The paradox of Breast Reduction surgery:
In my practice perhaps the most satisfied patients are those whose breasts I make larger, and those whose breasts I make smaller. I think in each case patients are striving for a sense of balance.
For my patients considering breast reduction it is more than that though. The amount of extra weight they carry is a burden, and often a painful one at that. Women with large, pendulous breasts can experience back pain, shoulder pain, restriction of physical activity, skin irritation and often feelings of extreme self-consciousness.
The idea of breast reduction surgery is terrifying for most women. I find that my patients both young and old have been contemplating it for years before they have gotten the courage to even have a consultation. Postoperatively, when the fear subsides, and the reality of the surgery has set in it is truly one of the most gratifying things I do.
In this section as in others on my site I will try to educate you about the fears and concerns most of my patients have through the questions they have asked me.
This 53 year old woman had been contemplating breast reduction surgery even as a teen. Her breast were dense and heavy. Four months post surgery she is thrilled with the weight which has been literally lifted off her shoulders.
The most common type of breast reduction is call a wise pattern. Sometimes people refer to it as an anchor pattern or keyhole pattern because of the scars it leaves.
In these images skin is first removed in the areas shaded in green and yellow. Next the breast tissue is reduced in the areas shaded green, but the yellow area is left intact with the nipple attached. The remaining yellow tissue with the nipple is then elevated and inserted in the skin at the top of the breast both lifting and reducing the breast at the same time.
There are other scar patterns in breast reduction that may leave only a vertical or a horizontal scar, but these to not remove as much excess skin and are used in select candidates.
In most patients the nipple and areola are left attached to the breast. In cases where the breast is excessively large or sagging it can be safer to remove the nipple and replace it like a skin graft. This technique is not used in most breast reductions.
In a standard breast reduction where the nipple is left attached it is possible to maintain nipple sensation. Unfortunately it is not guaranteed. If the free nipple technique is used the nipple would lose sensation.
Like sensation, if a standard reduction is performed it is possible that you may be able to breastfeed, but it can not be guaranteed. I tell all my patients to consider if they would be comfortable with breastfeeding alternatives as they consider this surgery. If the free nipple technique is used then breastfeeding is not possible.
The length of the surgery can depend upon the size of the breast and the technique used, but on average a breast reduction takes about 2 1/2 hours.
While each patient is different this surgery is generally not as uncomfortable as others. It is a skin and glandular operation and this type of surgery is not as uncomfortable as surgeries that tighten muscles such as tummy tuck.
A pain pump is a device that is connected to a tubes that go into each breast after surgery and drip local anesthesia. While I can always offer my patients pain pumps I don’t like the extra tubes going in and out. Rather than leave a pump I leave a generous amount of local anesthesia in the tissues while the patient is asleep.
Some doctors leave drain tubes that come out under the arms after breast reduction. I generally do not use them, but I always tell my patients that if I think it is necessary I will use them.
This is perhaps the toughest question of all. All plastic surgeons close their patients in the best way possible to minimize the cosmetic impact of the scars, but they are real and they are permanent. Genetics plays a huge factor in how we heal. Darker skin patients can be more prone to darker or thicker scars, but sometimes lighter skin patients can do the same. It is important to be comfortable with the scars and be sure the trade off is worth it.
While I would love to say yes, the most honest answer is no. Breasts are rarely identical before ore after surgery, but I certainly strive to make them as even as possible.
There are really two stages of the breast reduction surgery. The first is the surgery itself that lasts about 2 1/2 hours, the second is the rounding out or bottoming out process as the tightened skin relaxes and the breast takes on its final shape, this is something we watch together for about six months. If we are happy with the shape we are done. If not adjustments can be made.
There is strong evidence that reducing the weight of the breasts helps alleviate neck back and shoulder pain in most patients but I could never guarantee it. Neck back and shoulder pain can have other causes as well.
There is really no upper age limit as long as a patient is healthy, on the lower end there is sometimes confusion. For young women and particularly teenagers we want to be as certain as possible that puberty is complete and that the breasts have stopped growing. I usually perform the surgery on younger women after they have stopped growing in height.
Yes, breasts change throughout life. The biggest game changers are weight gain, pregnancy or both.
Generally yes. The wise pattern reduction can be repeated, but other types of lifts can be more difficult to repeat.
Another challenging question. Breast reduction is performed by look and by feel. It is truly as much art as it is science. It is made harder because patients and bra manufacturers treat cup size differently.
Here’s how I approach it.
First I am candid with my patients that they will really not know if they love the size for about six months. It takes that about that long for the tightened skin to relax and for the patient to see the full shape and size of the breast.
I go in with my patients goals in mind. I share this goal with my nurses, whose opinions I greatly value. I reduce the breast and temporarily close it. In surgery we sit the sleeping patient up to get a good sense of the shape, and volume. If I am happy that we have achieved the patients goal (and my three nurses are happy) then I turn to the opposite side. If not I will reduce more until we are happy.
Lastly, I play the god forbid game with my patients before surgery. If god forbid they are too large they could be reduced again. If they were too small an implant could be placed. I am fortunate that as of this writing I have not had to do either.
So, getting back to the original question- what size will I be? I strive for a sense of balance and proportion, but will always do my best to achieve the size my patients are looking for.
In these days of shrinking health care dollars it has become increasingly difficult to get insurance carriers to cover this surgery. They often make patients jump through hoops and still do not give guarantees of coverage. We offer this surgery as an elective cosmetic surgery for patients who do not have coverage benefits. I do not participate with the health plans, but if you have out of network benefits my staff can help to see if you can obtain coverage.
To schedule an appointment please us the contact form on this page or call my office at the numbers listed on the home page. Please ask for Pei (pronounced “pay”) my assistant. Consultations last about an hour. I evaluate your health and starting situation. We go over the risks, benefits and alternatives to breast reduction supported with teaching diagrams and photos.