Breast reduction surgery: what happens, risks and recovery

The NHS lists back, shoulder and neck pain, skin irritation under the breasts, grooves from bra straps, difficulty with exercise and low mood as reasons people seek a reduction. The operation is therefore usually considered a treatment for symptoms and not only a change of appearance.

It is not necessarily the first thing to try. The NHS says people qualify for NHS surgery when other measures, such as professionally fitted bras, have not helped and they have health problems linked to breast size. It adds that criteria vary by area, so your GP can explain the local rules. Physiotherapy, weight management where relevant, and good bra fitting are the usual alternatives to try first.

The surgeon examines you, takes photographs for comparison and talks through what is realistic. BAPRAS says pre-assessment may include blood tests, an ECG and sometimes a chest X-ray, and that you can change your mind at any point before surgery. The anaesthetist will also see you before the operation.

BAPRAS gives the fasting rule as no food for at least four to six hours and no drink for at least two hours before the operation, though your hospital's letter takes priority. Tell the team about every medicine you take, and ask what they advise about smoking, since smoking affects wound healing and your surgeon will have a view.

• Buy a well-fitting sports bra beforehand, as BAPRAS recommends a good quality one afterwards.

• Arrange help at home for the first fortnight with lifting, shopping and caring duties.

• Think about breastfeeding plans, because that is one of the main long-term considerations.

Surgery is under general anaesthetic. BAPRAS describes the most common method as an incision circling the areola, running down to the crease under the breast and along that crease, giving an anchor-shaped scar. Glandular tissue, fat and skin are removed and the breast is reshaped.

The nipple and areola are usually lifted on a pedicle, a stalk of tissue that keeps their blood supply. For very long, drooping breasts the nipple may have to be removed and replaced as a graft in a higher position, and BAPRAS says this causes permanent loss of sensation in the nipple. Your surgeon can tell you which technique they expect to use.

The NHS says the operation lasts two to three hours and that most people stay one to two nights. Drains and dressings, if used, are typically removed after a day or two according to the NHS.

Bruising, swelling, discomfort and some temporary numbness are expected. Scars are permanent, although the NHS says most fade and should not be visible under normal clothes, bras and bikini tops.

The NHS names more serious risks: permanent loss of the ability to breastfeed, loss of nipple sensation, uneven results, death of skin or nipple tissue, infection and blood clots. None of the pages retrieved gave percentages, so ask your surgeon for figures from their own practice.

Breast reduction can also leave the two sides slightly different in size or shape, and some people later want a revision. Realistic expectations before surgery matter more than any other factor in satisfaction.

The NHS says pain is controlled with medicines, people can often return to work after two to three weeks, and heavy lifting and strenuous activity should be avoided for up to six weeks. BAPRAS gives two to four weeks to resume normal activities, and about a month before strenuous upper-body sport.

Driving should wait until the seat belt causes no pain, according to the NHS. A supportive sports bra is recommended, and the NHS notes that some surgeons suggest wearing one day and night for up to three months. See the separate recovery timeline for the stages in order.

On the NHS the decision rests on local commissioning criteria, and waiting times vary by area. Private surgery is based on a surgeon's assessment and the patient's own decision, which usually means a quicker route but with fees. Whichever route, ask for the surgeon's own experience with the technique and their policy on revisions.