Cosmetic Surgery Breast Reduction / Mammaplasty - Plastic Surgery
Breast Reduction Topics Background Best Candidates Uncertainty & Risks Planning for Surgery Preparing for Surgery Where the Surgery is Performed Anesthesia How the Surgery is Performed Post-op Methods Q&A
Although most people think of breast augmentation procedures when they think of breast surgery, a growing number of women are undergoing breast reduction procedures, known as reduction mammaplasties. Women with very large breasts can be tormented by a variety of medical problems caused by the excessive weight of the chest, from back and neck pain and skin irritation to skeletal deformities and breathing problems. Disproportionately large breasts can also lead to extreme self-consciousness.
Breast reduction is designed especially for women with such problems. The procedure removes a particular amount of fat, glandular tissue, and skin from each or both of the breasts, making them smaller, lighter, and firmer. The surgery can also be used to reduce the size of the areola, the dark skin surrounding the nipple. The goal of breast reduction surgery is to give a woman smaller, firmer, better-shaped breasts that are in proportion with the rest of her body.
Breast Reduction / Mammaplasty - Are You A Candidate?
Women usually have a breast reduction to minimize the amount of pain and discomfort associated with unusually large breasts. Many of these women suffer extreme pain in their backs, neck, and shoulders, and often a reduction will remedy this situation. Other women have breasts altered by genetics, age, or childbirth and wish to regain a shapelier, more natural figure. Reductions are not recommended for women who expect to breastfeed in the future.
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Breast Reduction Procedures & Risks
Concentric
When women have smaller breast with less significant drooping, a surgeon may elect to use concentric or "doughnut" shaped incisions to remove extra breast tissue. Small incisions are made around the nipple and areola which are then repositioned higher up on the breast. Once the excess tissue is removed the surgeon uses very fine sutures to secure the new placement of the nipple. It is common for the new skin around the areola to wrinkle or "pleat" for the first few weeks after surgery, but this is completely normal and should subside shortly.
Anchor-shaped mammaplasty
When women have larger breasts with much greater sag or droop surgeons often elect to use an anchor-shaped incision to remove excess breast tissue. This incision is a small vertical cut down from the areola that curves out to either side of the tissue on the underside of the breast. This extensive incision gives doctors greater control over how to reshape the breast through tissue removal and liposuction. The surgeon then removes skin from around the area and stitches the remaining tissue together in order to form a tighter, smaller, and better defined breast. The benefits of the anchor incision are greater manipulation by the surgeon and less visible scarring on the breast.
Horizontally
The oldest form of breast reduction uses a long horizontal incision on the bottom of the breast crease where the skin meets the chest. This leaves the most visible scarring, and is only used to remove significant amounts of tissue.
Risks
Every surgery carries some degree of uncertainty. Consult your board certified plastic surgeon before the procedure to understand any potential risks.
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Where Mammaplasty Surgery is Performed
Most breast reductions are performed in a surgical facility, doctor's office, or hospital.
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Anesthesia for Breast Reduction Surgery
Virtually every breast reduction is performed under general anesthetic so you can sleep through the entire operation.
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Planning for Breast Reduction Surgery
Your surgeon will examine and measure your breasts to plan the most appropriate procedure. It is extremely important to openly discuss your expectations with the surgeon because everyone has a different opinion on what is the most aesthetically pleasing breast.
Women who receive medically necessary mammoplasties should inform their insurance companies before the surgery, as all or part of the procedure may be covered.
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Preparing for Breast Reduction Surgery
Some surgeons insist that you get a mammogram before your procedure to rule out the possibility of internal complications during tissue removal. Mammaoplasties can be rather involved surgeries so doctors often advise their patients to have some blood drawn prior to the operation in case a transfusion is needed. There are also specific guidelines regarding food, liquid, and medicine intake, so be sure to follow your doctor's orders.
It is also wise to prepare transportation to and from the operation and have someone to assist you for the first few days of recovery. Be sure to talk to your doctor about any questions you might have before your surgery.
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How Breast Reduction Surgery is Performed
Though there are many techniques for a mammaoplasty, most procedures begin with a donut-shaped incision around the areola with a vertical cut downward on the front of the breast. Your doctor will remove fat, skin, and glandular tissue from the breast, and reposition the nipple and areola to compliment the new size and shape of your breast.
One of the most important considerations is the placement of the nipple. Although the nipples remain connected to their nerves and blood supplies in most mammaplasties, in the cases that merit extreme reduction it is often necessary to graft the nipples and areola to a higher location on the breast. This restructuring causes a total loss of sensation.
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Recovery from a Mammaplasty Procedure
The post-operation recovery process is very similar to other breast procedures. After the surgery, you will be wrapped in an elastic bandage or a surgical bra over gauze dressings, and a small tube may be placed in each breast to drain off blood and fluids for the first day or two.
Although breast reduction is a safe procedure with few complications, you may feel some pain for the first couple of days, especially when you are mobile. A general discomfort may last for a week or more, and your doctor will prescribe medication to lessen the pain.
Your cosmetic surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work and social activities in about two weeks, providing that they are careful to avoid strenuous activity.
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Breast Reduction Surgery Questions and Answers
How will my doctor know if breast reduction surgery is right for me?
During your initial consultation your surgeon will measure and examine your breasts and most likely photograph them for your records. Skin quality, shape and size of your breasts, and location of your nipples and areolas are measured to assure proper placement.
Your doctor will also need your medical history such as previous surgeries, drug allergies, mammograms, and any other pertinent medical conditions you might have. The degree of candor you have with your doctor can greatly influence the outcome of your surgery.
I have medical insurance, but will it help cover the cost of my reduction?
If your breast reduction is for medical rather than cosmetic purposes, you may be eligible for insurance coverage. The terms of your coverage are outlined in your policy, so contact your insurance company before your procedure. You will often need a letter of predetermination prepared by one of your doctor's staff to submit to your company, so discuss this with your surgeon.
Breast reduction usually requires three incisions; the first around the areola, the second down the front curve of the breast, and third along the bottom of the breast. In some cases of extreme tissue removal the areola and nipple will have to be disconnected from the underlying tissues and grafted onto a new location on the reconstructed breast.
Breast reductions are typically performed in a hospital, surgical suite, or a doctor's office under general anesthesia. After the procedure you will be taken to a recovery room where your vital signs are monitored. Your breasts will be wrapped in a special compression garment with gauze and you will be sent home after a few hours.
You will undoubtedly feel sore and woozy after your procedure, but you should get up and walk around for short intervals to promote healing. Sleeping on your back is also advised. Bruising, swelling, and scarring usually begin to fade after a few weeks, and your stitches and sutures will be removed between one and three weeks after the surgery.
Most women return to work after a few weeks of recovery. You should avoid exercise, sexual activity, or any other physical exertion for a few weeks, or until your doctor advises you otherwise.
Without gaining or losing extreme amounts of weight your breast size should remain consistent with your body size. Age and gravity will eventually take their toll so some women elect to have lifts every few years to insure proper body contours. Smaller breasts allow many women to do things they could not before such as participate in sports, wear clothes that fit, and enjoy life without pain in their neck and back.
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If you’d like more specific answers to these questions, the best place to start is by consulting with a board certified plastic surgeon.
