Breast Reduction

Breast reductions can be for cosmetic reasons and out of medical necessity. Either way, like most surgeries, there are benefits and risks. This site provides a concise overview of what's involved as well as the benefits, risks and costs often associated with a breast reduction.

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Breast Reduction - Info
Breast reduction surgery or reduction mammoplasty removes fat, glandular tissue, and skin from the breast. Typically used when a woman has extremely large, pendulous and heavy breasts, breast reduction surgery not only removes tissue but reshapes the breast to make it higher, lighter and firmer. Ideally done after the breast has finished growing and no further changes are expected, the breast reduction surgery can make an immediate and obvious change in the body. The areola is often made smaller as well, and the end result is a breast that is sized and placed more appropriately for the woman’s body, frame shape, and personal preferences. While the breast reduction procedure has cosmetic benefits, it can also be medically indicated. Breast reduction surgery is not for every woman and there are some risks involved with the surgery the every patient should be aware of. Understanding all of the risks associated with breast reduction surgery will help the patient make an informed decision about having breast reduction performed.

Typically, incisions are made under the breast, in a line from the breast to the nipple, and around the nipple to remove excess tissue and reshape the breast. Liposuction may be used to help shape the breast and remove excess fat from the armpit. While scarring is extensive, it is placed on the lower side of the breast, and is not visible even in cleavage baring attire. Scars typically fade over time, becoming lighter and thinner, assuming there are no complications during healing.

Breast reduction surgery can be done as an outpatient procedure, or with a short hospital stay. The breast reduction surgery itself typically takes two to four hours, and patients should expect some degree of discomfort for several weeks. Return to work can typically occur within two weeks, assuming your job is not physically strenuous. You will wear a surgical bra for some amount of time, and many women require prescription pain relief for the first week following breast reduction surgery. Mild exercise can resume after two weeks, but patients are cautioned that full recovery takes approximately six weeks.

A Medical Necessity
While some people may consider breast reduction a cosmetic procedure, any woman who has lived with the burdens of overly large breasts understands the physical and psychological discomfort that makes breast reduction surgery a medical necessity. Fortunately, most major insurance carriers agree that the breast reduction procedure can be medically necessary, and will provide coverage assuming that you and your physician have worked together to fulfill the insurer’s requirements. Overly large and heavy breasts can cause discomfort, skeletal complications, back pain and limit activity and mobility.

If any of the following are problematic or bothersome for you, breast reduction may be a reasonable medical choice. If your breasts are too large for your body, reduction can bring your breasts into proportion with your frame, and make you more comfortable. Breast reduction can also be used to even dramatically uneven breasts. Extremely large, pendulous or downward pointing breasts are also good candidates for reduction surgery. If your breasts are causing medical issues, including skin irritation beneath the breasts, back or shoulder pain, indentions in your shoulders from your bra straps, or limitations on your activity due to the size of your breasts, breast reduction may be an option to make you both physically and psychologically comfortable.

Often, women with extremely large breasts find that their breasts have a detrimental effect on their mental health. They may find that they feel uncomfortable with the shape of their bodies, have difficulty finding suitable clothes, and are perceived in ways they don’t like. Breast reduction surgery can also have a beneficial effect on the psychological health and well being of the patient.

Risks of Breast Reduction Surgery
First and foremost, breast reduction surgery is a fairly substantial surgical procedure, and while typically safe, it does come with some risks. It requires general anesthesia, in some cases a blood transfusion may be necessary and recovery can be painful and difficult. Scarring is substantial even with the best outcomes. Bleeding, infection and reactions to anesthesia are all risks present during and after reduction mammoplasty. Some plastic surgeons encourage banking a unit of blood yourself for patients at high risk of bleeding prior to breast reduction surgery in the event that it is required.

Incision related problems can include fat necrosis, wound separation and keloid scarring. Fat necrosis is more common in reductions where more tissue is removed. Wound separation is considered a minor complication, but does extend recovery time. Keloid scarring and other scarring issues may require surgical revision to improve the overall appearance of the breast. Infection in the breast or incision sites will require antibiotics for treatment, and may also extend your recovery time somewhat. Smokers should be aware that scarring and recovery are more of an issue for them.

Other difficulties with the breast reduction procedure or the results can include slightly uneven breasts, or unevenly placed nipples or sized areolas. Permanent loss of sensation in the nipples is a risk, particularly in cases where the breast reduction is extreme. Typically, changes in sensitivity are temporary, but numbness and lack of sensation does occur and this risk should be considered when contemplating breast reduction surgery. In very rare cases, nipple or areola tissue may be lost and reconstruction will require skin grafts and further surgeries.

Breast Reduction Surgery and Breastfeeding
One concern that breast reduction candidates should consider is the possible impact of the surgery on their future breastfeeding experience, as well as the impact of pregnancy and the associated breast changes on their breasts. Many surgeons encourage women to postpone breast reduction until they have completed their families, due to both of these considerations. While younger women can, and do often, have breast reduction surgery, a positive long term result is more likely if all expected breast changes are past before the surgery occurs.

Typically, breast reduction surgery removes a substantial amount of glandular tissue and often severs the connections between the milk ducts and the nipple. The most significant damage occurs in more extreme reduction surgeries; however, it is typically difficult to predict how successful post surgery lactation will be. If future lactation is a consideration, speaking with your surgeon about preserving as much ductal structure as possible may be helpful. Mothers attempting to breastfeed their infants after breast reduction surgery will often struggle with milk supply and even in the best scenarios are likely going to have to supplement their infants with commercial infant formulas. While a young woman may not consider this effect upon her life when contemplating breast reduction surgery, it is not uncommon for women to regret not postponing their choice until their families were complete.

Furthermore, the weight gain, breast changes and hormonal shifts of pregnancy, lactation and the postpartum period can impact the breasts significantly. Size changes during pregnancy may be substantial and permanent, even after breast reduction surgery. It is not uncommon for women to choose another breast surgery following pregnancy and childbirth to regain the appearance of the breasts after the first breast reduction surgery.

Preparing For Surgery
What can you do to make your breast reduction surgery and recovery go well? First and foremost, choose a competent and experienced surgeon. Look for a surgeon who performs breast reductions frequently, offers honest assessments of the end results of your breast reduction surgery, and has appropriate professional qualifications. You should feel comfortable with your surgeon and his work. You should also be willing to following any and all recommendations offered by the cosmetic surgeon pertaining to what you should do both before and after the breast reduction surgery.

Work with your insurance company to obtain coverage for the breast reduction procedure, with your doctor’s assistance. Do your research, and assess the risks and benefits for yourself, ranging from the future impact on breastfeeding to the scars. Consider whether alternatives to breast reduction surgery remain, and if the benefits for you clearly outweigh the risks, prepare yourself physically for the operation.

If you are preparing for breast reduction surgery, work to lose weight so that you enter into the breast reduction procedure at a healthy and appropriate weight for your frame size. This also allows you to determine if your breast size will change with weight loss, perhaps alleviating the need for the breast reduction procedure. If you smoke, stop to speed recovery and reduce scarring. Eat a healthy diet, stay well hydrated and maintain your normal exercise routines until the day of breast reduction surgery. A healthy body will recover more quickly.

Arrange time off at work, and help at home during your recovery, especially if you have children. Expect two weeks off work if your work is fairly sedentary, and longer if you have a physically active job. Ask your plastic surgeon what sort of sports bras he recommends, and purchase them prior to breast reduction surgery. While you’re shopping buy a pretty bra or two in your soon-to-be size and enjoy off the rack bra shopping for the first time!

The Procedure Itself
A standard breast reduction surgery uses what is called a keyhole surgery. This procedure is appropriate if the breast tissue is primarily glandular, and is preferred for younger women, thin women, and those with pendulous breasts. In this case, incisions are placed under the breast, in the crease below, around the nipple, and in a vertical line connecting the nipple and the incision under the breast. The areola is then repositioned to a higher place on the breast and excess fat, glandular tissue and skin is removed from the underside of the breast. In extreme cases, the nipple and areola will be fully removed and regrafted; however, total loss of sensation is typical in this case, so it is generally avoided. Patient satisfaction with this procedure is generally high, even though scarring is typically wide and rather obvious.

The scarless alternative to traditional keyhole breast reduction surgery is breast liposuction. Liposuction is only a viable option when the breast tissue is primarily fatty as opposed to glandular. Mammography can determine whether the breast is primarily glandular tissue or fatty tissue. Often, liposuction is viable for heavier women, those desiring a less extreme reduction, or post menopausal women. There is minimal change in breast shape with liposuction, and typical reduction is around thirty percent. Liposuction has a faster recovery period, very, very minimal scarring, and is a less invasive and painful procedure. Speak with your plastic surgeon about the procedure that will offer the best results in your personal situation.

Recovering from Breast Reduction
Full recovery from breast reduction surgery can take more time than you might expect. While the surgery itself typically just takes a few hours and may be done as an outpatient procedure, you should expect the first days home to be challenging and uncomfortable. You will wear a surgical bra or elastic bandage over your dressings until your drains are removed. Sleep upright, exercise care while moving about, and expect to feel poorly during your recovery. Once drains and stitches are removed, the breasts should be supported with a sports bra or ace bandage during healing. Avoid underwire bras during this period.

Most women experience one to two weeks of moderate to severe discomfort following breast reduction surgery and will typically require pain medication during that time. Stitches are typically removed after a week and surgical drains after two days. Bathing and showering should be avoided until the drains are removed. Swelling and bruising can be expected to last two to three weeks, and numbness one to two weeks.

Sexual activity should be avoided for a week after surgery, and care should be taken with the breasts for six weeks following surgery to allow healing time. Assuming your job is not strenuous, you can return to work two weeks after surgery. Moderate exercise can resume at three to four weeks post surgery. Breast changes and healing will continue over the six months following surgery, and by six months you can expect that you can see the final results of the surgery. Scars will continue to fade over time, but the breasts will have taken on their final post surgery shape and appearance.

Cost and Insurance
Many insurance providers will cover breast reduction surgery, presuming it is deemed medically necessary. You will need to carefully review your health insurance policy to determine if breast reduction surgery is covered by the policy or not. As each provider has their own definitions of medical necessity, it may be helpful to contact your insurer or your human resources department if it is a group policy and ask what they require to approve the breast reduction procedure. Some insurance providers require that alternate means of relief have been tried to deal with the complications of breast reduction, while some require a certain amount of breast tissue be removed. Consulting your insurance provider is an important part of the diagnosis and preparation process, and can make your plastic surgeon’s job easier as he knows what to provide in order for the breast reduction procedure to be properly covered.

If your insurance company denies coverage, do appeal the decision. A well written letter detailing the health impact of your large breasts with regards to fitness, general health, day to day pain and more may improve your chances of breast reduction surgery. Ask your plastic surgeon and general practitioner to write on your behalf as well. Some insurance companies do require a second opinion.

If your insurance company typically covers reconstructive and other medically necessary cosmetic procedures, assuming you meet their criteria for medical necessity, it is likely that they will cover your breast reduction surgery. Typical criteria for medical necessity are related health problems including skin irritation, back problems, and difficulties with daily life due to breast size. Your plastic surgeon should be able to assist you in determining the medical necessity of the breast reduction procedure and meeting your insurance company’s requirements.

The Benefits
So, the medical benefits will be obvious to any woman who has struggled with overly large breasts. Back, neck and shoulder pain will typically improve dramatically very soon after reduction surgery. Ridges in the shoulders from bra straps will also heal quickly, and your self esteem and body image will also improve. There are, however, some benefits that aren’t so medically critical.

For the first time, clothes shopping can be fun as your breasts fit your frame size. Proportionate breasts mean that dresses, two piece outfits and swimwear will fit appropriately. Bra shopping, which has been a horrible chore resulting in expensive, often poorly fitting and ugly bras can now be a fun activity as you choose pretty and colorful lingerie.

While our culture often idolizes large breasts, the freedom to wear what you want, run, play and be physically active after your breast reduction surgery will likely be freeing. Moreover, full and perky breasts will work well in nearly any garment you might want to wear, and instead of hiding your breasts in oversized clothes, you can opt for plunging necklines and pretty halter tops. Weight loss following breast reduction surgery may be easier thanks to ease of movement, a new ability to exercise and improved self esteem. In some women, the procedure itself removes pounds of breast tissue.

Breast reduction surgery can be a life changing operation, allowing both greater physical and psychological comfort. If you have struggled with your breast size and it is impeding your daily life and causing you pain, consider consulting a certified and qualified plastic surgeon in your area about breast reduction surgery. Free yourself from the pain of overly large breasts, dreadful and expensive bras that do not fit properly, and an out of proportion frame.


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