Breast reduction surgery started as a medical procedure that was intended to offload significant pressure on the neck and back from huge breasts. The breasts ended up smaller, and often higher, without much concern for aesthetics. The surgery was long and labor intensive, and considered successful if the patient had any improvement in symptoms. This has evolved a lot in recent years.
As plastic surgery has evolved and techniques improved, we are now thankfully in a place where breast reductions can result not only in better comfort but also terrific cosmetic outcomes. I like to think of this operation as both form and function, and I always approach it with an aesthetic eye. Historically, the goal in terms of size has generally been to create something that is proportional to the patient’s frame, producing an instinctual sense of “balance.” But I have noticed lately that, as patients ask to go smaller and smaller, this middle ground is not for everybody.
In the last few years, I have had many more patients ask me to “go as small as you can.” My technique usually removes breast tissue from the sides and bottom, and moves what is left up to create cleavage. The goal is to have a projecting, or perky, breast, and a shaped silhouette. I am now seeing many women who want to go smaller than that, many of whom have already had reductions that landed in the middle, and it’s just not enough for them.
The radical breast reduction is a procedure that takes a large, often low hanging, breast, and turns it into a very small and perky one that needs little to no support, aka the “ballerina breast.” For most patients who request this, it is not a gender-affirming operation. They do not want to transform a breast into a pec, nor any nonbinary version thereof. These patients want to end up with a distinctively female breast shape, just very small and totally low-maintenance.
In most cases, getting to that point requires significant adjustments to existing surgical techniques, and the ability of the surgeon to improvise a lot. It also requires a lot of sculpting in order to get that very small shape to not come out flat or pec-looking. In some cases, patients will be told that they cannot get to that size starting from where they are, and they may be discouraged from wanting that result. While it is true that not all people can have all things, in most cases, a radical breast reduction is possible even if it is challenging.
The radical breast reduction has found me before I had a chance to find it. Patients are requesting it more and more, and it is extremely gratifying to be able to offer it to them. As a surgeon who focuses on breast surgery, and who performs many of these procedures, it is wonderful to be able to add this to my list of procedures. Seeing how happy most reduction patients are in the end also reinforces what a game changing operation this can be. And for those who really just feel like they are “over having breasts,” this can be life-defining in their everyday worlds. Even before the radical reduction came into my practice, I have often realized that “the smaller I make them, the happier they are.” This takes all of it to the next level.
