Macromastia & Breast Reduction in Dallas: Symptoms, Insurance & Cost

Medically reviewed by John L. Burns Jr., MD, FACS · Board-certified plastic surgeon · Dallas, Texas · Updated October 2026

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In this article

1. What is macromastia?
2. Symptoms
3. Types and causes
4. Who is a candidate
5. Breast reduction vs. breast lift
6. How breast reduction surgery works
7. Recovery timeline
8. Breast reduction scars
9. Risks and breastfeeding
10. Getting insurance to cover it
11. Breast reduction cost
12. Breast reduction in Dallas
13. My approach
14. FAQs

What is macromastia?

Macromastia, also called breast hypertrophy, describes breasts that are excessively large for a person's frame. The most severe form is often called gigantomastia. There is no single universal definition; one commonly cited threshold is breast tissue weighing more than about 1.5 kg (3.3 lb) per side, or at least 3% of body weight, though there is no global agreement on the cutoff (Radiopaedia).

For most of my patients, the number on a scale matters far less than how the breasts affect daily life. A woman with a petite frame can have significant symptoms at a size that would cause no trouble for someone taller. That is why I evaluate macromastia by symptoms, proportion and the breast's effect on posture and skin, not by cup size alone.

Symptoms of macromastia

The symptoms of overly large, heavy breasts tend to build gradually. On my breast reduction page I describe the classic pattern: breast, neck, back and shoulder pain, bra-strap grooving and rashes, along with stretch marks and sagging (ptosis).

If these sound familiar, you are not alone, and it is not something you simply have to live with. Reduction mammaplasty, the medical name for breast reduction surgery, addresses the cause.

Types and causes of breast hypertrophy

Macromastia does not have one single cause. Clinicians generally describe a few broad types:

Weight gain can enlarge the fatty portion of the breast, but in many women the excess is dense glandular tissue that does not shrink with diet and exercise. That is one reason weight loss alone does not resolve symptoms for everyone.

Who is a candidate for breast reduction surgery?

You may be a good candidate for breast reduction if you:

• Have ongoing physical symptoms from the size and weight of your breasts
• Have tried conservative measures, such as a well-fitted supportive bra, pain medication or physical therapy, without lasting relief
• Are at a stable, healthy weight (many insurers also require a body mass index in a specific range)
• Are in good general health and do not smoke, or are willing to stop before surgery
• Understand that many women cannot breastfeed after a reduction
• Are up to date on breast cancer screening; I recommend a mammogram before surgery based on your age and history

Teenagers with adolescent macromastia are evaluated individually, and surgeons often prefer to wait until breast growth has stabilized. Before any elective breast surgery, please review our breast cancer screening guidelines.

Non-surgical options to try first

Conservative care does not shrink breast tissue, but it can ease symptoms and is usually required before insurance will consider surgery. Options include professional bra fitting, physical therapy to strengthen the upper back and core, anti-inflammatory pain medication as directed by your doctor, treatment of skin rashes under the breast fold and, where relevant, weight loss.

Breast reduction vs. breast lift

Patients often ask whether they need a reduction or a breast lift. Both reshape the breast and raise the nipple. The difference is what is removed: a lift removes skin, while a reduction removes both excess skin and breast gland.

If your main concern is sagging rather than weight, my article on breast lift (mastopexy) for drooping breasts explains that procedure in depth. Women who are happy with their size but bothered by large areolas may only need a nipple and areola reduction.

How breast reduction surgery works

I make an incision around the areola so the nipple can be moved to a higher position, then a vertical incision down the front of the breast and a horizontal incision along the fold to remove excess tissue and reshape what remains. The goal is a smaller, lifted, teardrop-shaped breast with the nipple positioned at the level of the lower breast fold (the inframammary crease).

The anchor-pattern incision used in most breast reductions.

1. 01Consultation and planningWe review your symptoms, health history, insurance needs and goals, take measurements and plan your new size and shape.
2. 02Pre-operative preparationA mammogram is recommended based on your age and history, along with any lab work your health requires.
3. 03AnesthesiaSurgery is performed under general anesthesia.
4. 04Reshaping the breastExcess gland and skin are removed, the nipple is moved higher and the breast is shaped into a lifted, natural contour. The operation takes about three hours.
5. 05Going homeBreast reduction is an outpatient procedure, so you go home the same day with a responsible adult.

Breast reduction before and after

Breast reduction patient of Dr. John Burns. Individual results vary.

Breast reduction patient of Dr. John Burns. Individual results vary.

You can see more cases in our breast reduction before and after gallery and across all of our procedure galleries.

Breast reduction recovery timeline

How long does it take to recover from breast reduction? Most patients are back at a desk job in about a week. Here is the typical breast reduction recovery time, based on what I see in my practice:

1. 01Day of surgeryYou go home the same day. Plan for a responsible adult to drive you and stay with you the first night.
2. 02First daysSwelling, bruising and some soreness are normal. Rest, wear your support garment as directed and take medication as prescribed.
3. 03About 1 weekMost patients return to work and light daily activities.
4. 042–3 weeksStrenuous activity and exercise can usually resume, once you are cleared.
5. 051–2 monthsSwelling fully resolves and your final size and shape become clear.
6. 06Months 3–12Scars continue to soften and fade.

These are typical estimates, not guarantees.

Breast reduction scars

Breast reduction scars follow the anchor pattern: around the areola, down the front of the breast and along the fold beneath it. The fold scar is usually hidden by a bra or swimsuit top. Scars start pink or red and fade over many months. Silicone gel, strict sun protection and, when appropriate, laser treatment can help them settle. My guide to breast lift scars covers the same scar-care approach in detail.

Risks, common problems and breastfeeding

Breast reduction surgery is generally safe when performed by a board-certified plastic surgeon, but every operation carries risk. The risks I review with every patient include:

• Pain
• Bleeding
• Infection
• Wound-healing problems, especially where the incisions meet
• Changes in nipple sensation

Many women will not be able to breastfeed after breast reduction surgery. If you plan to have children and breastfeeding matters to you, we will talk through the timing of surgery. After a reduction, maintaining your weight helps prevent the breasts from enlarging again.

How to get a breast reduction covered by insurance

Will insurance cover breast reduction? It may, when the surgery is medically necessary. Each insurer sets its own criteria, so the most useful thing you can do is prepare early. Here is the step-by-step process most patients follow:

1. 01Get your plan's criteria in writingCall your insurer and ask for its medical policy on breast reduction (reduction mammaplasty), including any BMI limits, tissue-removal minimums and network or hospital requirements.
2. 02Document your symptomsSee your primary care doctor about neck, back or shoulder pain, rashes and strap grooving, and make sure each visit is recorded.
3. 03Complete conservative treatmentInsurers usually require proof that pain medication and physical therapy have failed. Keep dates, providers and results.
4. 04Meet the BMI requirementMany plans want a body mass index within a set range before approving surgery.
5. 05Have your consultationYour surgeon examines you, takes measurements and photographs, and estimates how much tissue will be removed.
6. 06Prior authorizationA request with your records is submitted to the insurer, which reviews it and approves or denies coverage.
7. 07Know your shareEven with approval, you will typically owe your deductible, copay or coinsurance.

Medicare and Medicaid coverage also depends on medical necessity and your specific plan, and Medicaid criteria vary by state. Bring your insurer's written criteria to your consultation so we can review them together (RealSelf).

How much does a breast reduction cost?

How much is a breast reduction? It depends on whether insurance participates, how much tissue is removed, anesthesia and facility fees, and your anatomy. These published averages give a useful starting point:

For self-pay patients, mammaplasty reduction cost typically includes the surgeon's fee, anesthesia and the facility. Ask for an itemized quote.

Breast reduction in Dallas: what to know

My practice is at 9201 N. Central Expressway in Dallas, on US-75, a short drive from Uptown, the Park Cities, Richardson and Plano.

• Plan for about a week away from work, longer if your job is physical.
• Dallas heat and humidity can make rashes under the breast fold harder to control, which is one more reason to document those symptoms for your insurer.
• In summer, plan to keep healing incisions out of pools and direct sun until you are cleared.

My approach to breast reduction

A good breast reduction is about more than removing weight. It is about proportion: a breast that fits your frame, sits at the right height and keeps a natural, teardrop shape for years.

Some patients combine a reduction with other procedures, such as liposuction of the sides of the chest or a mommy makeover after pregnancy. You can read what other patients say on our reviews page, and learn more about the procedure on my breast reduction surgery page.

Why patients choose Dr. John Burns for breast reduction in Dallas

I have spent more than 25 years shaping breasts that fit a woman's frame, and a reduction draws on every part of that experience: relieving the weight, lifting the breast and placing the nipple where it belongs. My laser fellowship also shapes how I care for scars once you have healed.

• Board-certified by the American Board of Plastic Surgery; Fellow of the American College of Surgeons (FACS)
• More than 25 years of experience in aesthetic plastic surgery
• First plastic surgeon in the U.S. to complete a fellowship in laser surgery, at UT Southwestern Medical Center, where he is a Clinical Instructor of Plastic Surgery
• Plastic surgery residency at the University of Texas Medical Branch (summa cum laude, Research Honors Program; Alpha Omega Alpha); microvascular training at MD Anderson Cancer Center
• Graduate of Vanderbilt University; cosmetic surgery training in Miami, Florida
• Named one of America's Best Plastic Surgeons by Newsweek (2022, 2023, 2024, 2025, 2026)
• D Magazine Best Doctors (2023, 2024, 2025, 2026) and D Magazine's "The Face of Breast Augmentation" (2024, 2025)
• Texas Monthly Super Doctors (2024)
• Medical Director of JOLA Aesthetics, an Allergan Double Black Diamond practice ranked among the top 20 in the U.S.
• Past President of the Dallas Plastic Surgery Institute
• Board of Directors and contributing surgeon, Share-A-Smile Foundation

Meet Dr. Burns

Breast reduction FAQs

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Breast reduction surgery in Dallas →Breast lift in Dallas →Breast lift scars and lifting without implants →Gynecomastia surgery in Dallas →

Sources: Dr. Burns' breast reduction page; Radiopaedia: gigantomastia; RealSelf breast reduction cost (updated June 2024); ASPS 2024 average surgeon fees. This article is for education and is not medical advice. Individual results vary. Pricing disclaimer: costs shown are published averages, not Dr. Burns' prices; prices vary, are not exact and can change. Your personal quote is provided at consultation.