Many women with large breasts are plagued by chronic back pain, poor posture, and rashes; leading to poor self-esteem, trouble exercising, difficulty dressing, and social awkwardness. Breast reduction, a procedure that decreases the size of your breasts and reshapes the contour, has changed the lives of many women. In fact, research has demonstrated that women who undergo breast reduction have improved self-confidence, are more likely to exercise, have decreased back, shoulder and neck aches, and feel more comfortable socially.
A breast reduction, or a reduction mammoplasty, is performed as an outpatient procedure in an ambulatory center. During the procedure, overly large breasts are reduced by removing excess breast tissue, fat and skin to create a smaller breast that is proportionate to your body. I use both traditional and new techniques (vertical reduction, liposuction, and a superomedial pedicle) to tailor an operation that is perfect for you, creating a beautiful, feminine silhouette.
- Improved quality of life
- Decreased back, neck and shoulder pain
- Reduced breast volume
- Improved breast shape
- Reposition and possible re-sizing of the nipple/areola
When large, uneven breasts interfere with your daily lifestyle, you should consider having a breast reduction. Many patients complain of back, shoulder and neck pain, irritation or infection underneath their breasts, difficulty finding appropriate clothing and bras, trouble with their posture, and social anxiety related to overdeveloped breasts.
A Procedure For Generations
Women of any age may benefit from having a breast reduction. We have had teenagers, mothers, and even grandmothers benefit from surgery. In fact, patients who have undergone a breast reduction are among the happiest of all plastic surgery patients. When patients are teenagers, it is important that they have a regular menstrual cycle and a stable breast size for six months prior to surgery. Due to the overwhelming satisfaction amongst teenagers, I find no reason in waiting until women are in their twenties to have the procedure.
Lollipops or Anchors
Breast reductions are typically performed through two skin patterns, vertical and Wise. In both procedures, skin is removed only from the lower part of the breast to avoid scars on the upper aspect of the breast, above the level of the nipple. The vertical incision involves a circle around your nipple and a straight line from the nipple to the base of your chest, creating a lollipop shape. The more traditional method, the Wise pattern, leaves an anchor appearance in which there is a scar encircling the nipple, a straight line from the nipple to the base of the breast and a line traveling under the breast. The vertical reduction mastopexy is ideal for patients who have an excellent breast shape but just too much volume or the breast is too wide. The Wise pattern is superior for patients who need more tissue removed and more dramatic shaping. Both methods will likely decrease the diameter of your nipple and raise the nipple to a more youthful position. The scars will fade over the course of a year.
Like so many plastic surgery operations, a breast reduction is a two-layered procedure. There is the skin excision and the restructuring of the breast tissue below. The pedicle design relates to the blood supply of the nipple. Traditionally, all breast reductions were performed via an inferior pedicle. This led to bottoming out or distortion of the breast mound. I have now converted to using a superomedial pedicle is almost all of my breast reductions as I have found that it leads to a superior cosmetic result, maintaining breast tissue where it counts most…along the cleavage line. The one exception is in very large breasted women for whom the blood supply is superior using a different pedicle. Once the pedicle is defined, tissue is removed from the surrounds areas. Most tissue is removed from the outer breast, less from the middle and least from the innermost part.
An Oncologic Reduction
Given that one in eight women are diagnosed with breast cancer, it is not surprising that some women with breast cancer also suffer from having very large breasts. Advances in breast surgery have changed how we treat breast cancer. Women now have more options than just a lumpectomy or a mastectomy. In some breast cancer cases, it is possible to perform a breast reduction while performing a lumpectomy. Once you have healed, you can undergo radiation therapy as you would after a traditional lumpectomy procedure. In these situations, I work closely with your oncologic breast surgeon so that she/he removes the cancer and then I reduce, elevate and shape your breast. When only one breast is treated for cancer, the opposite breast is also reduced during the same procedure for symmetry, allowing the removal of the cancer and complete reconstruction to occur at the same time. This is a great option for many women, combining positive long-term oncologic results with beautiful cosmetic and functional outcomes.
After the procedure, your breasts will be wrapped in gauze, and you will be placed in a supportive bra. You will wear this bra around the clock for one month. Most patients only require pain medication for the first few days after surgery and return to work in a week. I like to inject a new medication called Exparel®, a slow-release, numbing medication, to help mitigate post-operative pain. You can perform light exercise one day after surgery and strenuous exercise four weeks later.
THREE MONTHS POST SURGERY
During your consultation, I will ask you questions about your desired size. Many patients are nervous to be too small, and some patients want to be as small as possible. Although much of the decision is based on the geometry of your body, I will manipulate the operation to help obtain your personal goals. But the emphasis of the procedure is less about pursuing an exact cup size and more about relieving painful symptoms and improving the breast shape. The results from a breast reduction are visible immediately, but the contour of your breasts continues to improve over the next six to twelve months as the swelling subsides to reveal a more balanced and comfortable you.
Women who are able to breastfeed prior to surgery are often able to breastfeed afterward. Although the amount of milk-producing glandular tissue is reduced, the ductal system which transports milk to the nipple remains. Patients who require a smaller reduction are likely to have less change in the amount of milk produced.
All precautions are taken to preserve nipple sensation. For some large breasted women, they find that they have minimal sensation prior to surgery where others state that they have excellent sensation. Removing breast tissue and the resulting swelling after the procedure may reduce your sensation or increase it. This often resolves over time as swelling decreases. It is possible to lose all sensation. Total loss of sensation is more common in larger reductions but fortunately is not a common occurrence.
Many patients combine plastic surgery procedures so that they only require one healing period. Patients often have abdominal and thigh liposuction performed at the same time as a breast reduction. Depending on the age and desires of the patient, rhinoplasty, and blepharoplasty (eyelid surgery) are also commonly added. The key factor to adding additional surgery is the time required to perform the surgery and the required length of anesthesia, which has an effect on your recovery.
The results should be long-term, but weight change, pregnancy, menopause, and natural aging may alter your appearance. Despite this, it is uncommon for patients to have a second breast reduction as most patients remain pleased by the initial reduction.
Many patients question not only what size bra they will wear but if they will need to wear a bra at all. It is still necessary to wear a bra after surgery but the bra can be less supportive. The architecture of your breasts will change significantly so that you no longer need to raise your pendulous breasts. The lift will be accomplished through surgery. The bra will instead add to your comfort.
Dollars and Cents…Will Insurance Cover the Procedure?
There are many factors that determine if your insurance company will cover the cost of a breast reduction. Decisions vary amongst insurance companies and types of policies. Insurance companies are more likely to cover the cost of a breast reduction when there is a greater amount of breast tissue to be removed, conservative therapy has failed (supportive bras, strengthening exercises, pain medication), and there are well-documented disabling symptoms.
A Picture is Worth a Million Words
A picture may be worth a million words but in the age of the internet, online photos can be viewed by billions of eyes. In respect of patient privacy, a before and after section was not created on our website. Several patients have agreed to allow their photos to be viewed by prospective patients in the office. You may request to view photos during your consultation. Some patients have also agreed to speak with prospective patients if you would like to learn more about the procedure from a patient’s perspective.
What is the first step?
If you are considering having a breast reduction, please call our office at (212) 600.4109 to arrange for a consultation. Our New York City practice accommodates out of town and international patients who need to travel in for surgery as well as those who are local to Manhattan.