Breast reduction is more complex than breast enhancement (augmentation) although the procedure can still be performed on an outpatient basis if the patient's general health is good and when tissue removal is minimal. Otherwise, the procedure is performed at a hospital under general anesthesia The surgery is a reshaping process wherein excess fatty tissue, mammary tissue and breast skin are removed and the nipple-areola area possibly repositioned. Incisions are made around the areola, vertically from the areola to the chest wall and in the crease under the breasts. If the nipple-areola were totally removed and grafted to a new area of the reformed breast, the nipple may lose sensation and the breast would no longer issue milk. Therefore, this is generally not done. The nipple-areola complex remains attached to a pedicle of tissue and the surgeon slides it to a more appropriate position. This situation would be discussed in advance with patients of childbearing age so that they can make an informed decision about going ahead with the procedure.

Breast lifting (mastopexy) is a similar procedure to breast reduction; however, breast tissue is not removed. It involves relocating the nipple to a proper height, reshaping the breast gland and tightening loose skin. Breast size is unchanged unless an implant is used to enlarge the breast at the same time.

Preoperative instructions should be followed closely. Patients should refrain from smoking before and after surgery, completely, for at least 2 weeks. The reduced blood oxygen levels, from smoking, can impede normal healing of incisions and produce more conspicuous scarring. Diminished circulation, also from smoking, significantly increases the chance of tissue loss including the nipple complex. Vitamin E and anti-inflamitory substances, such as aspirin and other agents, that affect blood clotting should be avoided as well.