Breast reduction and bariatric surgery - which should be done first?

Final results may be better when weight loss comes first

August 26, 2011
American Society of Plastic Surgeons (ASPS)

For very obese women considering both bariatric procedures and breast reduction surgery, optimal results are achieved when weight loss is achieved first, suggests a study in the September issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Although initial breast reduction has some benefits, women may be disappointed with the appearance of their breasts after massive weight loss. "Thus, patients who are considering bariatric procedures should be encouraged to pursue that operation before proceeding with reduction mammaplasty," according to the new study by ASPS Member Jeffrey A. Gusenoff, M.D., and colleagues of University of Rochester Medical Center.

Best results when bariatric surgery performed before breast reduction

The researchers analyzed patient satisfaction and other outcomes in severely obese women who had massive weight loss of more than 50 pounds. Obesity is defined as a body mass index of 30 or higher, and the women in this study had an average body mass index of about 54. All but one of the women needed bariatric surgery to achieve massive weight loss.

The study included two groups of women: 15 who underwent breast reduction surgery before massive weight loss and 14 who did not have breast reduction surgery before massive weight loss. All of the women who underwent reduction mammaplasty thought their breasts looked better after the operation. In addition, most felt better able to exercise and to lose weight on their own after breast reduction surgery. However, all 15 women needed bariatric surgery to achieve their weight-loss goals. Further reductions in breast size followed bariatric surgery.

Bariatric procedures for obesity can affect the appearance of the breasts as a result of excess skin and other changes. After massive weight loss, 86% of the women who previously had reduction mammaplasty thought their breasts looked worse. About half of the women planned to have further surgery to improve the appearance of their breasts. Others said they would have further surgery if it was covered by insurance.

Because of the benefits of breast reduction - including relief from severe breast-related symptoms - most of the women did not regret their decision to have reduction mammaplasty first. However, if giving advice to a friend, they said they would recommend losing weight before undergoing breast reduction surgery.

Of the women who did not undergo reduction mammaplasty, 71% felt the appearance of their breasts was worse after bariatric surgery. Half planned to have breast reduction surgery, while more said they would if they could afford it.

The new results suggest that most women are dissatisfied with the appearance of their breasts after massive weight loss, whether or not they undergo breast reduction surgery before bariatric procedures.

Dr. Gusenoff and colleagues suggest that, in women who are candidates for both procedures, it may be a good idea to consider having bariatric surgery first. While reduction mammaplasty has benefits - including reduced pain and increased ability to exercise - the final appearance of the breasts seems better if breast reduction surgery is performed after massive weight loss. "These options must be weighed and individualized treatment plans made for obese patients seeking breast reduction prior to weight loss," the researchers conclude.