Candidates for Surgery
Candidates for Breast Reduction surgery are women who wish to have smaller breasts to achieve a more proportional appearance or to alleviate physical discomfort. Breast reduction can correct symptoms from excessively large, heavy breasts that may cause the inability to do certain exercises, or create back, shoulder and neck pain, poor posture, bra-strap shoulder indentations and chafing or rashes under the breasts. Women experiencing these discomforts may benefit from Breast Reduction, also called Reduction Mammoplasty. Furthermore, large breasts may interfere with normal daily activities or exercise and will be more comfortable when reduced. Women who feel that their excessive breast size decreases a sense of attractiveness and self confidence, or results in unwanted attention are also candidates.
Also known as reduction mammoplasty, Breast Reduction is an operation intended to reduce the size of a woman’s breasts and improve their shape and position. Frequently, the areola (dark skin around the nipple) is also made smaller. Functional symptoms (medical problems) caused by excessive breast weight may be relieved or improved by this operation. Mammoplasty patients will experience a more attractive contour and smaller breast size, freedom from health problems associated with excessively large breasts and improved self image. There is an extremely high rate of patient satisfaction from this surgery. They are some of the happiest group of patients we see at Pacific Center for Plastic Surgery.
Breast Reduction is performed as an outpatient procedure and the vast majority of our patients tell us that there was far less discomfort in the early recovery period than was anticipated. Dr Nichter and Dr. Horowitz use a minimal incision surgery using a “vertical” or “lollipop” scar technique this method has been used in Brazil and France for many years but is performed by a minority of Plastic Surgeons in this country. The benefits include: approximately fifty percent less scarring, a narrower breast, better forward projection and shape, longer lasting improvement, shorter surgery time and less complications. In general, we have stopped using the older traditional “anchor” or inverted “T” incisions as these provide inferior results. The procedure is done under general anesthesia on an out-patient basis or in the hospital it there are additional medical conditions.
Liposuction may be used during the procedure to reduce the size of the breast in selected patients. Liposuction alone has the least number and size of scars but has the greatest limitations in shaping and reducing the breast. Liposuction may be combined with the vertical method to give an optimal shape to your breasts. Adjustments of the Nipple and/or Areola can also be done at the same time.
In rare circumstances for extraordinarily large or bulky breasts, gigantomastia, for technical reasons, we sometimes remove the nipples completely and reattach them as “free grafts”. The sensory nerves are all cut, and even though a certain amount of sensation returns after healing, it will never be normal and erotic sensation if present prior to surgery (many of these patients preoperatively do not have this due to stretch of their nerves) is lost completely. The milk ducts are interrupted in this operation, so nursing would be impossible. You will be amply informed in advance if your breasts are in this category. This may be one of the exceptions where the inverted T or Anchor technique is utilized.
The incisions are covered with light dressings, and you will be place in a bra, which you should bring to the surgery center with you. Our staff at the Pacific Center for Plastic Surgery will help you select the proper size. The bra holds the breasts symmetrically during the initial healing. The initial discomfort subsides daily and can be controlled with oral medication.
Some discomfort, swelling and discoloration of the breasts are to be expected for several weeks. Usually, our patients return to almost normal activity within two weeks. The scars at the incision lines typically become reddish and few weeks after surgery are raised and firm. After many months they become pale and soft. After 8-12 months, the scars are relatively inconspicuous. The nipples and some areas of the skin may be numb or sensitive after surgery. Sensation may return within a few weeks or months, but may be diminished or overly sensitive.
Breast reduction may prevent your ability to breast feed, however the newer short scar techniques that we use lessens that risk.
Gravity continues to have its effect, and there is a tendency for the skin of the breasts to stretch over a long period of time. This can be slowed by regular bra use when upright. Although, women very a great deal in this respect, in general, the smaller the breasts the less the tendency for sagging to recur. If the breasts sag again, further excision of the skin on an outpatient basis can be used to correct the problem. If we try to lift heavy breasts without making them smaller at the same time, sagging will return soon. One key to a satisfying result is realistic expectations.
Risks of Surgery
The specific risks and suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance though insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses