La Jolla / San Diego Cosmetic Surgeon Dr. Tom Pousti Talks About Breast Reduction & Downsizing: Reduction Mammoplasty

Breast Reduction Surgery Description

Breast reduction is designed to improve the appearance and symptoms of overly large breasts by reducing their size and reshaping them. The surgery is specifically designed to relieve symptoms of pain and discomfort in the breasts, shoulders, neck and upper back. Juvenile breast reduction is also an excellent procedure for teens experiencing breast hypertrophy.

New developments in breast reduction surgery include the limited incision techniques, including the LeJour technique and the use of liposculpture for artistic shaping of the breast.

Before and After: Breast Reduction


The Surgical Procedure

The procedure takes approximately 3-5 hours. Breast reduction surgery is performed in an outpatient surgical facility. Breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin  this operation reduces AND lifts the breasts to a higher position on the chest wall (in other words, the breasts are “automatically” lifted when a breast reduction is performed). By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.

Generally speaking, it is always best to achieve long-term stable weight prior to proceeding with body contouring surgery. In other words, the “ideal weight” for a specific patient is one where he/she feels comfortable long-term, and does not expect significant fluctuation to occur after the procedure.

Achieving this long-term stable weight, will increase the safety of the operation, will likely improve the outcome of the operation, and will decrease chances that additional surgery will become necessary subsequently.

What To Expect After Surgery

There is relatively little pain associated with this surgery. Some swelling will occur but usually begins to go away by the third or fourth day. Rest as much as possible for the first week. Avoid raising your arms over your head for 2 weeks.

Resumption Of Physical Activities

Driving may be resumed in 1–2 weeks after surgery if completely off of the pain medication. Sports can be resumed 3- 6 weeks, sexual activity in 2 weeks. Avoid any strenuous exercising or lifting for 3-4 weeks.

Breast Reduction Surgerical Procedure

Breast reduction surgery explained

Before Surgery

Immediately after breast reduction

2 Weeks Post-Op

4 Weeks Post-Op

Breast Reduction Markings and Measurements Prior to Surgery

Explaining markings before breast reduction surgery

Breast Reduction Surgical Procedure with Before & After

Breast Reduction Procedure with Dr. Tom Pousti

White Paper By Dr. Tom Pousti on Breast Reduction Surgery

Breast reduction surgery is one of the most patient pleasing operations performed by plastic surgeons. Patients requesting this operation have often suffered from chronic neck, back, and shoulder discomfort as well as skin irritation/rashes secondary to the very large breasts. These patients often report that the large breast size does interfere with their activities of daily living.

Like most plastic surgical procedures performed a trade-off exists between the improvement in size and positioning of the breasts (and the resulting improvement up next, back, and shoulder symptoms) versus the resulting scars, potential loss of sensation in other complications associated with breast surgery in general. Most patients who undergo this procedure are very happy to accept the trade-off with a common regret afterwards being ” I wish I had the breast reduction procedure done earlier in life”.

One of the inevitable questions that arises when discussing any type of breast surgery is the issue of resulting breast size. Every patient will have different goals; some women wish to be “as small as possible”, some women wish to achieve breast size proportionate to the remainder of their body.

In order to achieve the patient’s goals, it is critical that the plastic surgeon be able to communicate clearly with the patient. I have found that the use of words such as “natural” or “C cup” or “fake looking” or “top heavy” means different things to different people and therefore these terms prove unhelpful. Also cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. Furthermore, every patient’s chest width varies; if the patient has a wide chest wall it may not be possible to achieve a smaller width or cup size.

In my practice I use goal pictures to communicate with patients. With this technique patients are able to demonstrate what they are trying to achieve and what type of looks they do not like as well. The patient’s goal pictures are hanging on the wall in the operating, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient’s goals as consistently as possible.

Unfortunately,despite the best efforts at communication, no plastic surgeon is able to predict exactly what cup size patient’s will be after breast reduction surgery. Unfortunately, there is also no direct correlation between the amount of tissue removed and the ultimate cup size that a patient will wear after breast reduction surgery.

For the patient who presents with the desire to achieve as small as possible breast size after surgery some words of advice may be helpful. First off, it is possible to reduce the breasts size very significantly. Sometimes when this is the goal the breast reduction should be done in two stages. The concern with the amount of tissue removed is related to blood flow to the remaining tissue; if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola) may be compromised. Part of the tissue that is left in place is called the “pedicle”; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible) then patient will likely have problems with tissue survival. Doing the procedure in more than one stage allows the tissues to acclimate to the surgically decreased blood flow before further tissue removal (and potentially further decreased blood flow) occurs ( with the second stage operation).

The other concern with overly aggressive breast reduction surgery is patient dissatisfaction afterwards. It is not unusual for patients who have lived with very large breasts to want to have as much as possible removed. Care must be taken to be judicious in this removal to avoid an outcome where the breasts are too small in relation (proportionately) to the patient’s other body parts. Again, it is not uncommon, for patients’ breasts to become smaller ( after the breast reduction procedure) with time and/or weight loss- breast augmentation may become necessary to achieve the patient size.

Breast augmentation (with breast implants) is certainly possible after previous breast reduction surgery. Typically patients requesting breast implants after breast reduction surgery wish to increase the size, fullness and projection of the breasts. This situation may be brought about by over reduction during breast reduction surgery or by weight loss that occurred after the breast reduction surgery was performed.

Another commonly asked question involves insurance coverage for the breast reduction procedure. This is a possibility given that some insurance companies consider the operation “medically necessary” for patients meeting their requirements.The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. The documentation and letter/pictures from the consultant plastic surgeon will also help obtain authorization. Make sure you’re working with a well-trained/experienced board-certified plastic surgeon.

Another commonly encountered a situation involves a teenager who presents with “juvenile breast hypertrophy”. This describes the young who presents with breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for her frame causing both physical and psychological distress. For the right teenager (enough symptoms) the breast reduction procedure maybe an excellent option. However, it is very important that the young lady contemplating breast reduction surgery does her homework and understands the potential risks and complications associated with the procedure. She should also understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

All in all, breast reduction surgery remains one of the most patient pleasing operations we perform. Critical in the decision-making will always be selection of a well experienced board-certified plastic surgeon, clear communication of patient goals as well as the potential risks and complications associated with the procedure.


Ive always had large breast and have endured the physical and emotional trial that comes with them. I often felt they got in the way of activities, limiting my mobility, limiting my ability to wear certain things. Not to mention they drew a lot of unwanted attention from others. My large breast also caused me to have headaches, indentations on my shoulders, heat rashes, neck pain and mid back pain. After breastfeeding my son, my breast became even bigger.

The size increased from a 34E to a 34F. I was told by other friends who breastfed, that I would shrink after breastfeeding but I never did. After much consideration and a long talk with my husband who LOVES my large breast, we both agreed it was time to look at some options for my emotional and physical well being. My search for a plastic surgeon begin. I thought about a breast reduction for about a two years. I spoke with other people who had it done. I had not heard any regret from the people I spoke with exception that they had wished they had done it sooner.

I begin to look online at images first and begin to compile a file of images of transformations that I thought looked great. I kept coming across some of the same surgeons. So I narrowed it down to three surgeons an based that decision on certification, experience and artistic signature. An “artistic signature” of a surgeoin to me is, what you start with and what you end up with. There are so many unique body types that I saw truly drastic, positive changes to. My personal goal is to have smaller breast but retain some of the unique character I was born with. My biggest fear is hypertrophic scarring and discoloration. Ive weighed the fear scarring and the desire to overcome some of the personal limitations I contribute to large breast and decided that the best decion for me is surgery. With the support of my family, friends and then finding an excellent surgeon, it feels as though Ive made the best decison.

When I narrowed down to three surgeons, I set up three consultations. Two surgeons were in CA and one in AZ where I live. I ended up choosing Dr Pousti because after my very first interaction with him. He was very easy to talk to, he listened to my goals and how I wanted to reach them. He also gave me questions to think about that I had not thought of. From the beginning he seemed to be an objective advocate to my goals and was very understanding about my personal concerns of scarring. I also appreciated that he had on his website a tab for reference for “African American” patients. It was very difficult in my search to find many images posted of African American outcomes. It was nice to see that he included this information on his website. He also had availiable patients who were willing to share thier personal breast reduction experience with me. I found this to be very helpful because I was able to ask specific questions about thier experience and if they would have done anything differently. Last, but not least, Dr. Pousti has the very best team of professional people working with him. His staff is warm, caring and you can tell that they love what they do and they enjoy working for Dr Pousti. Thats important to me because that speaks to the character of the Dr.,…in my opinion.

I am a 41 year old and have been fighting my weight gains and losses ever since I was 23 years old. In high school I thought I looked okay. It wasn’t until I married and had 2 children that my weight problem got serious. Every year the pounds just kept adding up until I was at 265 pounds and didn’t know how I got there. I tried many different weightless programs, and always seemed to put the weight back on just as fast as I lost it.

After 2 years of hard work at the gym and watching what I ate, I managed to loose 80 pounds, which left me with what I called my “skin tutu” around my middle and my breast hung down to my waist, which my kids referred to as my “cuddle buddies” because they laid on the bed next to me.

The more I lost the worst I looked! I wanted to love the body I worked so hard to get, but that isn’t what happened. The skin would just hang worse every pound I lost I wanted to love my body.

I started looking on the Internet at “mommy makeovers” before and after pictures, and at people like me who lost a lot of weight, and wanted the skin removed. I would say for every 10 women that I found, that I looked like in there before pictures, and loved their after pictures, 8 out of those 10 women were done by Dr. Pousti.

I looked at before and after pictures for at least a year prior to my surgery, wondering if I should do this or not. I was scared of what was involved and how I would look after. I didn’t want to look like one of those women who have surgeries and look worse afterwards.

Well, with the love and support of my fiancé, my children, my parents and my friends, I decided to make an appointment for a consultation with Dr. Pousti.

The day of my consultation, my fiancé and my mother came with me to my appointment. We went to Dr Pousti’s office in Murrieta, Ca. The moment I walked in, it felt so right. The women who work there were not just stunningly beautiful on the outside, but on the inside. They made me feel so comfortable and at ease! Dr. Pousti came in and looked at me and said he thought I would have amazing results. He suggested having an extended tummy tuck and a breast reduction, with some liposuction.

I weighted in at 207 and knew I had more weight to lose. I wanted to have this surgery in January when my business is slower. Dr Pousti suggested that an ideal weight he would like me to be for surgery was 180 pounds. Well, I was within a few pounds of my goal when surgery day arrived.

About 1 month prior to my scheduled surgery, my fiancé found out he had Thyroid Cancer. I wasn’t sure if I should cancel my surgery with Dr. Pousti. When I came in to see Dr. Pousti he could see I was nervous about my fiancé’s news. Dr Pousti asked who the surgeon was and he personally called every ENT Dr. That he knew to see if anyone had heard of this surgeon, and what his experience was. He called me personally the next day to tell me of his findings. Dr Pousti didn’t have to make those calls, but he did, and that meant the world to me. He doesn’t just care about me, but also about the man I love. My fiancé had his surgery and it was a success!

The day before my surgery my fiancé, and my mother came with me to Dr Pousti’s office in La Mesa ca. He did all his markings of what was going to remove, where he would cut and where he would lipo. He marked my breast so I would have my best results.

We stayed at my aunt’s house ,which was close to the surgery center, and is where I stayed for the first week after surgery. My mom was my nurse for the first week! I can’t thank her enough for helping me. I stayed at my aunts because Dr. Pousti wanted me to stay close by so he could check on me post surgery.

The day finally arrived, and we arrived at the surgery center. Dr Pousti uses the same surgery center, with the same anesthesiologist and the same nurses and assistants. I was so scared and everyone calmed me and made me feel comfortable and so special. They were very professional, and they had a way of making you feel like you were their only patient! Dr Pousti came in and checked his marking and did some minor adjustments,and then they took me back to the operating room. I woke up 8 hours later 6 hour surgery 2 hours of recovery, and I felt like I just got there.

The feeling I had was the feeling of tightness! I’m not going to lie week 1 was the hardest week but it was worth it! He installs a pain pump that numbs the incision area. I had 4 drains 2 from my breast and 2 from my pelvic area. They sent me home the same day of surgery. I really don’t remember too much as I was still really groggy.

I stayed at my aunts house and slept in a recliner for the first week. Dr Pousti and his wife  were so kind to check on me the first night after surgery! They even brought me flowers! Never have I heard of a Dr. doing this before. The compassion and love he has for his patients is very apparent! He has always made me feel like I was his only patient, and his # 1 priority, even though I know he has many more patients.

The nurse or office staff called me everyday to check on me! Everyday was easier than the day before. I got around with my trusty walker, my BFF after surgery!

Dr Pousti told me that after surgery you go through an emotional state, but what found was not what I expected at all! I was expecting tears of pain and thought of regret, but that isn’t what I had at all! I never once thought why did I do this? The emotions I felt were eye opening to my life! The tears I shed were tears of love and joy and how lucky I am to have parents who took care of me for 6 weeks, a fiancé who supported me, no matter what I wanted to do, and my daughters, who stood by my side the whole time. Then the flowers, the cards, and the text messages came from friends, and clients thinking about me. The love I felt was overwhelming! Every tear I shed, were tears of joy of my life, my new body, and my new life to come!

This whole experience was the best thing I could have ever done! The most important thing is I truly feel like I was led to Dr. Pousti, and the results I got are amazing! He is a true artist of the body! He knows what will look the best and what is needed and not needed. He doesn’t just make you feel like he’s just your surgeon, but your friend, with your best interests in mind! The surgery is going to change my life for the better, and can’t thank him enough!

I want to commend you and your staff for the excellent and attentive care I received from the initial exam and throughout my surgical recovery. Having Dr.
Pousti perform breast reduction surgery has been life-altering. Not only has my self-esteem soared, I’ve resumed a daily exercise program, combined with life style changes. I no longer have back, neck or shoulder pain after years of going to doctors seeking relief. I’m now wearing tank tops and sundresses without being self conscious of having large, heavy breasts.
I have you, Dr. Pousti to thank for giving me a new lease on life!!!

Before the breast reduction surgery, I looked very matronley. I have always felt great about myself and my self esteem is extremely high…. after the breast reduction surgery, I looked and felt better than ever thought I could!! I can not thank Dr. Pousti enough for making me look like the fabulous woman that I have always been!

Bear, Delaware

I am a 23 year old mother of one. Shortly after having my daughter, I realized that I was very uncomfortable with my enlarged breasts. I felt as if people were talking to them rather than me, not only that they were way too HUGE for my little body. I spoke with family and friends to get an idea of what they thought, a majority said to leave things the way they were, but I felt different. In June or July of 2003, I spoke with my primary doctor, Dr. Aiello, and he recommended me to speak with Dr. Pousti. I have to admit, I was very nervous at my first visit but once I met Dr. Pousti, I felt at ease. He and his staff were very friendly and made me feel very comfortable. After my second visit, I told my family that I had made the decision to get my breasts reduced. I set up my surgery date. The day before surgery, I met with Dr. Pousti for my markings. Through out the entire pre-op procedure, my main concern wasn’t about pain, loss of nipple/breast sensitivity, but about the scars. Dr. Pousti told me that he would do his best to minimize the scarring. I went home the day of my surgery and felt no pain. It was hard not being able to do things around the house or pick up my daughter. It has been 6 months since my surgery and I am both THANKFUL AND GREATFUL to Dr. Pousti and his staff. I am also very pleased to say that my scarring is barely noticeable. A huge plus is that since having my surgery, I have regained my sensitivity in my breasts (something I had lost after having my child). I would definitely do this again and have Dr. Pousti do the surgery. I have also recommended a few friends and would do so again. He is the best and has a great staff working with him.
Thanks again,
Lela H.

I am now eight weeks from surgery to have my very large DD breasts reduced, and I wanted to write a note so anyone considering this surgery would know what to really expect. I am 38 years old and have been considering have this surgery for about 12 years. My breasts went from a C cup to DD after having my first child. This might have been okay for some but I am a petite person and only weigh 117lbs. I might have been able to deal with the size but the fact that my breasts now hung very low and going without a bra was impossible. I now had back pain and rashes that would not go away. I had another child 5 years later and this did nothing to help my sagging breasts or back pain.

I finally decided to research the procedure and went to several consultations. Dr. Pousti was the only one that I even considered. He was very personable and answered all my questions. The staff helped with getting my insurance to pay for the surgery. Now I have never had surgery of any kind and I didn’t know what to expect. The staff and Dr. Pousti were very kind and reassuring. I wasn’t really worried about the pain and it wasn’t very bad the pain medication works.
However it does take sometime to get back to normal, and to feel a 100%. It was a little harder than I thought but I would go through it all again for the results I have received.

Let me tell you the back pain is gone and I now have small C cups and can wear whatever I want to. Button up shirts are now in my closet and sexy tops that require no bra are my friends. The best part is my breasts are now where they are supposed to be. I am renewing my vows in Jamaica in 7 months and I am going to where a backless dress for the first time. I really liked myself before I had surgery and I felt attractive, but now I feel like a supermodel and it shows in my walk and my smile even fully clothed.
People tell me how good I look and I know it is true!

If you have always wanted to have this surgery I say without reservation go for it and do not let anyone tell you not you are not worth it, I know I was and still am.

During High School I grew extremely large breasts overnight and they put great strain on my body. After graduating college at 22, I knew I wanted to reduce my 34 J cup breasts. My large breasts were greatly impacting my quality of life. I experienced chronic headaches, extreme back pain, and neck tension that hindered my ability to function without pain. That does not include the emotional consequences of having such large breasts. Clothing never fit me, I always looked heavier than I was, and at times received very unwanted attention. Bras were uncomfortable and dug into my skin. There were very few moments when I wasnt in pain, searching fruitlessly for relief.

Just before my 23rd birthday, I visited Dr. Pousti for the first time. Although he is a successful and busy surgeon with many patients, I felt taken care of and heard as an individual from the moment I walked in the door. Dr. Pousti was honest about expectations and recommendations, and I was impressed by the fact that he was double board certified. His staff was wonderful to work with and each member took the time to talk to me and approach me in a friendly manner. His office was organized and efficient, but tailored to my needs.

I was very nervous for the surgery, but Dr. Pousti and his staff took care of me and put me at ease through each step, including the morning of surgery. A member of Dr. Poustis staff called every day for the first two weeks after my surgery. I was able to ask questions and check my progress. I felt very taken care of in every way.

It has only been a few months since my surgery and I already cannot remember how I lived a normal life before. The recovery takes patience and time, but words cannot adequately convey what this surgery has done for my life. It has completely changed the way I feel, the way I move, and my ability to live my life. I have regained my health and I can move with an ease I never thought I would have again. My overall health and self-confidence has risen beyond measure. I can exercise again and wear any clothing I choose. It is extremely liberating!

Having a breast reduction changed my life and I cannot imagine anyone who could have taken better care of me then Dr. Pousti. I have complete trust and faith that he is the only surgeon who could have made this happen for me. He helped me each step of the way. He is a truly talented man who is not only skilled at his practice, but kind and goodhearted at his very core. There are not many people who have that rare mix of ability and honest concern for the lives of patients.

For Dr. Pousti, it is not merely an hour or two of surgery, but a life-long relationship which he realizes begins the first time you walk into his office. I would make this decision again without a moment of hesitation, worry, or doubt. I would fully recommend Dr. Pousti to anyone I know.

Prime Plastic Surgery consists of the top board-certified surgeons in the country providing the highest caliber of patient care. We offer cosmetic and reconstructive procedures, both surgical and non-surgical, to help patients achieve truly life-changing results. Our surgeons are members of several prestigious organizations, including:

  • American Society of Plastic Surgeons
  • American Society for Aesthetic Plastic Surgery
  • International Society of Aesthetic Plastic Surgery
  • American Association for Accreditation of Ambulatory Surgery Facilities

Discover what the Prime difference can do for you. Request a consultation online or call our practice at (858) 285-4667.

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