Who is a candidate?
A prime candidate for breast reduction surgery is a healthy individual of ideal, stable weight with large breasts, and experiencing back, neck, or shoulder pain, shoulder grooves from bra straps, persistent rashes beneath or between the breasts, or numbness or tingling in the arms. The surgery is most commonly recommended for women whose breast development is complete. Insurance companies often cover the procedure if the above complaints are present and the patient has tried conservative measures such as support bras, anti-inflammatory medications, physical or chiropractic therapy. There should be documentation from the primary doctor that the patient has a history of these complaints and that conservative measures have failed. Insurance approval is based on severity of symptoms, attempts at conservative therapy as well as the amount of breast tissue that will likely be removed.
What is involved?
Breast reduction surgery consists of removing excess skin, fat and breast tissue and recreating a smaller, higher breast. The nipple and areola (dark part around the nipple) are often made smaller during the procedure and are lifted into a higher position on the breast. There are several types of breast reductions depending on the incisions used. The three most common types are inverted ”T”, vertical and drape. All types require an incision around the areola to lift the nipple into its ideal location. The vertical reduction requires an incision around the nipple/areola and vertically down from the bottom of the areola in the shape of a “lollipop”. The drape reduction requires the nipple/areola incision as well as a horizontal incision underneath the breast at the breast crease. The inverted “T” reduction involves the incision around the nipple/areola, a vertical and horizontal incision. The type of incision used depends on the size and thickness of the breast as well as the goal size after reduction. Your plastic surgeon should discuss the options and together you will decide what incisions are best.
Due to the variability between bra sizes from different manufacturers, it is difficult to promise a final breast size after surgery. Post-op size may also be somewhat determined by insurance coverage as there are minimum requirements of the amount of tissue that needs to be removed for insurance coverage. A common goal is approximately a “C” cup but this can be adjusted depending on the patient’s goals. Breast reduction will likely not change the patient’s chest measurement (ex. 34, 36, 38, etc). If a certain cup size is desired, it is sometimes helpful to bring in a bra of that cup size with your current chest size.
Asymmetry between a patient’s breasts is very normal. These asymmetries will be observed and discussed during the consultation and addressed at the time of surgery.
Risks and Complications
As with any surgery, bleeding and infection are possible complications. Drains are not usually required but may rarely be used. If infection occurs, it is most commonly 1-2 weeks after surgery, but can be seen up to 4 weeks after surgery. Usually this is treated with antibiotics but may require opening of a small part of the incision and possible dressing changes. Scarring is always present after surgery. Usually the scars become fine white lines over 1-2 years time but can develop thickening or widening especially in a patient prone to poor wound healing. Nipple sensory loss, decreased or increased sensation are all possible and may be permanent. Very large breast reductions have a higher risk of loss of the nipple/areola due to lack of blood supply and may rarely require the nipple to be taken off and placed back on as a skin graft. If this is needed, the nipple will lose sensation and may have color changes especially in dark skinned individuals. Symmetry between the breasts is our goal however some minor asymmetries are possible including breast size, breast shape, scar placement, nipple size, nipple shape, and nipple position.
Details of surgery
The surgery is performed most commonly as an outpatient procedure. Rarely a patient will need to spend the night in the hospital due to pain control or nausea. The surgery is 2-4 hours in length but requires several hours before and after the surgery for preparation and recovery. Drains are rarely used and the incisions are closed with dissolvable stitches, which do not require removal. You will wear gauze dressing and an ace wrap home and be seen 1-4 days after surgery. A responsible adult should be with the patient the night of surgery. Simple arm movements for every day tasks are fine after surgery but excessive use of arms or lifting should be avoided. Within the first week you may start wearing a sports bra instead of the ace wrap. The bra should fasten in front or back for ease of placement. Results of the breast reduction are often felt immediately with many patients noting elimination of back and neck pain at their first post-op visit. Patients may return to work in 1-2 weeks depending on their job requirements. Wearing ace wrap or support bra in the early recovery period is important to reduce swelling. After reduction, patients should always wear very supportive bras whenever engaging in aerobic activities to help maintain the results. Significant weight gain or loss or pregnancy and breast feeding can affect breast size and the long term results. Breast feeding can become more difficult or unsuccessful after breast reduction.