It is common for women with overly large, pendulous breasts to experience both emotional and physical discomfort as a result of their enlarged breasts. Women who are self-conscious or embarrassed about their large breasts tend to avoid standing up straight or wearing certain types of clothes.

Women with overly enlarged breasts often suffer from chronic physical discomfort. Their bra straps constantly dig into their shoulders, creating grooves, or indents, in their skin. Large-breasted women may also experience chronic neck and back pain, due to the weight of their breasts constantly pulling them forward and causing them to hunch over inadvertently. They may also frequently get rashes under their breasts. Finally, engaging in certain physical activities such as running or jumping can be painful with overly large breasts.

Breast Reduction Benefits

Maryland plastic surgeon Joseph Michaels, MD, FACS, offers breast reduction surgery to help alleviate the pain, discomfort and embarrassment associated with having extremely large breasts.

The aesthetic goal of breast reduction surgery is not to reduce the size of your breasts so drastically that you no longer look like yourself, but to give you smaller breasts that are perkier, shapely and in balance with the rest of your body. The most common comment that Dr. Michaels’ breast reduction patients make after surgery is, “I can’t believe I didn’t do this sooner!”

Undergoing surgical breast reduction in Bethesda or Fairfax with Dr. Michaels provides relief from neck, back and shoulder pain — almost immediately after surgery.

Before & After Photos

Incision Pattern Options

Many of Dr. Michaels’ patients are concerned with the location and degree of scarring that they may have following their procedure. Traditionally, patients were left with significant incisions that surrounded the areola (the darker-skinned area around the nipple), a vertical incision that extended from the base of the areola to the natural fold of the breast and an incision that extended the full length of the natural fold of the breast. There are newer techniques that can limit the length of the incisions needed to obtain the desired size and shape of your breasts.

During your consultation, Dr. Michaels will evaluate your breast anatomy and discuss your aesthetic concerns. Based on this information, he will design a treatment protocol that best suits your individual needs.

Based on the degree of glandular breast tissue to be reduced, the amount of excess skin present and the distance that the nipple-areolar complex needs to be elevated, Dr. Michaels will determine which technique and incision pattern he will utilize during your procedure.

Anchor Incision

For patients requiring a significant breast reduction and elevation of nipple-areolar complex, the traditional breast reduction approach is still commonly utilized. Again, this procedure involves the use of a horizontal inframammary incision positioned underneath the breast’s natural crease, a vertical incision that extends down the front surface of the breast and a periareolar incision that runs along the outside edge of the areola. These incisions are sometimes referred to as the “anchor” pattern.

Lollipop Incision

Patients that require smaller reductions and minimal elevation of the nipple-areolar complex may be suitable candidates for a modified “short-scar,” or vertical, breast reduction approach. This procedure involves reducing the breast size through a periareolar and vertical incision only. These incisions are sometimes referred to as a “lollipop” pattern.


It is common for women to undergo breast lift at the same time as breast reduction surgery.

Typically, the breast reduction procedure is performed as an outpatient surgery. The procedure is done under general anesthesia to ensure the patient is comfortable for the entire duration of surgery.

After Dr. Michaels makes the incisions, he eliminates the extra skin, fat and glandular tissue from the breast. Most of the skin and tissue is removed from the lower part of the breast. This helps preserve the tissue in the upper part of the breast that contributes to breast cleavage. Dr. Michaels will also move the nipple to a more elevated and centralized position on the breast, taking care to keep the nipple attached to the underlying tissue to maximize the chance of preserving nipple sensation.

It is common for women with extremely large breasts to also have overly enlarged areolas. To decrease the size of the areola so that it is in proportion to the smaller size and shape of the breast, the Maryland breast surgeon excises some of the pigmented skin from the outer circumference of the areola.

Once Dr. Michaels is satisfied with the new size and shape of the breast, he closes the incisions with dissolvable sutures and then dresses the breasts with bandages and an overlying surgical bra.

Quick Facts


2-4 hours





Side effects

Temporary swelling, muscle tightness, bruising and some pain


Pain, bleeding, infection, asymmetry, damage to nerves (in rare cases), need for revision


4-7 days: back at work. 1 week: light exercise only. 2-3 weeks: more strenuous activity allowed. 8-12 weeks: swelling resolves and patient can resume normal activity.

Duration of results

Variable, as further sagging occurs with age

If you would like to learn more about breast reduction, click here or call (301) 468-5991 in Bethesda, Maryland or (703) 957-8610 in Fairfax, Virginia to schedule a consultation.