The size of your breasts is determined by a number of factors, including the genes you have inherited, your body weight and hormonal influences.

No matter what your age, large breasts can cause problems:

• Many women experience physical problems like back or neck pain, grooves in the shoulders from bra straps and rashes under the breast.
• Large breasts can also make it uncomfortable to exercise and difficult to find clothing that fits.
• They also often make women self conscious, especially if they attract unwanted attention from the opposite sex.

Breast reduction surgery, also called reduction mammoplasty, can improve these problems by removing excess breast tissue, fat and skin from the breasts. Breasts are then reshaped and the nipples repositioned to produce attractive, smaller breasts that are in better proportion to your body.

This surgery may also be appropriate for women who have one breast that is markedly larger than the other and wish to have it reduced to match the smaller breast.

Of all plastic surgery procedures, breast reduction results in one of the quickest body-image changes.

At your initial consultation, your surgeon will evaluate your health and explain the procedure to you. He will discuss the several approaches to reshaping the breasts, all of which involve a scar around the nipple and areola (the coloured skin around the nipple). These various approaches most often also involve vertical scars, which join to form a T-shaped scar in the fold below the breast.

Your surgeon will explain the advantages and disadvantages of these different approaches and may, with your approval, recommend the technique that would be best for you.

During this consultation, it's important that you talk honestly with your surgeon about the size of breasts you would like to achieve.

• If you wish a large reduction in size, your surgeon will explain that the shape and cosmetic quality of your breasts may less pleasing than in the case of smaller reductions. There is also a chance that your breasts will be somewhat uneven in size, although often less so than before surgery.
• For women with very large breasts, the benefits of a significant reduction in breast size may outweigh these potential imperfections and other limitations.
• If your breasts are only slightly larger than normal, you'll want to think carefully about all aspects of the surgery before proceeding.

Unless breast reduction surgery is done while breasts are still growing, they should not re-grow afterwards. They will, however, increase if you put on weight or become pregnant and they will decrease in size if you lose weight. You should also remember that even normal breasts have a tendency to droop with time and you can expect some changes in shape to occur after reduction mammoplasty.

As with all major surgery, there is some risk associated with general anaesthesia. Your surgeon will discuss this risk at your consultation.

The most obvious consequences of breast reduction surgery, other than the reduction in size and change in shape of your breasts, are the scars that result. These are designed to be invisible while you are wearing normal clothes and, as far as possible, to lie beneath the average bra or bikini top.

• Initially your scars will be red and may be thick and uncomfortable. Over the months following your surgery they should become much paler and less obvious. They will, however, always be visible when you are not wearing clothing.
• The scars from breast reduction surgery vary from one woman to another. In some they may be very thin. In others, they may stretch and become quite red and noticeable.
• Most women, however, feel the scars are an acceptable trade-off for the benefit of dealing with the problems caused by large breasts.

Another consequence of breast reduction surgery that you should consider is the fact that few women are able to breast feed following this kind of surgery. This is because during surgery the nipples are separated from the milk ducts, so one's milk supply gradually dries up, sometimes with the assistance of hormone treatment.

Pregnancy itself is not affected by breast reduction surgery but young women may want to think carefully about not being able to breast feed before deciding to have the surgery.

It is also important to be aware that your nipples are likely to be less sensitive following surgery because nerves have been divided. This numbness can extend over part of the breast as well.

In the weeks before your surgery, there are several things you will want to consider:

• Your surgeon will recommend that you lose weight before surgery if you are overweight and he will advise you on the risks of the contraceptive pill.
• Because smoking affects healing of the breast wounds, he will also advise you to reduce your consumption or give it up altogether.
• In addition to these precautions, it is probably also wise to see your general practitioner before your surgery, particularly if you have other medical problems.

You will be admitted to the hospital the day before or the day of your surgery. The staff will help you settle in and you will be seen by both your surgeon and anaesthetist. At this time you will be fitted with a pair of elastic stockings and given an injection to help reduce your risk of developing clots in your veins after surgery.

Your surgery will be carried out under general anaesthetic. When you wake up after the operation you should expect some discomfort for two to three days, for which you will be given pain killing injections or tablets.

Drainage tubes are not regularly used. If they are, they will be removed within a short period of time. All stitches used are dissolvable.

You'll find steri-strips over your scars with dressings over these. Finally a sports bra, which you will have been asked to bring to the hospital, will be placed over the dressings. Your dressings will be removed 24 hours after surgery but the steri-strips should be left in place until you are reviewed in out-patient ten days later. Although you will be up and about the next day, you may feel some discomfort for the first week or so, especially when you move around or cough. Your surgeon will prescribe medication to make you more comfortable.

You'll also probably find it helpful to continue wearing the sports bra around the clock for two or three weeks, until the swelling and bruising subside.

You'll be able to leave the hospital after one or two days; however you should expect to feel tired and to need help at home for between two and six weeks depending on your age, fitness and home circumstance.

• For your comfort, you should continue to wear a sports bra after you go home.
• It is important to avoid lifting or pushing anything heavy for three or four weeks.
• You may get your wounds wet after 48 hours. Showering is best or, if you bathe, simply splashing the water up over the scars. Do not soak your wounds and be sure to dry the scar line carefully afterwards.
• If the skin on your breasts is very dry, you may apply a moisturiser several times a day, taking care to keep it away from the suture line.

Your surgeon will give you detailed instructions for resuming your normal activities.

• Most women can return to work (if it is not too strenuous) and social activities in about two weeks. You will have much less stamina than usual for several weeks, though, and should limit your exercise to stretching, bending and swimming until your energy level returns. You should also continue to wear a sports bra for support.
• Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months.
• You should expect some loss of feeling in your nipples and breast skin as the result of swelling after surgery. This loss of feeling usually fades over the next six weeks or so, however in some women it may last a year or more and, in a few patients, it may be permanent.
• There is likely to be some tenderness and lumpiness of your breasts for several weeks or months, but there is no reason why you cannot sunbathe or go swimming once your scars have fully healed.
• A small amount of fluid draining from your wound or some crusting is normal. If you have any unusual symptoms, such as bleeding or severe pain, you should call your surgeon's office.

Over the next few weeks most of the swelling and bruising will disappear, although it may take six months to a year before your breasts settle fully into their new shape.

Your scars will take time to settle as well. Often they remain lumpy and red for months before gradually becoming less obvious. Fortunately, the scars are usually placed so you can wear even low-cut tops while this settling is taking place.

When healing is complete, however, you will be rid of the physical discomfort of your large breasts, your body will be better proportioned and you'll find it far easier to buy clothes that fit well.