I did have a breast reduction done before starting LCing. I would certainly advise waiting until you are at goal weight before doing this, since the surgeon will want to make everything as proportionate as he or she can, and you might as well have the body you want before deciding about the breast size you want.

The amount of tissue that must be removed (which is of course different for everyone) will usually dictate which procedure will be used; the keyhole incision is designed for a less-radical reduction in which the nipple and areola remain attached to the underlying tissue and are moved up higher on the breast skin, in the round part of the keyhole. The excess tissue and skin are removed and the incisions are closed around the areola, down the front "seam", and under the body of the breast in a sort of semi-circle. The other method is to reshape the breast as above, removing excess breast tissue and fat, but then to resect the nipple and areolar tissue by removing and re-grafting them onto the breast in a new spot without leaving them attached inside. I believe that plastic surgeons are less willing to do this as there is always the danger of tissue death with a graft (the tissue is literally cut off from its blood supply, after all, and must re-establish itself). As far as I remember this method is used only when the "gentler" keyhole incision cannot -- perhaps amount of tissue to be removed?

The post-op recovery time is short (mine was day surgery with an overnighter -- in before breakfast, home the next morning after breakfast, strapped and gauzed and bra'ed) but the incisions took weeks to heal and there was some breakdown of the tissue under each breast where the vertical and horizontal incisions met, which meant more scar tissue there. The scarring is quite visible (unlike an augmentation, say) and extends around under the armpit area so that revealing dresses or tops can actually reveal those scars.

There are also risks associated with general anaesthesia that you want to consider carefully; I don't know that I thought about it as much as I should have done. There have been cases quite recently of women dying after undergoing cosmetic surgery -- the author of "The First Wives' Club" and Micheline Charest, co-founder of Cinar Inc. Not to say that anyone would have trouble, but it is statistically possible.

Having said all that, I am happy that I had the BR done. I can run now without extreme discomfort (actually, I should say that I could run -- but usually I don't....) and my chronic neck/shoulder/back pain is gone. My shirts also button up properly, even without bust darts (yes, I previously had to put those into even man-tailored shirts.) I went from a DD or DDD cup to a C cup. I am in Canada, so this was considered a therapeutic and medically-mandated procedure and as such covered under provincial health insurance. There was no out of pocket expense for me (except for Advil and new bras!) But it is serious surgery and like all such should be examined warily and at length.

Good luck!