Breast reduction and liposuction in Switzerland: lighter breasts, a slimmer upper body

Heavy breasts do not only weigh on the shoulders. In many women, they are accompanied by excess fat that spills out of the bra under the arms, forms rolls on the back above and below the band, and thickens the flanks. A breast reduction that dealt only with the breasts would leave these bulges in place, or even make them look more visible around lighter breasts. Combining breast reduction with liposuction treats the whole upper body at the same time: breast volume, the sides of the chest, the back and, if needed, the waist and abdomen when the skin is firm. In some women, whose breasts are mainly fat and whose skin is of good quality, liposuction can even become the main tool of the reduction, with minimal scars. This page explains who each of these approaches is for, how the procedure and recovery unfold, what insurance may cover, the risks and results, and how provision and fees are distributed from one canton to another.

Under general anaesthesia, the surgeon removes part of the gland, fat and skin envelope of each breast, raises the areola and reshapes the breasts, with a scar around the areola and a vertical one, sometimes a horizontal one in the fold. They then suction fat from the sides of the chest, the extension towards the armpit and, as needed, the back, flanks or abdomen. In selected patients, the reduction can be carried out mainly by liposuction, without large scars. The procedure takes two and a half to four hours and is often accompanied by a night in hospital. A support bra and a compression garment are worn for several weeks. The reduction may be covered by basic insurance if the medical criteria are met; liposuction of the other areas remains cosmetic. Budget differences are detailed on the page on breast reduction with liposuction prices in Switzerland.

This combination brings together two complementary procedures. Breast reduction, or reduction mammaplasty, removes part of the gland, fat and skin of the breasts, raises the areola and restores a higher, firmer shape. Liposuction suctions excess fat from neighbouring or more distant areas through small incisions. It can also play a part in the reduction itself, by slimming the sides of the breast or, in some cases, reducing most of its volume.

The combination aims for a consistent result across the whole upper body: lighter breasts, with no residual rolls under the arms or on the back, and a slimmer figure from the front, in profile and from behind.

The breast is made of three main elements: the gland, which produces milk; fat, which surrounds it and gives it much of its volume; and a network of ligaments and fibrous septa that supports it. The skin forms its envelope. The proportion of gland to fat varies greatly from one woman to another and over a lifetime. Young, firm breasts are often rich in gland; breasts after menopause or in an overweight woman are often fattier.

This composition guides the choice of technique. Gland cannot be suctioned: only a surgical reduction can remove it. Fat, on the other hand, can be suctioned. That is why reduction by liposuction only suits mainly fatty breasts.

The breasts are supported by fine fibrous septa that connect the gland to the skin and the chest muscles. With weight, pregnancies and time, these structures stretch, and the breasts descend. In a conventional reduction, the surgeon builds a stable shape by bringing together the gland pillars and tightening the skin. Reduction by liposuction does not act on these structures: it lightens the breasts, which reduces traction, but does not tighten them.

These trends do not replace imaging, which clarifies the composition of each pair of breasts.

Sagging, or ptosis, is measured by the position of the areola relative to the fold under the breast. When it is above the fold, the breasts sag little; when it is at the level of the fold or below, the sagging is marked. The lower the areola, the more it needs to be raised, and the more necessary a conventional reduction becomes. Reduction by liposuction does not raise the areola: it is therefore only suitable for breasts that sag little.

Breast reduction was long surrounded by silence, with many women unaware that it could be covered or hesitant to talk about it. Today, information circulates more widely, and more and more patients consult having also identified the discomfort caused by the rolls surrounding the breasts. Combining reduction with liposuction responds to this demand for an overall result, focused on comfort and the harmony of the upper body.

The first breast reductions date back to the early twentieth century, but it was from the 1960s and 1970s that techniques preserving the blood supply to the areola became established. Liposuction, which appeared in the late 1970s, was first used to refine the sides of the breast during reductions, then, in the 1990s, to reduce some fatty breasts without large scars. The idea of treating rolls on the back and flanks at the same time developed with a more global approach to the figure.

When breast reduction is combined with a procedure on the abdomen, two situations must be distinguished. If the abdominal skin is firm and the excess is mainly fat, liposuction is enough: this is the subject of this page. If the abdominal skin is lax, often after pregnancies or weight loss, or the muscles are separated, an abdominoplasty is needed; this heavier combination is described on our page on breast reduction and abdominoplasty.

The combination with liposuction is generally shorter, with a faster recovery and a lower risk of thrombosis than the one with an abdominoplasty.

Large breasts are often accompanied by characteristic fat deposits. At the sides, between the edge of the breast and the armpit, a roll spills out of the bra and rubs against the arm. On the back, the bra band marks two horizontal folds, above and below. On the flanks, the fat sometimes extends these folds down to the waist. These rolls are accentuated by the very tight bra that large breasts require.

After a breast reduction, the bra band can be less tight, which softens these folds a little, but the fat remains. That is why combined liposuction often brings a clear improvement in comfort and appearance in clothes.

Several factors combine. The first is the natural distribution of fat, which in some women readily settles on the upper trunk. The second is mechanical: to hold large breasts, a very tight bra band and wide underwiring are needed, which compress the skin and push the fat above and below, creating folds that eventually become established. The third is postural: rounded shoulders encourage accumulation at the sides and under the armpit. Finally, weight changes and pregnancies often accentuate these deposits.

Understanding these mechanisms helps set realistic expectations: the reduction relieves the mechanical strain, but only liposuction removes fat that is already established.

We mostly look at ourselves from the front and know our backs poorly. Before the consultation, it can be useful to have photos taken in profile and from behind, in underwear, arms by your sides and then slightly apart. These images often reveal how marked the folds under the band or the bulge between the breast and armpit are. They help you express your request and understand the surgeon's proposals.

The breast does not stop sharply at its outer edge: its tissue sometimes extends towards the armpit, as gland or fat. In women with large breasts, this extension can be significant and painful, particularly during periods. During the reduction, the surgeon can remove it directly through the scar or refine it by liposuction. This gives more centred breasts, better separated from the arm, and a cleaner profile.

Accessory breast tissue in the armpit, distinct from the breast, is another situation; it too can be removed, after an imaging examination.

Some women have accessory breast tissue in or at the edge of the armpit, separate from the breast. It can swell and become painful during periods or pregnancy. It is distinguished from a simple roll of fat by its consistency and on imaging. Depending on its nature, it can be removed through a small incision in the armpit or reduced by liposuction. This can be done at the same time as the reduction.

In profile, heavy breasts often extend all the way to the arm, without a clear separation. After the reduction and liposuction of the sides, a slight dip appears between the breast and the armpit, as in a slim woman with medium-sized breasts. This discreet detail makes a big difference in a vest top or sleeveless dress, and it is often one of the first changes patients notice when looking at themselves from the side.

The roll between the breast and the armpit rubs against the inner arm with every movement, especially in summer. The skin becomes irritated, sweat accumulates and some clothes become uncomfortable. Once this roll has been suctioned, the arm regains a natural space alongside the body. Many patients cite this regained comfort, discreet but felt every day, among the most appreciated benefits of the combination, particularly when wearing sleeveless clothes or doing activities that use the arms.

Back folds are often a significant source of discomfort: they show under fitted clothes, make the bra uncomfortable and give the impression of a wider back. Back liposuction, performed with the patient lying on her front or side, smooths these folds. The thick skin of the back generally retracts well. The fat there is often fibrous, which makes suction more demanding and sometimes justifies an assistive technology, such as cannula vibration or ultrasound.

The skin of the back is the thickest on the body. It retracts well after liposuction and masks small irregularities, which makes it a favourable area. However, very marked folds with excess skin, particularly after major weight loss, do not disappear completely with liposuction; an upper back lift, with a scar hidden under the bra band, may then be discussed.

On the back and sides of the chest, the skin is thick and dense. This quality favours good retraction after liposuction and masks small irregularities, making these areas favourable ground, even in women who are no longer very young. This is an important difference from the inner arms or thighs, where thin skin requires more caution.

When love handles or a small belly accompany heavy breasts, treating them by liposuction at the same time extends the work on the figure. It only makes sense if the skin is firm: on a lax abdomen, it would worsen the appearance. The surgeon examines the skin standing and leaning forward to judge. A slimmer waist enhances the reduced breasts and gives a more balanced figure.

When the flanks are treated, the waist becomes defined and the reduced breasts take their place in a more balanced figure. The surgeon takes care not to create an artificial hollow and to respect the natural curve between the waist and the hip. Liposuction of the lower back often extends that of the flanks for a harmonious result from behind.

In women with large breasts, the arms are sometimes thick, especially at the back, and rub against the sides of the chest. Liposuction of the arms can be added if the skin is firm. If the skin is lax, an arm lift is more suitable; it is generally performed at another time. Our page on the arm lift presents this procedure.

In some women, large breasts are made up largely of fat, which is common after menopause, in overweight women or in some naturally fatty breasts. If the areola is not too low and the skin is of good quality, liposuction can reduce breast volume without the long scars of a conventional reduction. The skin partly retracts and the breasts lift a little, without the areola being repositioned.

This technique has limits: it does not remove the gland, does not correct marked sagging and does not allow the shape of the breast to be remodelled. The reduction in volume is often more modest than with a conventional reduction. It is therefore reserved for well-selected patients, after imaging confirms the fatty part of the breasts.

When several criteria are unfavourable, a conventional reduction remains more reliable.

Reduction by liposuction is attractive because there are no large scars, but it is not suitable for everyone. It does not remove the gland and therefore cannot reduce dense breasts. It does not raise the areola or correct a sagging shape. The reduction in volume is often more modest, of the order of one to two cup sizes. Finally, as the tissue removed is not analysed, good-quality prior imaging is required. It remains an excellent option for well-selected patients.

After reduction by liposuction, the breasts are on average one to two sizes smaller, slightly higher thanks to skin retraction, and keep their overall shape. The scars amount to a few marks of a few millimetres. Nipple sensation and the ability to breastfeed are generally preserved, as the gland stays in place. On the other hand, the areola keeps its position and size, and the shape is not remodelled. For many post-menopausal women whose breasts have become heavier over the years, this compromise is very satisfying.

Some women see their breasts grow after forty-five or fifty, with menopause and weight gain. These breasts, which have become fatty, sometimes cause new pain and discomfort in clothes. For them, if the areola is not too low, reduction by liposuction offers an attractive option, with a short recovery and minimal scars. Breast imaging is then routine before the procedure.

After reduction by liposuction, the breast skin must retract to fit the new volume. It does so better if it is young and elastic. Some technologies, such as radiofrequency or plasma, aim to encourage this retraction; their value depends on skin quality. Our page on J-Plasma liposuction describes one of them. Skin that is too lax remains an indication for a conventional reduction.

In most cases, liposuction complements a conventional reduction rather than replacing it.

Combining the two — a conventional reduction with liposuction of the sides — brings together the power of the first and the refinement of the second.

The combination is for a woman in good health whose breasts are too large and bothersome, and who has fat deposits on the sides of the chest, back or waist. Her weight is stable, the skin outside the breasts is of good quality, and she does not smoke or agrees to stop. She has finished having children or is not planning any in the near future. She understands the scars of the reduction and the limits of liposuction.

Women who consult for a reduction describe symptoms that are often long-standing: neck, shoulder and upper back pain that worsens at the end of the day, grooves dug by the straps, sometimes painful, irritation and fungal infections in the fold under the breasts, breathing discomfort when lying down, difficulty running, jumping or playing sport, and tingling in the hands for some. Added to these physical symptoms are difficulty finding clothes, discomfort at how others look at them and, often, a damaged self-image.

These symptoms are important to describe precisely, as they form the medical indication for the reduction and the request for insurance coverage. They are detailed on our page on breast reduction in Switzerland.

Under heavy breasts, the skin of the fold stays moist and rubs constantly. Redness, itching, fungal infections and unpleasant odours are common, especially in summer or after sport. Regular care, careful drying and breathable fabrics limit these problems without eliminating them. The reduction generally removes this moist fold. Repeated episodes of irritation, if documented by a doctor, count in the coverage file.

The weight of the breasts is transmitted to the shoulders by the straps and to the muscles of the neck and upper back, which work constantly to maintain posture. These muscles contract, become painful and can cause tension headaches. After the reduction, this workload decreases sharply. Many patients describe an immediate feeling of lightness, then, over the weeks, the gradual disappearance of neck tension.

The straps of a bra carrying large breasts dig grooves into the skin of the shoulders that are sometimes deep, red and painful, visible in a vest top. They reflect the load carried and are often mentioned in coverage files. After the reduction, the load decreases and these grooves gradually fade, even if a slight mark may remain when they were very old.

Very large breasts weigh on the chest when lying down and can make sleeping on your back difficult. During exertion, they make breathing less comfortable. Many patients describe more restful sleep and freer breathing during sport after the procedure. In the first few weeks, the support bra and compression garment may feel tight; a few regular deep breaths help you get used to them.

Very large breasts often attract stares and comments, sometimes from adolescence. Many women have adopted strategies to hide them: loose clothing, a hunched back, avoiding certain activities or the beach. This discomfort counts in the decision and in the benefit felt after the procedure. If it is accompanied by deeper distress, psychological support can be useful, before as well as after.

The side and back rolls add their own drawbacks: rubbing against the arms, irritation under the armpit in summer, discomfort from the bra band, the impression of a wide back in clothes. They do not, on their own, justify insurance coverage, but they count in the discomfort felt and in satisfaction after the procedure. Many patients say that their disappearance was as welcome as the lightening of the breasts themselves.

Before the consultation, it is useful to ask yourself a few simple questions. At what time of day does the pain appear? Which activities have I given up? How long does it take before the straps start to hurt? Which clothes do I avoid? These answers, written down, allow the discomfort to be described precisely and distinguish what stems from the breasts themselves from what stems from the rolls around them. Some surgeons also use validated quality-of-life questionnaires, useful for the insurance file.

Running, jumping, swimming front crawl or playing tennis with large breasts is often painful, even with two sports bras on top of each other. Many women gradually give up these activities, which encourages weight gain and, in a vicious circle, an increase in breast volume and rolls. For them, the procedure is not merely cosmetic: it reopens the door to regular physical activity, beneficial for health and for maintaining the result.

In young women, reduction is considered once the breasts have stabilised, generally after eighteen; symptoms can be significant from adolescence. Combined liposuction is then often limited to the sides of the chest. In middle-aged women, after pregnancies, the breasts are often heavier and lower, and deposits on the back and flanks are more common. After menopause, the breasts become fattier, which sometimes opens the way to reduction by liposuction. There is no age limit, but the medical assessment adapts.

Some jobs make large breasts particularly trying: care work involving frequent bending, prolonged screen work that accentuates neck tension, physical or sporting jobs, and jobs where a fitted uniform is worn. Many patients describe a new comfort at work after the procedure, with fewer breaks forced by pain. It is useful to mention these constraints at the consultation and in the coverage file.

Hypertrophy can appear from adolescence and cause significant physical and psychological distress. Reduction is generally considered once breast growth is complete, which is confirmed by stable measurements over several months. Combined liposuction is then limited, as the figure may still change. Parental involvement, sufficient time for reflection and psychological support if necessary are part of the process.

Breast reduction and liposuction give their best results in a woman whose weight is stable. Significant weight loss after the procedure would reduce breast volume and could make the breasts sag; weight gain would make them grow again and thicken the treated areas. In an overweight woman, prior weight loss is often advised: it also reduces breast volume and sometimes symptoms. A reduction that would relieve significant pain should not, however, be postponed indefinitely; it is a decision to make with the surgeon.

In an overweight woman, the breasts often contain a large proportion of fat, and the rolls on the trunk are more marked. Weight loss before the procedure reduces these volumes, lowers certain risks and improves the quality of the result. But large breasts sometimes make physical activity painful and hold back weight loss: in these situations, a reduction can on the contrary make things easier afterwards. The surgeon discusses this with you to find the best time.

Keeping fit before the procedure makes recovery easier. Walking, cycling or gentle swimming, depending on what your breasts allow, improve endurance and circulation. Strengthening the back and shoulder muscles, as advised by a physiotherapist, sometimes already relieves pain and will prepare for your return to activity. It is not about performance, but about arriving in good shape.

• Being pregnant, still breastfeeding or planning a baby in the coming months.
• Weight that is still changing significantly.
• Active smoking, because of the risk to the areola and healing.
• An abnormality on breast imaging that has not been investigated.
• Diabetes, blood pressure or a clotting disorder that is not sufficiently controlled.
• Very lax skin in the planned liposuction areas.

These situations most often lead to postponing the procedure or adapting the plan.

When the discomfort is significant and a pregnancy is planned later, the decision is delicate. A reduction before the pregnancy brings relief for years, but pregnancy and breastfeeding may change the result. Waiting until you have finished having children ensures a more lasting result, but prolongs the discomfort. There is no single right answer; the surgeon helps you weigh these elements according to your situation and plans.

Well-controlled diabetes does not contraindicate the procedure, but it increases the risk of infection and delayed healing, particularly at the junction of the scars under the breast. Strict blood sugar control before and after the procedure is essential. High blood pressure must be controlled to limit the risk of haematoma. The anaesthetist may ask for the opinion of the GP or a specialist.

A reduction combined with liposuction is a personal decision. It should respond to discomfort that you feel yourself, not to pressure from a partner, comparison with idealised images or a difficult period in life when you hope that changing your body will change everything. The surgeon takes time to explore these motivations. If they sense deeper distress, they may suggest postponing the procedure or relying on psychological support.

A personal history of breast cancer calls for specific care, coordinated with the oncology team; the reduction may then form part of a symmetrisation plan. In the case of a significant family history, prior imaging is particularly careful, and a genetic consultation may sometimes be offered before the procedure. The tissue removed during the reduction is always analysed.

The consultation begins by listening to your discomfort: symptoms, how long you have had them, treatments already tried, bra sizes, sports given up. The surgeon takes your history, pregnancies and breastfeeding, your weight and how it has changed, your treatments, your smoking and your family history of breast cancer.

They examine the breasts, measure them, palpate the gland, and assess the position of the areola, skin quality and the extent of the lateral extension. They then examine the fat areas — the sides of the chest, back, flanks and abdomen — assessing the skin quality of each. Photographs are taken from the front, in profile and from behind. They then present their plan: the volume envisaged, the scars, the liposuction areas and the procedure with the insurer.

The surgeon measures the distance between the top of the breastbone and the nipple, between the nipple and the fold, the width of the breast base and the diameter of the areola. These measurements show how far the areola needs to be raised, which technique is most suitable and what volume can be removed. They are also used in the coverage file, with the estimate of the weight of tissue to be removed.

When the two breasts are very different, a reduction may concern only one side, or be clearly larger on one side. Liposuction can refine the differences on the sides of the chest. The goal is balanced breasts, knowing that perfect symmetry does not exist naturally. Insurance coverage for a one-sided reduction follows the same rules of prior request.

The shape of the chest influences the result. An asymmetrical ribcage, a slightly curved spine or a difference in shoulder height can give the impression of asymmetrical breasts even after a perfect reduction. The surgeon observes these elements, photographs them and shows them to you, so that you know what can be corrected and what will remain.

The photographs taken at the consultation, from the front, in profile, at three-quarters and from behind, are used for the insurance file, preparing the procedure and follow-up. For this combination, the profile and back views are particularly important, as they show the rolls that the front view does not reveal. These images are confidential and are not used for other purposes without your written consent.

When several areas bother you, it is useful to rank them. The breasts are generally the priority, as they are the source of the symptoms. Next come the sides of the chest, often treated in the same procedure, then the back, then the flanks and abdomen. This ranking helps the surgeon build a plan that is reasonable in duration and cost, and decide what can wait for a second stage.

Before a reduction, an ultrasound, a mammogram or both are recommended, depending on age and history. They check for any abnormality, serve as a reference for future follow-up and, when reduction by liposuction is being considered, show the proportion of fat and gland in the breasts. The tissue removed during the reduction is sent for analysis; fat suctioned by liposuction, however, does not allow an equivalent analysis, which is a further reason for careful prior imaging.

Ultrasound and mammography show the distribution between dense glandular tissue and fatty tissue, which appears lighter on a mammogram. The radiologist can indicate whether the breasts are mainly fatty or, on the contrary, dense. This information, combined with the clinical examination, helps the surgeon choose between a conventional reduction and reduction by liposuction. It also serves as a starting point for comparing future examinations.

The final volume is decided with the surgeon according to your build, the width of your shoulders and pelvis, your wishes and technical constraints. A reduction that is too large can unbalance the figure; one that is too modest may not be enough to relieve the symptoms. In this combination, liposuction of the sides and back slims the upper body, which may allow a little more volume to be kept at the front while achieving a lighter figure.

The weight removed per breast varies from a few hundred grams to more than a kilo in significant hypertrophy. It is weighed in theatre and appears in the operative report. Insurers often refer to this weight, in relation to body shape, when assessing the coverage request. Fat suctioned during liposuction of the sides is generally not counted in the same way; ask the surgeon how they present these elements in the file.

Cup size is only an imperfect guide. It is more useful to talk about the shape you want: high, round breasts, natural slightly sloping breasts, more or less marked projection. Photographs of breasts you like, in women with a comparable body shape, help you understand each other. The surgeon explains what is achievable with your skin and gland.

Basic insurance may fund the reduction when the breasts cause documented physical problems and specific criteria are met, including a sufficient volume to be removed relative to body shape and the failure of conservative measures. The request is sent by the surgeon before the procedure; the insurer's medical adviser decides case by case.

Liposuction of the sides of the chest, when it is an integral part of the reduction, may be included in the covered procedure. Liposuction of the back, flanks or abdomen, however, is considered cosmetic and remains at the patient's expense. A reduction performed solely by liposuction raises specific coverage questions, to be clarified with the insurer before the procedure.

Before the procedure, do not hesitate to contact your insurer directly to check that the request has been received, find out how long the reply will take and understand what will be reimbursed: recognised facility, room category, deductible (franchise) and co-payment (quote-part). Ask for written confirmation. These steps avoid unpleasant surprises when the bill arrives.

When the reduction is covered and liposuction of other areas is added, the bill is split into two parts: the medical part, settled according to the insurance rules, and the cosmetic part, billed directly. Shared costs, such as those of the operating theatre and anaesthesia, are apportioned according to the time spent on each procedure. It is essential to have, before the procedure, the insurer's written reply and a quote that clearly sets out this split, including the deductible and co-payment.

A strong request file describes the symptoms and their duration, the treatments tried — such as physiotherapy, painkillers or suitable bras — and any skin irritation, and includes photographs and measurements. An estimate of the weight of tissue to be removed is often requested. A letter from the GP, rheumatologist or physiotherapist supports the request. If coverage is refused, it is possible to ask for the reasons and supplement the file.

Insurers often ask for proof that conservative measures have been tried. These generally include physiotherapy sessions to strengthen the back and correct posture, painkillers or anti-inflammatories for the pain, bras fitted by a professional and, if necessary, dermatological care for irritation under the breasts. Keeping the prescriptions, reports and invoices for these treatments strengthens the file.

Noting for a few weeks your pain, its intensity, when it occurs, the activities you have had to give up and episodes of skin irritation gives a precise picture of the discomfort. This diary helps the surgeon write the coverage request and, after the procedure, allows the relief obtained to be measured.

The GP has often known about breast-related pain for a long time. Their letter, describing the symptoms, how long they have lasted and the treatments tried, supports the coverage request. They can also prescribe the prior imaging, handle part of the follow-up and step in if there is a problem after discharge.

Planning early allows you to choose the date that best suits your working and family life.

Before the procedure, the surgeon gives you an information document describing the reduction technique, the liposuction areas, the scars, recovery, risks and alternatives. Take time to read it, ask your questions and discuss it with those close to you. Consent is signed after this reflection period. Keep a copy, along with the quote and the insurer's reply.

Several weeks beforehand, the tests requested by the surgeon and anaesthetist are carried out, along with breast imaging if it is not recent. All nicotine must be avoided for at least a month before the procedure. Aspirin, anti-inflammatories and certain supplements that thin the blood are stopped, with the doctor's agreement. Hormonal contraception is discussed if the length of the procedure or other factors increase the risk of thrombosis.

On the practical side, plan two to three weeks off for office work, help for the first few days, two wire-free support bras that fasten at the front, the compression garment suited to the liposuction areas, loose clothing and a place to sleep with your upper body raised.

The assessment generally includes a blood test, breast imaging and, depending on age and history, an electrocardiogram. Iron deficiency is common in women and accentuates fatigue after the procedure; it is useful to look for and correct it. Chronic illnesses must be well controlled.

Iron deficiency, common in women, accentuates fatigue after the procedure. It is useful to look for it during the assessment and correct it in advance if necessary. After the procedure, a diet rich in iron and protein helps recovery, and treatment may be prescribed if anaemia develops.

The combined pill increases the risk of thrombosis. For a procedure of this length, many surgeons do not ask women with no other risk factors to stop, but the question must be raised at the anaesthesia consultation. If other factors are present, stopping a few weeks beforehand may be advised, with non-hormonal contraception in the meantime.

For two to three weeks, you must avoid raising your arms high and carrying loads. Store what you will need at chest height, prepare a few meals, plan clothes that open at the front and pillows to sleep with your upper body raised. If you have young children, arrange help to carry them.

After a reduction, the areola remains connected to the rest of the breast by a bridge of tissue that supplies it. Smoking constricts small vessels and can compromise this blood supply, with a risk of areola compromise and delayed healing, particularly at the junction of the scars under the breast. It also increases the risk of infection and slows recovery after liposuction. Stopping completely is therefore required, including nicotine e-cigarettes and substitutes.

The procedure is generally performed under general anaesthesia. The anaesthetist sees you beforehand to assess your health, treatments and risk of thrombosis, and to explain pain management. Local anaesthetic infiltration in the liposuction areas and around the breasts prolongs comfort on waking.

• What type of anaesthesia is planned?
• How will back and breast pain be relieved on waking?
• Should I adjust my contraception or treatments?
• Will I need injections against thrombosis after the procedure?
• What if I had nausea after a previous anaesthetic?

The surgeon draws the midline, each fold, the future position of the areola and the pattern of skin to be removed, checking that both sides match. They then mark the liposuction areas — the lateral extension, the sides of the chest, the back folds, the flanks or abdomen — distinguishing the areas to slim, the transitions and the areas to preserve. This drawing is shown to you before you go to theatre.

The surgeon often begins with the areas that require turning, such as the back, with the patient lying on her front or side. They then perform, with the patient on her back, liposuction of the sides of the chest and possibly the abdomen, then the breast reduction. Others prefer to begin with the reduction. What matters is that the drawings of the breasts and liposuction areas are consistent and that the total duration remains reasonable.

When the back needs to be treated, the patient is first placed on her front or side. After back liposuction, she is turned onto her back for the sides of the chest, any abdominal work and the breast reduction. Turns are performed under anaesthesia, with precautions for the shoulders, eyes and pressure points. Finishing on the back allows breast symmetry to be checked in a semi-sitting position.

Depending on the chosen technique, the surgeon makes incisions around the areola and vertically, sometimes also in the fold. They preserve a pedicle of tissue that supplies the areola, remove the excess gland, fat and skin, raise the areola and bring together the remaining gland pillars to give the breast a high, firm shape. The tissue removed is weighed and sent for analysis. They check symmetry in a semi-sitting position, then close in several layers.

During the reduction, the areola remains connected to the breast by a pedicle of tissue that brings it vessels and nerves. It can be oriented upwards, downwards, inwards or centrally. The choice depends on how far the areola must be raised, the volume to be removed and the surgeon's practice. A well-chosen pedicle preserves blood supply, sensation and, to some extent, the ability to breastfeed.

The vertical technique leaves a scar around the areola and a vertical scar down to the fold; it gives well-projected breasts and suits moderate reductions. The inverted-T technique adds a horizontal scar in the fold; it allows larger volumes to be removed and excess skin to be better controlled. In both cases, liposuction of the sides of the chest refines the outer edge of the breast and can sometimes shorten the horizontal scar.

In the inverted-T technique, the horizontal scar in the fold can be long, especially when the breasts are wide and spill over to the sides. Liposuction of the sides of the chest often allows it to be shortened, by reducing the tissue that would otherwise have to be removed laterally. This is one of the technical benefits of the combination, beyond improving the figure.

Before closing, the surgeon raises the table to place the patient in a semi-sitting position. They compare the height of the areolas, the volume and shape of the two breasts, and the evenness of the sides of the chest. If necessary, they adjust by removing a little more tissue on one side or completing the liposuction. These checks reduce the need for touch-ups.

Liposuction of the sides of the chest and the extension towards the armpit is often performed through the reduction incisions or through a small additional incision. The surgeon refines the area while staying superficial, without approaching the hollow of the armpit, where vessels, nerves and lymph nodes are located. This liposuction gives the breast a cleaner outer edge and frees the arm.

Before each liposuction, the surgeon injects into the fat a solution of saline, local anaesthetic and adrenaline. It swells the tissues, makes it easier for the cannulas to pass, limits bleeding and prolongs pain relief after waking. Its quantity is calculated according to your weight and the area treated, as the local anaesthetic has a maximum dose.

These technologies are not essential. Their value depends on the density of the fat and the quality of the skin, and they may increase the cost.

The surgeon introduces fine cannulas through incisions of a few millimetres and suctions the fat in a fan pattern, with crossing passes from several entry points. They leave an even layer of fat under the skin, which avoids hollows and protects the skin's circulation. On the sides of the chest, they work superficially, away from the hollow of the armpit. On the back, they adapt the cannula diameter to the thickness of the tissues.

The back folds are treated through small incisions placed in the area of the bra band, where the scars are hidden. The surgeon suctions the fat evenly, taking care with the transition to the sides of the chest. As back fat is often fibrous, a vibrating cannula or ultrasound emulsification can make the procedure easier; our page on VASER liposuction presents this technique.

The area under the armpit links the front and back of the chest. If the sides are suctioned without touching the back, or vice versa, a step may appear at the transition. The surgeon therefore treats these regions as a whole, overlapping the cannula passes and checking evenness at each change of position. The result is judged by looking all around the chest, not just from the front.

When the reduction is carried out mainly by liposuction, the surgeon infiltrates the breasts with a solution that limits bleeding, then suctions the fat through two or three small incisions, often in the fold and at the side. They work evenly to preserve a harmonious shape and leave the gland in place. Assistive technologies can help the skin retract. The volume removed is more limited than with a conventional reduction, but the scars are minimal and recovery lighter.

Recovery is lighter than after a conventional reduction. The breasts are swollen and bruised for a few weeks, and a compression bra is worn day and night for about a month. A return to office work is often possible after a week. Volume continues to decrease as the swelling resolves, and the result is judged at around three to six months. As with any liposuction, small irregularities or asymmetry may require a touch-up.

The total volume of fat suctioned in one session is limited, according to the patient's weight and health. Combined with a breast reduction, liposuction generally remains moderate. If the plan exceeds these limits, some areas are kept for a second procedure. This choice, sometimes frustrating, is above all a safety choice.

When many areas are involved, or when health calls for caution, the surgeon may propose performing the reduction and liposuction of the sides first, then, a few months later, liposuction of the back, flanks or abdomen. This strategy shortens each procedure, reduces fatigue and allows the second stage to be adjusted to the result of the first. It costs a little more overall.

The breast scars are closed with fine, often absorbable stitches and protected by strips or dressings. The small liposuction incisions are left open or closed with a stitch. Drains are sometimes placed in the breasts for one or two days. You wake up already wearing the support bra and the compression garment.

If you stay at the clinic overnight, the nurses regularly check your blood pressure, pain, the colour of the areolas, the drains and the suctioned areas. A haematoma, if it occurs, is usually spotted during this night and treated quickly. The surgeon visits the next morning before discharge.

The breasts feel tight and heavy with dressings, but many patients describe a feeling of lightness on their shoulders from the moment they wake up. The liposuction areas, particularly the back, ache and are tender under pressure. Pinkish fluid drains from the small incisions for one to two days. Painkillers are almost always enough. You are helped to take your first steps the same day.

Many patients describe, from waking or in the first few days, a feeling of lightness on the shoulders and upper back, despite the dressings and the pain from the scars. This feeling is confirmed over the weeks as long-standing muscle tension eases. It is often the moment when you realise the real weight you had been carrying for years.

You leave with a prescription for painkillers and possibly an anticoagulant, written instructions, the number to call and the date of the first check-up. You travel home accompanied. A small cushion between the seat belt and your chest improves comfort. At home, alternate rest and short walks.

The first night at home is often the one that worries patients most. Prepare a bed with several pillows in advance to keep your upper body raised, a glass of water and your medicines within reach, and soft lighting. If the back has been treated, a pillow wedged behind you allows you to turn slightly. It is reassuring to have someone with you. Waking up may be stiff; a few steps around the flat in the morning help loosen up.

• Two wire-free support bras that fasten at the front.
• The compression garment for the back and sides, in two copies.
• The prescribed painkillers and, if necessary, the anticoagulant.
• Several pillows to sleep with your upper body raised.
• Loose tops that open at the front.
• Bed protection for the first few nights.
• The team's number and the date of the first check-up.

A relative present in the first few days helps you get up, dress, prepare meals and look after children. They can also photograph your back to follow the bruising and reassure you when the shape of the breasts is surprising. Explaining the course of recovery and the signs that require calling the team to them in advance is invaluable.

The start of recovery, over two or three days, is the most difficult phase. The breasts are tight, the scars pull, and the back is painful when you lean on it. Avoid raising your arms high and carrying loads, and walk several times a day. Bruises spread over the suctioned areas, sometimes onto the breasts, and fade within two to three weeks. Showering is generally allowed after forty-eight hours, depending on the dressings.

The first shower is generally possible after forty-eight hours. Lukewarm, preferably with a relative nearby the first time, it is taken after removing the bra and compression garment. Gently wash the scars without rubbing, pat dry, then quickly put the support garments back on.

For two to three weeks, avoid raising your arms above your shoulders, carrying more than a few kilos, and pushing or pulling forcefully. Washing your hair with your arms raised, hanging out washing or reaching for something high up requires a little organisation. These precautions protect the scars and limit pain.

For two to three weeks, carrying a child is not advised, as it puts strain on the arms and chest. Arrange help for getting them up, bath times, school runs and the moments when the child wants to be picked up. You can cuddle them sitting down, with the child beside you. Simply explaining what is happening to older children helps them understand and take part.

Bruising on the back is often extensive and moves down towards the waist with gravity. You cannot see it yourself, which may reassure or worry you. A photograph taken by a relative allows its progress to be followed. It changes from purple to yellow and disappears within two to three weeks. An area that remains red, hot and painful, however, should be shown to the surgeon.

The support bra is worn day and night for four to six weeks. It supports the breasts, limits swelling and protects the scars. The liposuction areas are held by a suitable garment: a vest or long bra covering the back and sides, possibly a panty if the flanks and abdomen have been treated. These garments must be compatible: a compression bra that also covers the breasts can replace the support bra, depending on the surgeon's choice.

For liposuction of the sides and back, the suitable garment is a long bra or vest reaching down to the waist, covering the back and sides. If the flanks or abdomen have been treated, a panty or girdle is added. The garment must be tight enough to support without cutting off circulation, without thick seams over the suctioned areas, and easy to open at the front. Two copies allow one to be washed without interruption.

Shirts and cardigans that button at the front avoid having to raise your arms to dress. The support bra and compression garment are easy to hide. Many patients are delighted to discover that they can wear more fitted clothes once the swelling has resolved, without buttons straining across the chest or rolls marked by the band.

The breasts are sensitive and tight, without generally being very painful; pain is often more marked on the back and sides, liposuction areas strained by movement and pressure. It decreases markedly after a few days. Pain that suddenly increases in one breast, with tense swelling, requires calling the team.

You often feel exhausted for ten to fifteen days, while the body recovers from the anaesthetic and heals in several areas. This is more marked when several areas have been treated. Allow yourself naps, drink plenty and resume your activities step by step; unusual breathlessness together with intense fatigue must be reported.

In the first few weeks, sleeping on your back with your upper body slightly raised is the most suitable position. When the back has been treated, lying on it may be painful in the first few days; a slightly three-quarter position, supported by pillows, is often more comfortable. Sleeping on your side becomes possible again after a few weeks, on your front later.

After back liposuction, lying on your back is tender in the first few days, even though it is the recommended position for the breasts. A compromise is to sleep turned slightly three-quarters, supported by a long cushion behind you, or in a reclining chair for the first few nights. The discomfort decreases markedly after a week as the back aching fades.

After reduction by liposuction alone, the return is often quicker, sometimes after a week.

For a successful return, plan a few days part-time or working from home if possible, adjust your workstation to avoid raising your arms, and take breaks to walk. The compression garment is worn under loose clothing. Avoid long sedentary meetings in the first few weeks. If your job involves repetitive arm movements, ask for a temporary adjustment.

Intimate relations can resume when you feel ready, often after two to three weeks, taking care of the breasts and back. Breast sensation may be altered for a while. For many women, lighter breasts also make intimacy more comfortable.

Dressed, nothing gives away the procedure. Most patients go out again after one to two weeks. The pool and beach wait until the scars have fully closed and the bruising has gone.

For a self-employed woman, time off linked to the cosmetic part of the procedure is generally not compensated, whereas the part linked to a covered reduction may be, depending on the insurance. For a job that uses the arms, such as care work, hairdressing or handling, returning often takes three to five weeks. Scheduling the procedure during a quieter period is useful.

For many patients, returning to sport is one of the highlights of recovery: lighter breasts make possible activities given up long ago.

The return is gradual: walking, then cycling or brisk walking, then running and strength training. At each stage, a well-supporting sports bra protects the scars and the shape of the breasts. Exercises that strongly stretch the chest or work the arms intensively wait six to eight weeks. Unusual pain or swelling after exercise means slowing down and, if it persists, seeking advice.

After a reduction, finding an effective sports bra becomes much easier. A well-supporting sports bra protects the scars during exercise and limits breast movement, which helps the shape hold over time. It is better to wait until the shape has stabilised, at around two to three months, before investing in several models.

A balanced diet rich in protein, fruit and vegetables promotes healing. Drinking enough helps clear swelling. Eating less salt for a month limits swelling; any diet can wait until recovery is over. After that, the key will be to keep a stable weight.

The reduction scars go around the areola and run vertically towards the fold; in the inverted-T technique, a horizontal scar follows the fold. They are pink at first, sometimes slightly thick, then thin out and fade over one to two years. The liposuction incisions, a few millimetres long, are placed in creases or under the bra band. Care is simple: gentle massage once the scars have closed, silicone gel or sheets, and strict sun protection for at least a year.

As soon as the scars have fully closed, massage them for a few minutes a day with a neutral cream. Silicone, as a gel or sheet, applied for several months, makes them flatter and lighter, and sun protection is essential for at least the first year.

Some skin tends to form thick, red scars, especially on the breasts, at the junction of the scars and at the end of the horizontal scar. This risk is greater on olive or dark skin and in people who have formed such scars before. Mention it before the procedure: preventive measures can be taken, and treatments exist if thickening occurs, such as silicone dressings, injections or certain lasers.

Exposed too early, scars darken permanently: cover them or protect them with high-factor sunscreen for twelve months. Baths, swimming pools, saunas and steam rooms wait four to six weeks. The liposuction areas, whose sensation is reduced, must not be exposed to direct heat.

Many patients prefer autumn or winter: covering clothes hide the support garments, the scars are naturally protected from the sun, and the shape has time to stabilise before summer. A procedure in spring means giving up swimming for a few weeks.

Beyond the season, it is useful to look at your diary: avoid periods of heavy workload, major travel or family events in the month that follows. For a mother, scheduling the procedure at a time when her partner or family can be more present makes recovery easier. Also allowing for the insurer's reply time, which can take several weeks, avoids having to postpone a date already set.

Just after the procedure, the breasts are high, firm and sometimes slightly square at the bottom, especially with the vertical technique, whose scar looks puckered in the first few weeks. They gradually descend and round out over two to three months, and the puckering of the vertical scar fades. The liposuction areas are swollen and sometimes firm; the contours take shape as the swelling resolves. It takes three to six months to judge the result.

In the first few weeks, everything seems provisional: high, slightly square breasts, a puckered vertical scar, a swollen, firm back. This is the normal appearance of breasts and a trunk that are healing. The final shape emerges over three to six months, and the scars mature over one to two years. Setting milestones for judging, at three months and then one year, avoids a lot of needless worry.

In the first few weeks, it is common to be disconcerted by the shape of the breasts, still high and slightly square, by the pink scars and by the swelling of the liposuction areas. The feeling of lightness on the shoulders, however, is often immediate and comforting. Taking regular photographs helps you see the progress. Sadness that sets in beyond a few weeks deserves to be discussed with your doctor.

For many women, the procedure is also a rare opportunity to put themselves first for a few weeks. Accepting help, delegating heavy tasks, postponing certain obligations and genuinely resting are all part of a successful recovery. Patients who resume all their activities too quickly, out of habit or guilt, are more prone to fatigue, a seroma on the back or slower healing. A few weeks of well-organised patience prepare years of comfort.

It can be useful to plan calm activities for these weeks: reading, series, calls to friends and family, short walks. They help you get through the recovery period without impatience, giving the body the time it needs to heal. Those close to you, often keen to help, also appreciate being told exactly what you need: shopping, meals, journeys or simply company during the first few days. This clarity avoids misunderstandings and allows everyone to find their place in organising the recovery. It also relieves the patient, who no longer has to improvise every day. A list on the fridge, with the tasks and everyone's names, is often enough.

Regular photographs from the front, in profile and from behind, taken in the same light and posture, help you follow the breasts settling, the fading of the puckering on the vertical scar and the evolution of the suctioned areas. Comparing week three with the day before the procedure is often disconcerting; comparing month three with month one generally shows clear progress.

Manual lymphatic drainage can help reduce swelling in the liposuction areas, particularly the back and flanks. It generally starts after one to two weeks. The breasts themselves are not massaged in the first few weeks. Later, gentle massage of the treated areas helps soften firm areas.

The suctioned areas remain numb for a while, then tingle or become sensitive to the touch as the small nerves repair. It is common to feel firmer patches under the skin, especially on the back; they soften over the months, helped by massage. These sensations are normal in the absence of redness, warmth or fever.

You will be seen at one week, then at one, three, six and twelve months; at each visit, the surgeon examines healing, the shape and symmetry of the breasts, the blood supply to the areolas, the liposuction areas and skin retraction. They give you the result of the tissue analysis. Breast imaging surveillance then resumes according to the usual screening recommendations.

At around one week, the surgeon checks the scars, particularly at the junction under the breast, the colour of the areolas, the absence of haematoma and the liposuction areas. They remove any drains and non-absorbable stitches, check the fit of the bra and compression garment, and clarify the next instructions.

The reduction does not change the need for breast cancer screening. The procedure leaves internal changes and sometimes tiny benign calcifications that the radiologist must be able to interpret; keeping the operative report and the tissue analysis result makes follow-up easier.

The combination brings together the risks of breast reduction and those of liposuction. Most are benign; serious complications are rare.

Blood can collect in a breast in the first few hours or days, with rapid, tense, painful swelling on one side. It often requires a short return to theatre to drain the blood. In the liposuction areas, extensive bruising is common but is not a haematoma. Stopping blood-thinning products beforehand and controlling blood pressure limit this risk.

Infection is uncommon. It shows as a scar that becomes red, hot and increasingly painful, cloudy discharge or fever. It more often affects patients who smoke, have diabetes or are overweight. Antibiotic treatment is generally enough; a collection may require drainage.

The most fragile spot is the junction between the vertical and horizontal scars, under the breast, where tension is greatest and blood supply poorest. It sometimes opens slightly between the first and third weeks; the wound usually closes with local care within a few weeks, sometimes leaving a slightly wider scar that can be revised later. Smoking, diabetes and excess weight increase this risk.

The areola depends on the pedicle of tissue that connects it to the breast. If this supply is insufficient, particularly in smokers or very large reductions, the areola may darken and lose part of its surface; close monitoring in the first few days allows early action. A partial loss can be reconstructed later.

After a reduction, some of the breast fat may not survive well and form small firm nodules, called fat necrosis. They are benign but can be worrying on palpation or appear on imaging. The radiologist can generally recognise them, especially if informed of the procedure. A further examination is sometimes needed to be sure. They often shrink over time.

On the back and sides, hollows, bumps or a step between treated and untreated areas may appear. As long as swelling and firm areas persist, it is too early to conclude there is a defect. A hollow or bump still present after six to twelve months can be revised with a small additional suction or a fat injection.

A seroma is a collection of fluid under the skin in an area of extensive liposuction, particularly the back or flanks. It shows as a soft swelling that ripples under pressure. It is treated by aspiration at the practice. Wearing the compression garment regularly reduces its frequency.

Areola sensation may be reduced or increased for several months. It usually returns, but a lasting reduction is possible, more common after a large reduction. The liposuction areas may remain numb for a few weeks to a few months, then become the site of tingling as the nerves recover.

Breast tenderness before periods may persist after the reduction, as the remaining gland still responds to hormones. It is often reduced, as the volume is smaller. New, localised or persistent pain, however, should be reported.

A slight difference between the two breasts, in volume, shape or areola position, is common after a reduction, as it often was before. It sometimes eases as the swelling resolves. Clear asymmetry that persists after a year can be corrected with a touch-up, often under local anaesthesia. In the liposuction areas, a difference between the two sides of the back or flanks is corrected in the same way.

At the end of the horizontal scar, on the side of the chest, a small fold of skin may persist. Liposuction of the sides reduces this risk by slimming the area. If the fold is still visible after several months, a small touch-up under local anaesthesia corrects it.

After the reduction, the areolas are smaller and rounder. Their colour may be slightly altered for a few months. The scar around the areola may widen a little over time, especially if the skin is thin. Specific closure techniques limit this; if widening is bothersome, a small touch-up is possible.

Depending on the case, breastfeeding remains complete, becomes partial or is no longer possible. Maintaining continuity between the areola and the gland beneath it better protects this function. Reduction by liposuction, which leaves the gland in place, generally affects it little. If future breastfeeding matters to you, talk to the surgeon.

The longer the procedure and the larger the suctioned area, the higher this risk. Compression stockings, inflatable leg sleeves in theatre, getting up early, drinking plenty and sometimes anticoagulant injections make up the prevention, tailored to each patient. A painful or swollen calf, breathlessness or chest pain require a call to 144.

• A breast that swells rapidly and becomes painful.
• An areola that darkens or turns purplish.
• A fever above 38.5 degrees, spreading redness or cloudy discharge.
• A scar that opens widely.
• A painful calf, breathlessness or chest pain.

Keep the number the team gave you close at hand.

In doubt? Call the team, even for a question that seems trivial to you. Sending a photograph, if the team offers this, often allows a quick response about a scar or an areola. Report any fever, new medication or unusual symptom.

A touch-up can be considered after six months to a year, once the result has stabilised: asymmetry, a small excess of skin at the end of a scar, a widened scar, a liposuction irregularity. It is often performed under local anaesthesia. If the insurer paid for the reduction, a purely cosmetic revision will in principle be billed to you: ask at the quote stage how the surgeon handles these situations.

Some patients want, once the result has stabilised, to treat an area that was left out, such as the arms, inner thighs or abdomen if the skin allows. This second, shorter procedure is generally scheduled at least six months after the first. It is not unusual, once the breasts are lighter and the back slimmer, for the concern about these secondary areas to diminish and the second stage to become less necessary.

When the reduction has been covered, treatment of a medical complication generally falls within the same framework. Correcting a small asymmetry or a scar, however, is cosmetic and will be billed to you, like any revision of the liposuction. Clarify these points with the surgeon before the procedure.

When the combination is successful, the breasts are lighter, higher and proportionate, and the upper body looks slimmer: no more roll under the arms, a smooth back under the bra band, a better-defined waist if the flanks have been treated. Physical relief is often rapid: many patients describe the disappearance of shoulder and neck pain in the following weeks. The choice of clothes widens, sport becomes possible again, and self-image changes.

After the procedure, the back folds under the bra band are clearly softened or disappear, especially as the band can now be less tight. The bulge between the breast and the armpit gives way to a clean transition. On the flanks, the waist takes shape. These changes emerge gradually as the swelling resolves and can really be judged after three to six months. A very slight fold may persist where the skin is thick; it is rarely bothersome.

The reduction lightens the load on the neck and shoulders. Many patients straighten up spontaneously in the following weeks, the shoulders open and the head returns to its natural position. Neck and shoulder pain decreases markedly in most. Lower back pain depends more on the spine and musculature. Strengthening physiotherapy, once recovery is over, helps consolidate this new balance.

To relieve the weight of the breasts, or to hide them, many women round their shoulders forward. Over the years, the chest muscles shorten and those of the upper back weaken, which maintains the posture even after the reduction. Shoulder-opening and upper-back strengthening exercises, begun once healing is complete, help regain an upright posture and prolong the benefit of the procedure.

In some patients, back pain persists after the procedure because it is also linked to the spine, osteoarthritis or long-standing muscle weakness. The reduction has then relieved the part linked to the weight of the breasts, but not the rest. An assessment by the GP or a rheumatologist and targeted physiotherapy allow this residual pain to be treated. It is useful to know this before the procedure, to keep expectations realistic.

Once recovery is over, many women resume or start regular activity: running, swimming, dancing, fitness. This activity maintains the result, helps keep a stable weight and strengthens the back. A suitable sports bra protects the shape of the breasts. A programme to strengthen the postural muscles, guided by a physiotherapist, consolidates the relief of pain.

Beyond the physical relief, many women describe a profound change in how they see themselves: the end of a long-standing discomfort, sometimes since adolescence, the freedom to choose their clothes, the possibility of playing sport without thinking about it. Getting used to smaller breasts after so many years sometimes takes a few weeks.

Many patients discover they can finally wear clothes chosen for their taste rather than to hide their breasts: button-up shirts that no longer gape, fitted dresses, vest tops, one-piece swimsuits without reinforced underwiring. Top sizes decrease, sometimes the band size too. It is wise to wait a few months before renewing your wardrobe, until the shape has stabilised.

Once the back folds have been smoothed, fitted clothes hang differently: a close-fitting T-shirt no longer shows rolls, a figure-hugging dress traces a continuous line from the shoulders to the waist, and the bra no longer creates a visible ridge. This change is often one that those around you notice, without always knowing what to attribute it to.

With large breasts, finding a swimsuit that supports properly without compressing is often a headache, and the back rolls bulge above the back of the swimsuit. After the combination, the choice widens considerably. You must, however, wait until healing is complete, generally six weeks, before swimming, and protect the scars from the sun during the first year, with a covering swimsuit or high-factor sunscreen.

Once healing is complete, the disappearance of the moist fold under the breasts simplifies hygiene and ends recurrent irritation. Underarm sweating, partly linked to the rubbing of the side rolls, is often less bothersome. These very concrete improvements count for a great deal in daily comfort, particularly in summer and during sport.

Just after the procedure, the breasts look high and flat at the top, fuller at the bottom. Within a few weeks, the gland descends slightly and the breasts take on a more natural shape, with a fuller upper pole and a rounded lower pole. The puckering of the vertical scar fades. This evolution, well known to surgeons, explains why the final shape is judged after several months.

Repeating a few simple measurements at three, six and twelve months — bust, underbust and waist — and comparing them with those taken before the procedure gives an objective picture of the change. Combined with photographs taken under the same conditions, they show what the mirror, influenced by the mood of the day, sometimes reflects poorly.

Wait two to three months, until the shape has stabilised, before buying permanent bras. The choice becomes much wider: light, wire-free, colourful styles that large breasts used to rule out. The band can be less tight than before, which helps the back folds disappear.

Twelve months after the procedure, a consultation reviews the shape and symmetry of the breasts, the scars, the liposuction areas and the relief of symptoms. It is the time to discuss a possible touch-up and to recall the breast surveillance schedule.

Going back, a few months after the procedure, to the symptom diary kept beforehand lets you measure how far you have come: neck and shoulder pain, headaches, irritation, activities resumed. Many patients are surprised to see how much their daily life has changed. This review is also useful for the surgeon in assessing the result beyond appearance.

The volume removed does not come back, and neither does the suctioned fat. The result is lasting as long as weight remains stable. The breasts nevertheless continue to change with age, hormonal variations and gravity: some sagging may reappear over the years, without returning to the original volume. A pregnancy can also make the breasts grow again. Regular physical activity and suitable support during sport help preserve the shape.

The volume removed does not come back, but significant weight gain would make the breasts and the remaining fat areas grow again. Conversely, marked weight loss can make the breasts sag. Keeping a stable weight, through a balanced diet and regular activity, is the best way to preserve the result.

A pregnancy remains possible after a reduction. During pregnancy, the breasts regain volume, then may empty or sag again, which affects the result. Breastfeeding is possible for some women, partial or impossible for others, depending on the technique. The liposuction areas may also be changed by weight gain. It is preferable to have finished having children or not to be planning any in the near future.

At menopause, the gland decreases and the breasts become fattier. After a reduction, this evolution may slightly change the shape, with some slackening, without returning to the original volume. Weight tends to redistribute towards the waist. Regular physical activity and a stable weight limit these effects.

With hindsight, most women keep lighter breasts and lasting comfort, even if the shape changes over the years. The liposuction areas keep their appearance as long as weight remains stable. The scars, now fine and pale, are often forgotten. Many say they no longer think about their breasts in daily life, which was precisely the goal.

Breast reduction is one of the plastic surgery procedures that brings the greatest satisfaction, both physically and in terms of quality of life. Patients rarely regret their decision; the regret most often expressed is not having done it sooner. Adding upper-body liposuction further improves aesthetic satisfaction, by removing rolls that a reduction alone would have left.

Several observations come up repeatedly in testimonials. Relief in the shoulders is often felt from the moment of waking. The back aching from the liposuction is surprising in the first few days. The shape of the breasts is slightly worrying at first, then rounds out. And the disappearance of the rolls under the arms and on the back is often cited as an unexpected benefit, almost as welcome as the lightening of the breasts.

Studies of women who have had a breast reduction show a clear and lasting improvement in pain, the ability to be physically active, sleep quality and self-image. These benefits are maintained over several years. Adding upper-body liposuction has not been the subject of as many specific studies, but patients often report that it completes the result by removing a discomfort that the reduction alone left behind.

Before surgery, some measures relieve part of the symptoms: a bra properly fitted by a professional, with wide straps and a firm band, strengthening of the back and shoulder muscles through physiotherapy, weight loss if indicated, and skin care in the fold under the breasts. They are often required by the insurer before accepting a reduction. When discomfort persists despite them, surgery becomes the most effective option.

Many women with large breasts wear a poorly fitting bra, often with a band that is too large and a cup that is too small. A band that is too loose rides up at the back and transfers all the weight to the straps, which worsens shoulder pain. A fitting with a professional, with a firm band and enveloping cups, sometimes brings surprising relief. It is not an alternative to reduction when the discomfort is significant, but it is a useful step, and one often required by the insurer.

Before the procedure, physiotherapy strengthens the back and shoulder muscles, corrects posture and relieves some of the pain. It also documents the relative failure of conservative measures, which is useful for the file. After the procedure, once healing is complete, it helps regain an upright posture and consolidate the relief. A few sessions are often enough, supplemented by exercises to do at home.

Sagging breasts of reasonable volume are lifted rather than reduced. A breast lift, possibly combined with a slight reduction, is then more suitable; our page on the breast lift describes it. Liposuction of the sides and back can be combined with it in the same way.

To compare options without amounts, each one is expressed relative to a base of 100: a breast reduction with liposuction of the sides of the chest and back, performed in Geneva and entirely at the patient's expense.

When the reduction is covered, the amount you pay is largely limited to the cosmetic liposuction. Details are on our page on breast reduction with liposuction prices.

Several elements affect the amount: the number of areas suctioned, the reduction technique, the use of an assistive technology, the length of stay, the room category and the clinic are the main factors. The insurer's reply for the reduction profoundly changes the amount left to pay. Follow-up consultations, support garments and the touch-up policy may or may not be included.

The quote should detail the surgeon's and anaesthetist's fees, the cost of theatre and the stay, the reduction technique, the liposuction areas, tissue analysis, support garments, follow-up included and the touch-up policy. If coverage is planned, it distinguishes the medical part from the cosmetic part and indicates how shared costs are apportioned.

To compare two quotes, check that they cover the same reduction technique, the same liposuction areas, the same length of stay and the same services included: follow-up consultations, garments, tissue analysis, touch-ups. Also check how each facility splits the costs between the covered part and the cosmetic part. A lower quote may simply include fewer areas or fewer services.

The quote is supplemented by the deductible (franchise) and co-payment (quote-part) for the covered part, new bras once the shape has stabilised, any drainage sessions, painkillers and dressings, and loss of income for self-employed women. Planning for these allows a calm decision.

Some clinics offer staggered payment for the cosmetic part. Before accepting, calculate the total amount repaid and check that the instalments remain affordable, taking into account any time off work.

Breast reduction is performed in many hospitals and clinics in Switzerland, and combined liposuction by most plastic surgeons. Here, for twenty-two cities, are the extent of provision and the price of the non-reimbursed part, compared with Geneva.

The reimbursed part, for its part, follows the tariffs set by the insurance, wherever you have surgery.

For the medical part, the chosen facility must be recognised by your insurer; a hospital stay outside your canton may change the reimbursement depending on your cover. Have your insurer check this point before you choose.

The Lake Geneva region, from Geneva to Vevey via Lausanne and Pully, offers the widest choice, with hospital departments and private clinics. Northern Vaud around Yverdon, central Valais and the Chablais, Neuchâtel and Fribourg also have plastic surgeons who regularly perform breast reduction. Patients from Jura often turn to Delémont, Biel/Bienne or Basel.

Zurich has the widest provision and attracts patients from the whole north-east of the country. Basel and Bern are two other major centres; Lucerne and Zug serve central Switzerland, St. Gallen eastern Switzerland. In the small cantons, the consultation and procedure generally take place in these centres, with check-ups then possibly shared with the GP.

Lugano and Bellinzona have plastic surgeons and hospitals that perform breast reduction. Consultations are in Italian, and most practitioners also speak French or German. In Graubünden, a few practitioners work in Chur, but Zurich, St. Gallen and Lugano attract a good share of patients.

The post-operative instructions about the bra, compression, movements to avoid and warning signs must be fully understood. In bilingual regions, such as around Biel/Bienne or Fribourg, the consultation can be held in either language. In Zurich, Basel or Bern, many practitioners are also happy to consult in French or English. In Ticino, Italian predominates, with good French.

Consulting far from home is possible, but the first check-up, at around a week, is important for checking the scars and areolas. You need to plan to be accompanied home and to have a local contact — GP or nurse — in case of a problem. For the covered part, check that the facility is recognised by your insurer.

A second opinion is useful to confirm the reduction technique, the extent of the liposuction and, where applicable, the value of reduction by liposuction. It can also shed light on the procedure with the insurer. If opinions differ, ask each surgeon to justify their recommendation.

The surgeon must master both breast reduction and liposuction, and be used to combining them. Ask how many reductions they perform, which techniques they use, whether they perform reduction by liposuction and for which patients, and look at results in women with a comparable body shape, from the front, in profile and from behind. A good surgeon will also tell you when liposuction is not suitable, for example on a lax abdomen.

The procedure involves a surgeon, an anaesthetist, theatre and recovery room staff, ward nurses and, afterwards, possibly a drainage therapist, a physiotherapist and the GP. Ask who your contact is after discharge and how to reach the team at night and at weekends.

Check online, in the federal register, that the practitioner holds the specialist title in plastic surgery. For a reduction covered by insurance, the surgeon must operate in a recognised facility. For the combined liposuction, they must have an anaesthesia team and post-operative monitoring.

For a covered reduction, the facility must be recognised by your insurer, and the room category depends on your cover. For the combination, it must have an operating theatre, an anaesthesia team, post-operative monitoring and the possibility of staying overnight. Find out how complications are handled.

• Which reduction technique do you propose, and what scars should I expect?
• Is reduction by liposuction possible in my case?
• Which liposuction areas do you recommend, and which do you advise against?
• Is liposuction of the sides of the chest part of the covered reduction?
• How will the bill be split between the insurer and me?
• How long does the procedure take and do I need to stay overnight?
• Which problems do you see most often in your patients?
• What happens if a correction is needed, and at what price?

• Thinking that liposuction can replace a conventional reduction for all breasts.
• Asking for abdominal liposuction when the skin is lax.
• Scheduling the procedure before the insurer's reply.
• Continuing to smoke.
• Abandoning the support bra or compression too early.
• Judging the shape of the breasts in the first few weeks.
• Neglecting breast surveillance after the procedure.

The young sportswoman

At twenty-four, this handball player has very large breasts that cause her pain during matches, with side rolls that rub against her arms. Her skin is firm. The surgeon proposes a vertical reduction combined with liposuction of the sides of the chest. A request for coverage of the reduction is made and accepted.

The mother with a full back

At forty-three, after two pregnancies, this patient suffers from shoulder pain and complains of folds on her back under the bra band. Her abdomen is firm. The combination includes an inverted-T reduction and liposuction of the sides and back. The back liposuction remains at her expense.

The post-menopausal woman with fatty breasts

At fifty-eight, this patient has seen her breasts grow with menopause. Imaging shows mainly fatty breasts, the areola is only slightly descended and the skin is of good quality. Reduction by liposuction is proposed, with minimal scars and a one-week recovery. The surgeon warns her that the reduction will be more modest than a conventional one.

The patient with a lax abdomen

At forty-one, this patient wants to combine a breast reduction and abdominal liposuction. Her abdomen has excess skin and separated muscles. The surgeon explains that liposuction would worsen the appearance and proposes either a reduction with abdominoplasty or two separate stages.

• My symptoms are described and documented.
• I have tried conservative measures or I know why they are not enough.
• The reduction technique and scars have been explained to me.
• I know which liposuction areas are planned and which are cosmetic.
• I have the insurer's reply for the reduction.
• I have a quote that distinguishes the medical and cosmetic parts.
• I have stopped smoking or I commit to doing so.
• My weight is stable and no pregnancy is planned in the short term.
• I have organised two to three weeks of recovery.

Before you decide, re-read your notes and check that you have clear answers on the technique, scars, liposuction areas, how the bill is split and how recovery is organised. If in any doubt, it is better to see the surgeon again or seek another opinion than to decide in haste. Well informed, you will approach the weeks of recovery more calmly.

Three questions sum up the decision. Does the discomfort caused by the breasts justify a reduction, and which one? Do the surrounding rolls deserve to be treated at the same time, and does the skin allow it? Are the conditions met — in terms of health, organisation and budget — for a single-stage procedure? When the answers are clear, the decision becomes simpler.

Combining breast reduction and liposuction treats both overly heavy breasts and the fat deposits surrounding them: the sides of the chest, the extension towards the armpit, the back and, if the skin is firm, the flanks and abdomen. In selected patients, liposuction can even form most of the reduction, with minimal scars. The procedure generally takes two and a half to four hours, and recovery takes two to three weeks for office work.

The reduction may be covered by insurance if the criteria are met; liposuction of other areas remains cosmetic, leading to a two-part bill. Depending on the canton, the cosmetic part can cost up to fourteen per cent less than in Geneva. Choosing a surgeon experienced in both procedures remains decisive.

If your breasts cause you pain and the rolls around them bother you, a consultation will review the suitable technique, the areas to treat and the procedure with the insurer. Take time to understand and compare. Medespoir Suisse helps you, free of charge and without obligation, to find a plastic surgeon experienced in this combination, in the region that suits you.

Budget

Price differences between cities and cantons, the quote breakdown and ways to save are detailed on our page Breast reduction and liposuction: prices in Switzerland.

Related procedures

• Pectoral implants and Full HD liposuction in Switzerland
• Full HD liposuction and BodyTite for men in Switzerland
• Gynaecomastia and 360 liposuction in Switzerland
• Breast augmentation and liposuction in Switzerland
• RibXcar and 4D HD liposuction in Switzerland
• Breast fat transfer and liposuction in Switzerland

The procedures that make up this combination

• Breast reduction in Switzerland
• Liposuction in Switzerland
• VASER liposuction in Switzerland
• J-Plasma liposuction in Switzerland
• 4D HD liposuction in Switzerland

Our guides

• Combined procedures in Switzerland
• Cosmetic surgery in Switzerland

Lighter breasts, underarm rolls, a smoother back: the most common questions before a reduction combined with liposuction, and our answers.

Understanding the combination

Why combine liposuction with a breast reduction? To also treat the rolls that often surround heavy breasts, under the arms, on the back and sometimes at the waist.

Which areas are most often treated? The sides of the chest and the extension towards the armpit, the back under the bra band, and sometimes the flanks and abdomen.

Can breasts be reduced by liposuction alone? Yes, in some women whose breasts are mainly fatty, not very saggy, with good-quality skin.

How does it differ from a reduction with an abdominoplasty? An abdominoplasty treats a lax abdomen with excess skin. Liposuction is only suitable if the skin is firm.

Does the combination lengthen the procedure much? By half an hour to an hour and a half depending on the liposuction areas.

Do the rolls disappear with reduction alone? Rarely. They shrink a little with a less tight bra, but the fat remains.

For whom?

Who can benefit from this combination? A woman in good health, with a stable weight, bothersome breasts and fat deposits around them, who does not smoke or is prepared to stop.

Should I wait until I have finished having children? It is preferable not to plan a pregnancy soon, as it can make the breasts grow again.

Is there a minimum age? Reduction is considered once the breasts have stabilised, generally after eighteen.

Is it possible after menopause? Yes, and as the breasts become fattier, reduction by liposuction is sometimes possible.

Should I lose weight beforehand? If you are overweight, prior weight loss is often advised, without indefinitely postponing a reduction that would bring relief.

Can smokers have surgery? Only after stopping all nicotine for several weeks beforehand.

Insurance

Does insurance pay for the reduction? Compulsory insurance may fund it if the symptoms are documented and the criteria are met, after prior approval.

And the liposuction? Liposuction of the back, flanks or abdomen is cosmetic. Liposuction of the sides of the chest may be part of the reduction.

How is the bill handled? It is split between the covered part and the cosmetic part, with shared costs apportioned.

Is reduction by liposuction covered? This must be clarified with the insurer before the procedure.

What if coverage is refused? Ask for the reasons, supplement the file and, if necessary, lodge an objection according to the insurer's procedure.

Will I pay a deductible? For the reimbursed part, the deductible (franchise) and co-payment (quote-part) apply as for any treatment, according to your policy.

The procedure

How long does the procedure take? From two and a half to four and a half hours depending on the areas; about two hours for reduction by liposuction alone.

Do I need to stay overnight? Often one night. Reduction by liposuction alone is generally day surgery.

What scars on the breasts? Around the areola and vertical, sometimes in the fold. With liposuction alone, a few incisions of a few millimetres.

Where are the scars from back liposuction? In the area of the bra band, where they are hidden.

Is the tissue removed analysed? Yes, the tissue from the reduction is sent for analysis.

Is the areola raised? Yes in a conventional reduction. Not in reduction by liposuction.

Are drains used? Sometimes in the breasts for one or two days.

What anaesthesia? Generally general anaesthesia.

Recovery

Is the pain severe? Generally moderate. The back and sides are often more painful than the breasts in the first few days.

How long is the support bra worn? Continuously, day and night, for a month to six weeks.

And the compression garment? Three to four weeks day and night, then often during the day for a few weeks.

When can I return to work? Ten to fourteen days for office work, longer for physical work; often one week after reduction by liposuction.

How should I sleep? On your back, upper body slightly raised, or turned three-quarters if the back has been treated.

When can I drive? Generally after one to two weeks, when movements are no longer painful.

When can I raise my arms? Wide movements are limited for two to three weeks.

Is bruising significant? It can be on the back and sides, and disappears within two to three weeks.

Is lymphatic drainage useful? It can help for the liposuction areas, especially the back and flanks.

Why is the vertical scar puckered? This is normal with the vertical technique. The puckering fades within a few weeks to a few months.

Sport

When can I resume sport? Walking from the next day, running at around four to six weeks, sports with arm movements at around six to eight weeks.

Will sport be easier? It is one of the most cited benefits: running, dancing or racket sports become comfortable again.

When can I swim? After about six weeks, once the scars have fully closed.

Which sports bra should I choose? A well-supporting sports bra, ideally bought once the shape has stabilised.

Risks

What is the most common risk? Delayed healing at the junction of the scars under the breast, generally not serious.

Can the areola be compromised? Rarely, especially after a large reduction or in smokers. An areola that darkens must be reported without delay.

What is fat necrosis? Small benign fat nodules in the breast, which may be palpable or visible on imaging.

Can liposuction leave irregularities? It is possible, especially on the back. Many soften over time; others can be touched up.

Does areola sensation return? Usually, but a lasting reduction is possible after a large reduction.

Is the risk of thrombosis high? It is moderate and prevented by appropriate measures.

Will my two breasts be identical? Rarely perfectly: a small difference is common, and a clear difference can be corrected after a year.

Results

When is the result final? The shape stabilises in three to six months, and the scars fade over one to two years.

Is the result lasting? Yes, if weight remains stable. The breasts nevertheless change with age and hormones.

Does back pain disappear? Neck and shoulder pain decreases markedly in most patients. Lower back pain depends on other factors.

Will I be able to breastfeed? It varies with the technique. Reduction by liposuction has little effect on the gland.

Can the breasts grow again? With significant weight gain or a pregnancy, yes.

Will mammograms remain possible? Yes, by telling the radiologist about the procedure.

Price

Does the combination cost more than reduction alone? Yes, liposuction is added, generally at the patient's expense.

Why do prices vary? Depending on the areas, the technique, the clinic, the region and the insurer's reply.

Where is the cosmetic part most expensive? Rather in Geneva and Zurich; in other cantons, it can cost up to fourteen per cent less.

What should the quote contain? Fees, anaesthesia, theatre, stay, areas, tissue analysis, garments, follow-up and the split between medical and cosmetic parts.

Can I spread the payment? Some clinics offer this for the cosmetic part.

Choosing

How do I choose the surgeon? Check their specialist title and experience of reduction and liposuction, and look at comparable results.

Is a second opinion needed? It is useful, particularly for the reduction technique and whether reduction by liposuction is worthwhile.

Can I consult in French in Zurich? Yes, many surgeons see patients in French or English.

Must the facility be recognised by the insurer? Yes for the covered part. Check before choosing.

Practical questions

What should I prepare for the consultation? A description of your symptoms, your bra sizes, the treatments tried, your weight history and your questions.

Do I need someone to take me home? Yes, someone must take you home and, if possible, stay with you for a day or two.

Which season should I choose? Autumn and winter are practical for compression and sun protection of the scars.

Does my employer need to know? No, a sick note is enough.

When should I buy new bras? After two to three months, once the shape has stabilised.

What is Medespoir Suisse's role? To put you in touch, free of charge and without obligation, with a plastic surgeon who performs this combination.

Particular situations

Can a gland in the armpit be removed? Yes, accessory breast tissue in the armpit can be removed or reduced, after imaging confirms its nature.

What if my breasts are very different? The surgeon removes more tissue from the larger side, and liposuction can perfect the balance.

Can the areolas also be reduced? Yes, the areola is reduced and rounded during a conventional reduction.

Does back liposuction reduce shoulder width? No, it smooths the folds and slims the back, but does not change the bone structure.

Can the arms be treated at the same time? It is possible, with a longer procedure. Our page on the arm lift describes the alternative if the skin is lax.

What if I have diabetes? It must be well controlled. It increases the risk of delayed healing and infection.

Is high blood pressure a problem? It must be controlled to limit the risk of haematoma.

Do breast stretch marks disappear? Those on the skin removed disappear; the others remain.

Is gigantomastia treated the same way? It requires a very large reduction, sometimes with an areola graft. Combined liposuction is often limited.

Should I stop the pill? This is discussed with the doctor according to the length of the procedure and your other risk factors.

Can I have a reduction after breast cancer? This requires specific care with the oncology team. The situation must be discussed case by case.

Can a thigh lift be combined? It is rarely done at the same time, as the procedure would become long. A second stage is preferable.

Can liposuction slim just the upper abdomen? Yes, if the skin is firm, the upper abdomen and waist can be treated without the lower abdomen.

Are the lymph nodes in the armpit affected? No, the liposuction remains superficial and away from the hollow of the armpit.

What if a nodule appears after the procedure? Report it to the doctor. It is often a benign fat nodule, but imaging can confirm this.

Does the result change at menopause? The breasts may become fattier and slacken, but without regaining their original volume.

Will I ever be able to sleep on my front? Yes, generally after two to three months, and often more comfortably than before the reduction.

Can I get a tattoo over the scars? Not before the scars are fully mature, often after one to two years, and after medical advice.

Can a reduction help skin irritation? Yes, the disappearance of the moist fold under the breasts often clears up irritation and fungal infections.

Will wire-free bras be enough afterwards? Often yes, as lighter breasts are easier to support. The choice becomes much wider.

How much tissue is removed per breast? It varies from a few hundred grams to more than a kilo depending on the starting volume.

Can a reduction be repeated later? It is possible if the breasts grow again, but more delicate because of internal scarring.

Does liposuction alone leave the skin sagging? If the skin is of good quality, it partly retracts. That is why this technique is reserved for selected cases.

Can I travel by train soon afterwards? Short journeys are possible after a few days; on a long journey, get up regularly to walk.

Does a reduction improve breathing? Many patients describe freer breathing, particularly when lying down and during exertion.

What if I gain weight again? Moderate weight gain is generally well tolerated; significant weight gain can make the breasts and treated areas grow again.

Do periods make the breasts painful afterwards? Cyclical tenderness may persist, often reduced with smaller volume.

Can the nipples lose sensation? It is possible, especially after a large reduction, but sensation often partly returns.

Is underwiring allowed? Not straight away: wait for the surgeon's go-ahead, when the fold scars are strong.

Will my back be painful for long? Back aching from the liposuction decreases within one to two weeks.

Can a check-up ultrasound be done afterwards? Yes, follow-up imaging is recommended according to the usual screening schedule.

Are the back scars visible? They are very small and hidden by the bra band or swimsuit.

Tell us in a few lines what bothers you, about your breasts and around them, and where you would like to have surgery: an adviser will suggest, free of charge, a surgeon experienced in this double procedure.