Medicare for breast reduction and costs and Medicare.
Results
A breast reduction gives smaller, lighter, higher breasts, and most patients notice relief of neck and shoulder pain soon after surgery. Cup size is a goal agreed at consultation rather than a guarantee; most patients aim to come down two to three cup sizes, and the aim is proportion to your frame. The breasts can change with weight, pregnancy and age. Individual results vary. Before and after photographs of Dr Kumar’s patients are in the breast reduction gallery.
Where Dr Kumar consults and operates
Consultations are held at Westmead, Penrith and Orange. Breast reduction is performed at Westmead Private Hospital, or at Somerset Private Hospital in Kingswood as a day case. Patients from Orange and the Central West can have their follow-up in Orange. If you live a long way away, you can send photos to Dr Kumar’s team before your first appointment. Read the information for travelling patients.
Common questions
How long does a breast reduction take?
Usually 2 to 3 hours under general anaesthetic.
Will I stay in hospital?
Most patients go home the same day or the next morning.
How much time off work will I need?
About two weeks for desk-based work, longer for physical work. Most people return gradually to everyday activities over the next four weeks and are cleared for full activity at about 12 weeks.
Does Medicare cover a breast reduction?
It can. Item 45523 applies to a reduction of both breasts with repositioning of the nipple, for breasts that are large for your frame and cause neck or shoulder pain, without an implant. Whether it applies is assessed at consultation.
How much does a breast reduction cost?
It depends on the operation, the hospital and whether a Medicare item applies. You receive a written, itemised quote after consultation.
Do I need a GP referral?
Yes. A GP referral is needed to see Dr Kumar, and it also allows a Medicare rebate on the consultation.
How many cup sizes smaller will I be?
Cup size is a target agreed at consultation, not a guarantee. Most patients aim to come down two to three cup sizes. What is achievable depends on your breast dimensions, your frame and keeping the nipple’s blood supply safe.
Can I breastfeed after a breast reduction?
Some women can, but it cannot be guaranteed. If you plan to breastfeed, discuss the timing of surgery with Dr Kumar.
Where will the scars be?
Around the areola and down to the breast fold, often with a scar along the fold. They fade over 12 months or more.
When can I wear an underwire bra?
Only once Dr Kumar’s team clears you. A compression garment or support bra is worn for the first six weeks.
Can I have a breast reduction after weight loss?
Yes, once your weight has been stable for at least three months. If the breasts are low and empty rather than large, a breast lift may suit you better.
Download the breast reduction guide
Dr Kumar’s breast reduction guide covers who it suits, the operation, recovery and Medicare in more detail. You can also ask Dr Kumar’s team to call you.
Talk it through with Dr Kumar
A consultation establishes whether a breast reduction or a breast lift fits best, and whether a Medicare item applies. Dr Kumar consults in Westmead, Penrith and Orange, and a GP referral is required.
This page is intended as general information and is not a substitute for individual medical advice. All surgery carries risk, and individual results will vary. Surgical photographs on this website are intended for viewers aged 18 and over. Read more about the risks of surgery here.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
