• You are physically healthy;
• You have realistic expectations;
• You don't smoke;
• You are bothered by the feeling that your breasts are too large;
• Your breasts limit your physical activity;
• You have back, neck and shoulder pain caused by the weight of your breasts;
• You have depression in your shoulders, in place of your bra straps, due to the weight of your breasts;
• You have skin irritation below the breast crease;
• Your breasts are saggy and hanging;
• The nipple is below the breast crease when your breasts are not supported;
• You have enlarged areolas and loose skin.

• The reason why you want to undergo surgery, your expectations and the desired result;
• Medical conditions, drug allergies and medical treatments;
• Current use of medications, vitamins, natural medicines, alcohol, tobacco and drugs, including steroids;
• Previous surgeries;
• Family history of breast cancer and results of previous mammograms or biopsies.

• Assess your general health status and any pre-existing health conditions or risk factors,
• Examine your breasts, take detailed measurements of their size and shape, check the quality of the skin and the position of the nipples and areolas,
• Take photos for your medical record,
• Discuss your options and recommend the most appropriate treatment,
• Discuss possible outcomes of the breast reduction process and any potential risks or complications,
• Discuss the type of anesthesia to be used during the reduction procedure breast.

The decision to undergo breast reduction surgery is a personal one and it is up to you to decide whether the benefits will meet your goals and whether the surgery's risks and potential complications are acceptable. Your plastic surgeon and/or assistants will explain, in detail, the risks associated with the surgery. You will be asked to sign the consent form to ensure that you fully understand the procedure you will undergo and any potential risks or complications.

• Unfavorable scarring;
• Infection;
• Changes in sensitivity in the nipple or breast, which may be temporary or permanent;
• Anesthetic risks;
• Bleeding (bruise);
• Poor healing;
• Irregular contour and shape of the breast;
• Skin discoloration, permanent changes in pigmentation, swelling and bruising;
• Damage to deeper structures such as nerves, blood vessels, muscles and lungs, which may occur temporarily or permanently;
• Breast asymmetry;
• Accumulation of fluid (seroma);
• Excessive chest rigidity;
• Possibility of inability to breastfeed;
• Potential for necrosis of the skin/tissue where the incisions are located;
• Possibility of total or partial necrosis of the nipple and areola;
• Deep vein thrombosis, cardiac and pulmonary complications;
• Pain, which may last;
• Allergies to tape, sutures, glues, blood products, topical and injectable medications,
• Skin necrosis;
• Possibility of a new surgical procedure (touch-up).

• Breast reduction surgery may interfere with some diagnostic procedures;
• Breast and nipple piercing can cause infection;
• Your ability to breastfeed after reduction mammoplasty may be impaired, so talk to your doctor if you are planning to have children;
• The breast reduction procedure can be performed at any age, but it presents better results when the breasts are fully developed;
• Changes in the breasts during pregnancy can alter the results of the surgery, as can significant fluctuations in weight.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve the best results with a single procedure, requiring further surgery.

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

If you experience shortness of breath, chest pains, or an abnormal heartbeat, seek medical attention immediately. If any of these complications occur, you may need hospitalization and additional treatment.

Following your doctor's recommendations is essential for the success of the surgery. It is important that surgical incisions are not subjected to excessive force, abrasion, or movement during the healing time.

It is important that you ask all your questions directly to your plastic surgeon. It is natural to feel a little anxiety, to have expectations about the result or pre-operative stress. Discuss these feelings with your plastic surgeon.

• Carry out laboratory tests or medical evaluation;
• Taking certain medications or adjusting current medications;
• Have a baseline mammogram before surgery and another after surgery to help detect any future changes in breast tissue;
• Stop smoking well before surgery;
• Avoid taking aspirin, anti-inflammatories and natural medications, as they can increase bleeding.

• What to do on the day of surgery (fasting time, medications, bath),
• Post-operative care.

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

Be sure to ask someone to accompany you and stay with you for at least the first night after surgery.

What happens during breast reduction surgery?

Breast reduction surgery is generally performed through incisions in the breasts with the surgical removal of excess fat, glandular tissue and skin. In some cases, excess fat can be removed through liposuction, in conjunction with the techniques described below. The technique used to reduce the size of your breasts will be determined by your anatomical particularities, breast composition, amount of reduction desired, your personal preferences and the surgeon's advice.

Step 1 – Anesthesia

Medications are administered for your comfort during surgery. Options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

Step 2 – Incision

Incision options include:

• Circular pattern around the areola. The incision lines that remain are visible and the scars are permanent, however, they are usually well hidden undera swimsuit or bra;
• Keyhole pattern or racket shape, with an incision around the areola and vertically downward to the breast crease,
• Inverted T- or anchor-shaped incision pattern.

Step 3 – Removing the tissue and repositioning

After the incision, the nipple (which remains with its original blood supply) is repositioned. The areola is reduced by excising skin around the perimeter, if necessary. Underlying breast tissue is reduced, lifted and shaped. Occasionally, in cases of extremely large and pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

Step 4 – Closing the incisions

The incisions are brought closer to remodel the breast, now smaller in size. Sutures are placed deep within the breast tissue to create and support the breasts; sutures, adhesives, skin, and/or surgical tape can close the skin. Scars are permanent, but in most cases they tend to improve significantly over time.

Step 5 – Results

The results of breast reduction surgery are immediately visible. Over time, the swelling decreases.

Breast reduction procedure is completed, gauze and micropore will be applied to the incisions. An elastic bandage or bra can be used to minimize swelling and support the breasts. A drain may be temporarily placed under the skin to drain any excess blood and fluid that may accumulate.

How to care for your breasts after breast reduction surgery, medications to take by mouth to help reduce the risk of infection, concerns about the surgery site or your general health, and follow-up with your plastic surgeon.

• Where will I remain in recovery after the surgery ends?
• What medication will I be given or prescribed after surgery?
• Will I have bandages after surgery? When will they be removed?
• Will the stitches be removed? When?
• When can I resume normal activities and physical exercise?
• When will the return appointment be?

The new breast size will help alleviate pain and physical limitations that existed prior to surgery. A more proportional breast can improve your self-esteem and self-confidence. However, over time, your breasts can change due to aging, weight fluctuations, hormonal factors, and gravity.

For many patients, the cost of breast reduction surgery and other elective surgeries is a consideration. A surgeon's fees can vary based on factors such as experience and the type of procedure performed.

The cost may include:

• Surgeon's fees;
• Hospital and surgical center costs;
• Anesthetist's fees;
• Prescribed medications;
• Post-operative meshes;
• Medical exams.

When choosing a plastic surgeon for gynecomastia surgery, remember that the surgeon's experience and your good relationship with him or her are just as important as the final cost of the surgery.

• Areola: Pigmented skin around the nipple.
• Breast reduction: Also known as reduction mammoplasty, this is the surgical removal of breast tissue to reduce the size of the breasts.
• General anesthesia: Drugs and/or gases used during surgery to relieve pain and reduce consciousness.
• Hematoma: Acúmulo de sangue sob a pele.
• Intravenous sedation: Sedatives given by injection into a vein to help you relax.
• Liposuction: Procedure that suctions fat from beneath the surface of the skin to reduce volume.
• Local anesthesia: Drug injected directly into the incision site during surgery to relieve pain.
• Mammogram: An x-ray image of the breast.
• MRI (Magnetic Resonance Imaging): Painless examination to evaluate breast tissue, similar to an x-ray.
• Breast reduction surgery: Surgical removal of breast tissue to reduce the size of the breasts, also known as breast reduction surgery.
• Sutures: Stitches used by surgeons to hold skin and tissue together.

Use this list as a guide during your consultation:

• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Is the installation of the surgical center in the office authorized by the Health Surveillance of your city?
• Am I a good candidate for this procedure?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure be performed?
• Which surgical technique is recommended for me?
• How long can I expect to recover, and what kind of help will I need
during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications treated?