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Breast Reduction FAQ

Your Breast Reduction Questions Answered By Dr. Neavin

What is a breast reduction?

A breast reduction is also called reduction mammoplasty.  It is a procedure to reduce the size of the breasts including the areola and often lift the breasts to make them perkier.  It is performed under generally anesthesia.

Why would I want a breast reduction?

While many women seek a plastic surgeon to enlarge their breasts, many women desire them to be smaller. Large breasts can be a nuisance for those women who experience the emotional and physical discomfort that they can harness. For many women with very large breasts, the surgery can be life changing. It can alleviate back pain and rashes, and can be emotionally gratifying for those that do not enjoy the unwanted attention that large breasts can generate. Smaller breasts can simply make life easier for some and improve the ability to exercise and lose weight.

Am I a candidate for breast reduction surgery?

Ideal candidates for breast reduction meet one or more of the following criteria assuming that there are no contraindications for surgery and that the breasts are fully developed:

  • Breasts are much larger in proportion to body frame
  • Back or shoulder pain caused by the weight of your breasts
  • Rashes in the breast creases
  • Numbness or tingling shooting down the arm related to breast weight
  • Bra strap indentations on shoulders
  • Emotional stress related to large breasts (however, this isn’t recognized as a reason for health insurance coverage for surgery)

Who is NOT a good candidate for breast reduction surgery?

Women who smoke should not have a breast reduction.  The nicotine in tobacco (and in Nicorette gum and patches) cause the small vessels of the body to shrink rendering healing to surgical sites a potential problem.  Women should be off ALL nicotine products for a minimum of 4 weeks prior to surgery.

In addition, severely obese patients may want to lose weight before surgery.  Being overweight increases intra operative and post operative complications. Women who have saggy breasts and want them lifted without a reduction in size should consider a mastopexy (breast lift) rather than breast reduction. Women without a proper mammographic work up (age appropriate) should not undergo breast reduction surgery since it will alter the internal tissues.  Depending on age and any family history of breast cancer, screening may be in order first.  Women with major health issues should first be cleared by their physician before considering breast reduction.  Likewise, certain medications may have to be held before surgery.  Cessation of medications should first be cleared by the physician.

What are the types of breast reduction?

There are several types of breast reductions.  They all virtually function the same.  Breast reductions reduce the size of the breasts (while often improving symmetry), raise the nipple and make the breast perkier, and reduce the size of the areola – all with the trade off of incisions (and scars).  As a rule, the more that is reduced or the saggier the breast, the more (or larger) incisions are needed to get the job done.  Below is a list of some of the breast reduction techniques.  While they are referred to as techniques, understand that the type of reduction performed is more dependent on breast size and shape than surgeon preference.  And some techniques may be appropriate for certain breast sizes and others may not.

Pedicle Method

Most breast reduction involve some type of “pedicle”.  The pedicle refers to the main portion of the remaining  breast tissue that attaches to the nipple complex. This mound can either be attached to the chest wall superiorly (at top of the breast), or inferiorly (bottom of breast).  Other variations exist.  The pedicle is the main supply of blood to the nipple, and as such, important for its proper healing.  Inferior and superior pedicle are generally a surgeon preference.  Most surgeons prefer the inferior pedicle technique, but both when performed properly function well to provide adequate blood flow to the nipple.  It is debatable as to which technique provides superior cosmetic results and longevity.

Free Nipple Graft

Sometimes when the breast is very, very large or, very very droopy, the pedicle technique won’t suffice.  That is, the pedicle will be too long and lose its ability to supply proper circulation to the end of the tissue – the nipple.  In this situation, the nipple and areola may be removed and placed back onto the breast in a higher (perkier) location as a skin graft.  This technique refers to free nipple graft.  The downside is that the nipple can no longer function during lactation. The upside is that surgeries that like this that don’t employ the pedicle technique can sometimes be done more expediently thus reducing operation room time.  The free nipple graft is generally not necessary.

anchor incision or inverted t incisionAnchor Incision Pattern or Inverted “T”

By far, this is the most common breast reduction technique performed.  The Anchor or inverted “T” really just refers to the final incisions that rest on the breast.  A superior or inferior pedicle and even a free nipple graft can all be used with anchor or inverted T incisions.  The incisions (and hence, scars) from this approach run around the new reduced areola, down from the bottom of the areola to the breast crease, and along the breast fold.  This incision pattern will often result in the perkiest breasts.  Variations of the anchor incision exist by eliminating either the vertical or horizontal limb, but the shape at this expense does generally suffer a little.

vertical incision or lollipop incisionLeJour Incision Pattern (or lollipop incision)

Lejour technique is a type of vertical breast reduction.  This approach uses the same scars as an anchor or inverted T minus the horizontal limb that runs along the breast fold.  There is generally a medial pedicle that is used which makes the interior architecture a little different than the prior pedicles discussed.  The advantage to the vertical breast reduction is the elimination of the horizontal scar.  The disadvantage is that the breasts tend to look a little funny for the first few months – almost upside down looking in some cases.  Without the horizontal incision, much of the tissue bunches up at the bottom of the breast necessitating a small revision in about 25 percent of cases.  For some, this risk is well worth the elimination of the scar.  However, the major disadvantage to this surgery is patient selection.  Most women have breasts that are too large or too droopy for this approach.

Will insurance cover my breast reduction surgery?

Health insurance may cover part (or in some cases all) of your breast reduction surgery. However,  insurance companies have in recent years been very difficult to work with, particularly with breast reduction surgery.  The companies require intra operative weight measurements of all tissues and will not cover any costs unless at least a specific amount of breast is removed.  Often, this value that is required leaves a woman with very little breast tissue.  The office can run insurance verification for prospective patients to inform you of benefits, but almost always some down payment will be required prior to surgery.

What is the downtime of a breast reduction?

Breast reduction is a surface operation.  Meaning, there is no deep dissection that puts big vessels or nerves in harm’s way.  The operation entails resection of breast tissue and skin.  Thus, post operative restrictions are not overwhelming.  When we think of down time, what we are often asking is, “when can I resume work or exercise”.  And, “will I be bed ridden”?  Patients who have breast reduction surgery should ambulate the day of surgery.  There should be no period of bed-bound.  Early ambulation is actually beneficial to avoid possible leg clots.  Most of the incisions are healed by 7 to 10 days.  Every surgeon may have their own post operative protocol when it comes to exercise and showering.  Generally, patients may shower after 48 hours.  They may return to work within a few days if they are up for it, but strenuous exercise should be avoided for 2 weeks minimum, and up to four weeks depending on the individual.  Sexual activity should be avoided for a week.

How much does a breast reduction cost?

Prices for breast reduction vary considerably based on whether insurance covers any cost and the extent of the reduction.  Out of pocket costs may average around $10,000.  Often, breast reductions or breast lifts are combined with mommy makeover surgeries than include liposuction and tummy tuck.

What are some of the risks of breast reduction surgery?

Like any surgery, bleeding and infection are risks.  Because the surgery site is remote from major vessels, the kind of bleeding complication that may occur is generally not life threatening.  Bleeding may develop from a small vessel after surgery leading to a hematoma (collection of blood) necessitating an evacuation either in office or operating room.  Surgical drains may be placed in the breast to collect blood after surgery.  If they are placed, they are often pulled the next day or two in the office.  Infections of the breast after this type of surgery is rare.  If infection occurs, they can almost always be managed with oral antibiotics.  The most likely unwanted event is poor healing.  As one may imagine, the length of the incisions can be quite long.  Breast tissue and skin on the chest wall isn’t as vascular as it is in the face or hands.  Thus, healing here may be more difficult.  This is why it is imperative to be off vasocontricting agents like nicotine. In addition, the bigger the reduction (and longer the pedicle), the more difficult blood flow is to the nipple.  Thus, poor nipple and areola healing, perhaps one of the most dreaded complications, is a real risk.  Poor healing of these tissues may lead to pigmentary changes of this darker skin.  These risks, of course, are minimized with proper patient selection and appropriate technique from an experienced surgeon.

What will the scars look like with breast reduction surgery?

While scars are a part of surgery, plastic surgeons are the masters of camouflaging incisions to minimize scar visibility.  Larger reductions will require larger incisions (and hence, larger scars).  The incisions are placed around the areola, and possibly running from lower areola to breast crease, and along the breast crease.

Can I have a breast reduction without scars?

No.  Perhaps the least invasive technique for breast reduction is liposuction.  However, few women are candidates for this procedure since the decompression of the breast can generate droopiness – and, breast tissue is fibrous.  It often isn’t amenable to liposuction.

Can you liposuction my breasts?

While liposuction can reduce some of the fatty component of breast tissue, it won’t remove the breast tissue itself which is more fibrous.  Picture the breast being a grapefruit and the liposuction removing only the juice.  Thus, there are some major limitations to liposuction of the breast for breast reduction.  It is almost never performed for this reason.

When can I expect to return to work and resume my normal daily activities?

After breast reduction surgery, most women will return to normal activities within the end of the week.  There is no role for being bed-ridden.  Light activity is actually encouraged.  Showering can commence after 2 days (sometimes longer in certain cases).  As a rule, one shouldn’t lift anything heavier than a gallon of milk for the first 2 weeks.  After that, it is ok to slowly resume light exercise.  However, there is no better substitute than common sense.  Jogging that may put pressure on the breasts should be avoided until you get the ok from your plastic surgeon.

When can I shower after breast reduction surgery?

One can shower after breast reduction usually after 48 hours. Sometimes, this activity may be delayed depending on circumstances, but sponge bathing is almost always acceptable after 2 days.

How long with the results of breast reduction surgery last?

The results of a breast reduction are permanent.  There is no fix to combat effects of aging and gravity, but you can be sure that after a breast reduction your breasts will always be smaller and perkier than if you never had a reduction.  For many with pre operative back pain or rashes, they will soon find relief after surgery.  Pregnancy and weight gain are enemies of the post-breast reduction breast.  These changes to the body can add volume and weight to the breast leading to larger breasts and/or saggier breasts.  Breasts that become droopy after time may still need a lift (mastopexy).

Can I breastfeed after a breast reduction?

While much of the breast is removed during breast reduction surgery, the lactation apparatus should still function assuming that a free nipple graft isn’t performed.  A free nipple graft with prohibit breast feeding and it may reduce sensation to the nipple.

Will my breasts and nipples have same sensitivity after breast reduction?

For the first 6 months, many women will have sensation changes to the nipple – some less sensitive, and some more sensitive.  After 6 months, almost all of these changes return to normal.  However, there are chances that sensation changes may be permanent.  This is a potential risk one must accept before choosing breast reduction surgery.

Will a breast reduction make my areola smaller?

Yes, one of the goals of this surgery is to improve the cosmesis of the breasts and restore them to a more youthful shape and appearance.  The areola is often reduced significantly to under 50 mm diameter.

Will a breast reduction make my breasts perkier?

Yes.  The goal of breast reduction surgery is to not only make the breasts smaller, but to make them prettier.  Universally, perkier breasts are considered more attractive than saggy ones.

Is it a bad idea to have a breast reduction if I have a family history of breast cancer?

A personal or family history of breast cancer is not a contraindication for breast reduction surgery.  However, it should be approached a little differently than someone who has no such history.  For one, the screening algorithm changes.  Breast exams and mammography should always begin earlier with a personal or family history.  It is unwise to have breast reduction surgery that will alter the internal tissues without baseline studies.  A dialogue between plastic surgeon and medical doctor is always a good first step.

Will I need to be asleep during the surgery?

Almost always, breast reduction surgery is performed while the patient is asleep during general anesthesia.  Breast reduction surgery is a long surgery, and with general anesthesia pain can be controlled well and the airway can remain protected.

Will I have to go to a hospital for breast reduction surgery?

Breast reduction surgery is usually performed in an outpatient setting.  This means that one may go home after surgery.  Exceptions to this rule include women with other comorbid conditions that would warrant closer evaluation.

Will I be in a lot of pain after breast reduction surgery?

Surprisingly, breast reduction surgery doesn’t hurt all that much.  While the incisions can be large, the operation itself is a surface operation avoiding major vessels, nerves, and muscle.  Most women are surprised at how little post operative pain they have after surgery.  Pain can easily be managed after surgery with oral analgesics.  Ibuprofen containing products should be avoided both at least a week before and week after surgery since these medications can cause bleeding.