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Medications are administered for your comfort during the surgical procedure. An anesthesiologist will administer general anesthesia, which is nearly always required for this procedure.

For more information about our breast reduction procedure, please contact us online or call us at We look forward to helping you look your best.


Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin. In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction. If no skin is removed, it can take 6-12 months for the skin to retract and shrink, thus creating some lift.

The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and Dr. Alexander’s advice.

Step 1 – Marking

While you are sitting up, Dr. Alexander makes careful measurements and markings on the breast. This is arguably the most important part of the procedure, and requires skill, patience, experience, and a good eye for symmetry and detail.

Step 2 – Liposuction

After infiltrating the breast with saline tumescent solution, liposuction is performed to remove volume from the breast. In some cases, the breast is too dense, and little fatty tissue is present. In these situations, this step is skipped, and tissue is removed in the traditional fashion through the incisions in the breast skin.

Step 3 – The incision

There are three common incision patterns, depending on how low the breast sits and how much skin needs to be removed:

  1. Around the areola. This is called a “periareolar” or “donut” mastopexy. The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra. This can only be done for smaller breasts.
  2. Around the areola and vertically down from the areola to the breast crease, often referred to as a “lollipop” or “vertical” mastopexy, because it requires a vertical line. Patients often worry about this incision, but it actually heals extremely well.
  3. Around the areola, vertically down from the breast crease and horizontally along the breast crease. This is often called an “anchor incision,” or “inverted T.”

Step 4 – Removing tissue and repositioning

After the incision is made, the nipple-which remains tethered to its original blood and nerve supply-is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.

Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

Step 5 - Closing the incisions

The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.


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