“This heat has me in a flare-up under my breasts, and it hurts so much. I have an appointment to talk to my doctor about a breast reduction. Would that help decrease my flare-ups?” asked a myHSteam member.

To get the answer to this question, myHSteam spoke with dermatologist Dr. Julia Riley. Dr. Riley specializes in hidradenitis suppurativa (HS) and other skin, nail, and hair disorders. She’s affiliated with Northwestern Memorial Hospital in Chicago. She’s also a member of the Hidradenitis Suppurativa Foundation’s Treatment and Research Committee.

Here’s what she — and myHSteam members — had to say about breast reductions with HS.

How Does HS Impact the Breasts?

Several myHSteam members have experienced breast-related symptoms. They’ve reported symptoms like pain, itching, and soreness:

• “I am experiencing a flare-up right now and have an open wound on my breast. I’ve been dealing with this condition for almost 20 years now and haven’t really found any long-term relief.”
• “My left armpit is always sore down to my breast. It itches. I can’t stop the itching. I have noticed my left breast has grown, probably a third larger than my right breast.”
• “I’ve had problems with infection in my breasts since 2017. I just had a biopsy for a sore in my breast, and it came back with severe inflammation with a possible infection.”

Sometimes, the symptoms come from HS alone. Other times, more than one breast condition needs medical attention. “My left breast was a little swollen and achy and itchy, but when I went to get it checked out, they said I had swollen lymph nodes and it should pass,” shared one member. “Two days later, I had to have emergency surgery. I had woken up with an apple-sized abscess on my breast.”

“I have had two breast surgeries on my left breast to remove abscesses,” said another. “I have been told I have mastitis, that it is related to the HS, and also that I have fibroid cysts. I need to see a breast specialist that can give me a definitive diagnosis.”

You should talk to a heath care provider right away if you’re concerned about breast symptoms or changes. It’s important to find out if they’re caused by HS or if you need more testing for another condition.

Breast Reduction Surgery Basics

During a breast reduction surgery, a certified plastic surgeon removes a portion of the breast skin and tissue. They may make incisions to remove breast tissue, or use techniques like liposuction to achieve the desired result. Then, the surgeon reshapes the breasts to lift and position them to look naturally smaller and symmetrical. Breast reduction can offer multiple benefits, including:

• More comfort during exercise
• Decreased skin irritation
• Less pain when wearing bras
• Reduced back pain

Breast reduction is a major procedure that’s performed under general anesthesia at a hospital or surgical center. After the surgery, you’ll need to wear a surgical bra, take pain medication as prescribed, and take it easy for four to six weeks to give your body time to recover. Swelling after surgery can take months to subside. You won’t know the final results until you’ve had enough time to heal.

Breast reduction can profoundly impact your physical and mental health. It may change the way you feel and how you see yourself. You should take time to consider all of your options before deciding what’s best for you.

Is Breast Reduction Safe or Helpful for HS?

According to Dr. Riley, there’s no one-size-fits-all answer to this question. “Every patient with HS is unique,” she said. “An open dialogue between a patient, their dermatologist, and their breast surgeon would be the best way to determine if breast reduction surgery would result in an optimal outcome for the patient.”

She said people who have HS lesions on the lower part of the breast may benefit from breast reduction surgery to remove the lesions. However, those with lesions on the upper abdomen below the breasts may want to consider other treatment options. This is because breast reduction surgery might not help improve symptoms in this area.

Some members worry that having a breast reduction surgery (or any type of surgery) will cause an HS flare-up. However, Dr. Riley said this isn’t likely. “In general, HS does not develop at the site of surgery or trauma,” she explained. “However, we know with HS that new areas can be affected at any time. So, it is possible that you could develop HS around the breasts after surgery, even if it is unrelated to the surgery itself.”

myHSteam Members’ Experiences With Breast Reduction Surgery

Some myHSteam members have shared their experiences with breast reduction surgery. “I had a breast reduction, then was on a biologic for a few years,” said one member. “I feel better and haven’t had a flare in recent years. I’m not sure which helped more. It was probably the breast reduction.”

“I had a breast reduction and lift. It was suggested to help my under-breast situation with HS,” another member wrote. “I’m scared it might irritate it, but I hope it’s worth it in the long run.”

Another member shared their history of breast surgeries: “Mine was at first lesions on the breasts but advanced to where pus was coming out of the nipple. I have now had two breast surgeries on the left and have been back for an incision and drainage. Finally, it’s getting under control.”

One member reported undergoing a mastectomy related to HS symptoms: “I’ve had surgery a couple of times, under my arms and my breast. I ended up having a mastectomy. That was and still is hard to swallow. I’m so self-conscious.”

While there are instances of this type of surgery being performed to treat HS, it is not a standard treatment approach.

Considerations and Next Steps

Many people with HS think about surgical intervention to help treat their condition. But lots of factors must be weighed when making that decision. Following are some things to think about when considering any surgical procedure, including breast reduction surgery for HS.

Type of Surgery

Many surgical procedures can be used to treat HS. These include deroofing and excision. Deroofing is a procedure where the skin covering a tunnel (sinus tract) or lesion is removed. Excision is a more invasive procedure. It involves removing more tissue than deroofing. Many types of laser procedures can also be used to treat affected areas of the body.

There are also different methods for performing a breast reduction. For example, surgeons can make incisions in different parts of the breast. For very large breasts, the surgeon may need to fully remove and reposition the nipple and areola.

The right procedure for you will depend on your specific symptoms. You may also want to consider how invasive a procedure is and its expected recovery process.

Risks of Surgery

Dr. Riley emphasized the importance of understanding surgery risks. This is especially important if you’re planning an invasive procedure like breast reduction.

People with HS may have bacteria or open areas of skin under the breasts. These issues can make it harder for the body to heal. Dr. Riley said people with HS should try to avoid any unnecessary plastic surgery. This is because they may be more likely to develop scars, especially if they have a medical history of keloids or hypertrophic scars (both types of scars that can occur after surgeries).

Breastfeeding Plans

Breast reduction surgery can make breastfeeding more difficult, though there are surgical techniques that can help preserve the ability to nurse. If future breastfeeding is important to you, make sure to talk about it with your surgeon before having a breast reduction procedure.

HS Symptom Control

Dr. Riley explained that it’s crucial to have good control of HS symptoms before having a breast reduction. She encourages people to stay on HS medications, if possible, before and after surgery to avoid flare-ups. If you would like to have a breast reduction but your symptoms are not well-controlled, talk to your dermatologist about treatment options.

Finding the Right Provider

Your dermatologist may be able to perform surgical procedures for HS. If not, they can refer you to a surgeon who treats HS. If you’re looking for a surgeon for a breast reduction, you should make sure they are familiar with HS, Dr. Riley said. She also said to let the rest of your health care team know if you’re planning to have breast reduction surgery.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 44,000 members come together to ask questions, give advice, and share their stories with others who understand life with this challenging skin condition.

Have you considered breast reduction or other surgical treatments? Share your experience in the comments below, or start a conversation by posting on your Activities page.