The normal breast
The optimal position and volume of the breast are important elements when choosing the final result. Classically, the position of the nipple is described as being at a distance of 18-22 cm from the middle of the clavicle, or at 1-2 cm under the line between the middle of the arms. The optimal volume varies between 200-350 cc depending on the type of the physical constitution.

About the mammary hypertrophy
It is said that large breasts are beautiful, but this statement is true only as long as the breasts have also a posture and a commanding appearance. Large breasts are generally affected by ptosis, with the mammary areola also lower than the optimal position that is 1-2 cm under the imaginary straight line between the middle of the arms.
The enlargement of the breasts or the hypertrophy may start in puberty when, under the influence of the hormonal changes, the mammary gland increases significantly, with over 350-400 cc, and evolves with the deformation of the mammary region and its secondary ptosis. Another cause, probably the most common one, is the development of the mammary gland during the pregnancy. The return to a normal mammary volume is not a complete one; the gland remains large. The patients with hypertrophic breasts may complain of backbone pains at the backside level and may claim to suffer from frequent maceration and suprainfections of the submammary groove. Very large breasts are an impediment in the vestimentation, in the socio-professional life and even in the sexual life.

About the mammary ptosis
The mammary ptosis is a morphological state as a consequence of a hypertrophic process or of the tissue ageing processes.
The mammary ptosis may be a glandular ptosis resulting from the gland involution or a cutaneous ptosis due to the relaxation of the connections between the skin and the gland. The virginal hypertrophy without early ptosis may be encountered at the young women.
Neither of the two types of ptosis benefits of surgical reparation. Thus the intervention can only be applied to the tegumentary excess, the gland remaining intact or the excision might include the tegument as well as the gland.

Remember!
This procedure restores the esthetical appearance of the breast, with an optimal volume and position. There will be circumareolar and subareolar scars, as well as scars in the submammary groove.
These scars will remain more or less visible, or they could burst and require a new intervention for scar revision.
The intervention is not a mutilating one, pregnancy and breastfeeding being possible after it.
The results last long time.
After the operation it is necessary to wear a brassiere, for shaping reasons, for about 3 months.

Consultation and analysis
The patient will report her entire medical history insisting on the medical problems of the breast, pains, inflammations, mastitis in the clinical record, surgical operations, personal physiological clinical record, the number of births and abortions, breastfeeding period, the installation of the first menstruation, of the climacteric period, the types of birth controls used.
The required preoperatory analysis: analysis of the blood, urine, radiological examining of the breast - mammography/scopy, echographical examination, the examination by a specialized oncologist.

The surgical intervention
The intervention takes place under total anesthesia and it lasts for about 2-4 h. The intervention implies the abscission of a part of the gland as well as of a part of the surrounding tegument. Scars will depend on how big the excess of the glandular and tegumentary tissue is.
The operating doctor will choose the proper procedure in order to reduce the amplitude of the scars as much as possible and to balance the volume and the remaining shape to the aspect and the thorax of the patient.
Postoperatory pains are minimum and endurable, especially in the first 24-48 h. Many patients do not feel any kind of pain, only a sensation of tension that disappears in a few days. Postoperatory, a bandage and a few aspirative drains are placed at the operated area level.
The bandages will be placed in the first days after the operation and later the period between the bandages will increase. Most of the stitches are either reabsorbable or can be removed in 10-14 days.
A 1-6 day hospitalization is necessary. At the worldwide level, some surgeons execute the reducing mammoplasty in an ambulatory regime. The hospitalization period depends on the opinion of the operating doctor and on the evolution of the case.
Cold local applications reduce the inflammation and the pains.

About complications
The complications are minimum, the most unpleasant problems being the burst, the hypertrophy of the scars and the need to review the scar tissue after a period of at least 6 months. Other complications - the haematoma, the serum, the suprainfection, the fat mortification, small cutaneous mortifications, hypo or hyperesthesia of the mammary areola - are easily resolved by treatment. The mammary volume asymmetry is resolved through a revision intervention after 3-6 months from the main operation.

Results
The results are good, in over 80-90% of the cases the patients are very content, willingly recommending the procedure to other people. The breast gets a size and a volume that are proportional with the aspect and the constitution of the patient but the final look is to be appreciated after 3-6 months. The results last long time.
The intervention is not a mutilating one, pregnancy and breastfeeding being possible approximately 1 year after the operation.

Recommendations
The normal sexual life can be resumed 3 weeks after the operation.
The socio-professional activities can be resumed after 10-14 days.
The hygiene of the area can be resumed after removing the bandage, in about 14 days.
It is necessary to keep on wearing a brassiere for about 3 months. Patients can procure surgical brassieres with anti-decubitus support.