Scheduling Breast Reduction Surgeries: Before or After Surgical Weight Loss Procedures?


For patients considering weight loss surgery to combat obesity and to resculpt their figures, deciding when to schedule breast reduction procedures, also known as reduction mammoplasty surgeries can be a real challenge. Some studies suggest that the best results are usually achieved when surgical weight loss procedures are performed first and time is allowed for weight loss to occur. Dr. Shahram Salemy is a Seattle plastic surgeon who specializes in breast enhancement and reduction surgeries. Here are some of his insights regarding the best way to combine weight loss surgery and breast reduction procedures successfully.

Weight Loss Surgery: What Is It?

Dr. Salemy notes that weight loss surgery is usually performed to address moderate to serious obesity issues. Gastric band and gastric bypass procedures are among the most commonly performed weight loss surgeries in the U.S. These surgical methods reduce the physical room available for food in the stomach, preventing patients from overeating and causing significant reductions in caloric intake in most cases. Weight loss surgery has proven to be effective for reducing caloric intake and reducing the risk of significant medical problems in many patients.

Weight Loss and Breast Size

As most women can attest, breast size can fluctuate significantly depending on increases or decreases in overall weight. According to Dr. Salemy, these changes are normal and should be expected after weight loss surgery. The rapid weight loss caused by these surgical procedures can significantly reduce the size of breasts, hips, thighs and other areas of the body where fat tends to accumulate. A study published in September 2011 in the scholarly journal Plastic and Reconstructive Surgery measured satisfaction levels in two groups of patients:

• One group of women scheduled reduction mammaplasty before achieving significant weight loss through surgery or through other means.
• The second group waited until after losing a significant amount of weight before undergoing breast reduction surgery.

While both groups involved in this University of Rochester Medical Center study expressed satisfaction with their initial results, women who waited until after their surgical procedure and the weight loss associated with it were happier with their results. Women who scheduled reduction mammaplasty surgery first, by contrast, were more likely to report dissatisfaction with their results:

• About 86 percent of these women indicated that their breasts looked worse after they lost significant amounts of weight.
• Nearly half of this group indicated that they were planning additional cosmetic surgery procedures to improve the appearance of their breasts.

The results of this study may provide added insights for plastic surgery patients wondering about the right timing for these medical procedures.

Mitigating Circumstances

Dr. Salemy cautions that there may be good reasons to schedule reduction mammaplasty procedures prior to a planned surgical weight loss procedure. Some of the most important of these include the following:

• Breast reduction procedures can make it easier for women to engage in vigorous exercise, allowing for more effective and rapid weight loss.
• Women who frequently or routinely experience shoulder and back pain due to the weight of their breasts may experience relief from these symptoms after reduction mammaplasty.

Working with a professional plastic surgeon is the most effective way to ensure the best results for breast reduction procedures and other cosmetic surgery options.

Shared Decision Making

While the University of Rochester Medical Center study does present some compelling arguments for scheduling weight loss surgery in advance of breast reduction procedures, the final decision is usually made as a joint effort between the plastic surgeon and the patient. After losing large amounts of weight with the help of surgery, many patients choose to undergo body contouring procedures that include the following:

• Tummy tucks to eliminate unwanted abdominal fat
• Breast lifts to reduce sagging and dropping
• Liposuction for problem areas, including HIPS, thighs and upper arms
• Removal and smoothing of excess skin to present a sleeker, more attractive appearance

In many cases, enhancements to the size, shape and lift of the breasts can be performed during other procedures. This flexibility can provide women with increased options for the timing of reduction mammaplasty procedures and can ensure results tailor-made to suit patient needs. Ultimately, determining the right treatment plan and the right schedule for weight loss surgery and breast reduction should be the result of shared decision making between the cosmetic surgeon and the patient in question.

Dr. Salemy goes on to note that some women consider breast reduction procedures as part of a post-pregnancy makeover. In these cases, weight loss can often be achieved quickly and can present aesthetic issues similar to those arising from weight loss surgery. Consulting with an experienced plastic surgeon who specializes in breast enhancements, augmentations and reduction surgeries can provide patients with the guidance and expert help needed to achieve optimal results.


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