What is breast reduction?
I am glad you asked that question. A breast reduction is an operation usually considered in patients who have very large breasts. Most often these women present with back and neck pain that in some cases is chronic. They contact their primary physician and go through an extensive workup for this pain. At the end of this workup, they are left with the idea that most of their pain is actually due to their large breasts. Most of these women complain that their breasts sag and weight down their body. They have heavy groove marks over their shoulders. In some cases they suffer from significant skin changes below their breasts. All of these are possible effects of abnormally large breasts. In order to effectively treat this problem, we tend to decrease the size of breasts. We do this by choosing between several different types of operations. Most often our emphasis is to make sure that the breasts are symmetric and that the patient’s pain is resolved.
Please note that there are patients in whom breasts are simply large. They may choose simply to make them smaller. This is often seen in patients who have lost a lot of weight and therefore want their breasts to match. In this way by getting their breasts smaller, their body seems to fit more comfortably. Not everyone wants to have their breasts reduced because they have pain.
Is this surgery covered by insurance?
Great question. Insurance in most cases nowadays will try not to cover this procedure. This is because in general insurance is trying to pay for fewer and fewer operations in general and this procedure is no different. In many cases, after months of the approval process, the insurance company will pay for some part of the procedure. However, for this to happen, there has to be a very diligent cataloguing of the patient’s pain, diagnoses, history and visits to the primary physician. Also if the patient has seen a chiropracter or a neurosurgeon for their back pain, this should also be documented. The documentation should be brought in to us when the consultation is made. With this information, we will maximize the chances for getting the operation/procedure approved.
What size can I be?
Size is a curious question. Most women have an idea of what size they wish to be. However, when a breast redution is considered they are less concerned about size as opposed to shape. The emphasis of this operation is to reduce the breast size and give the patient a symmetric pleasing end result. Also, a particular concern in most patients is to remove enough tissue so that their pain is relieved. Most women fail to realize the dynamics involved. Let me elaborate. When loose breast tissue is recontoured and a nipple/areola is lifted, the breast tissue is still loose, but the nipple and areolar complex is now more where it should be. The tissue lends itself to giving the patient the fullness they desire. Also by lifting the nipple areolar complex, the patient is able to feel perkier and is left with a younger look, what every patient wants.
What are the possible complications of breast reduction?
Like any surgery, there are risks and complications. With breast reduction, the most common risks and complications are bleeding, infection, nipple skin sloughing, numbness, and contour irregularity. Bleeding can happen if the local epinephrine solution has not had time to work. Infection is always a concern with any surgical procedure in which the skin is violated. Preoperative antibiotics are given. This is further complemented with post-operative oral antibiotics. Nipple skin sloughing is a concern because some of the skin sometimes seems to slough. Most often the skin around a nipple is rather resilient and the sloughing is allowed to heal secondarily like a scrape. After several weeks, the area has good remodeling and is not even noticed. Numbness is some cases is the most pressing concern. For obvious reasons, in females, any surgical procedure that may interfere with a sensation around a nipple needs to be approached carefully. Because the incision for the breast reduction goes all the way around the nipple, there is a concern that there may be loss of skin sensation. This may be permanent or may last only a short time. Most often the loss of sensation or the change in skin sensation is short-lived. But the patient should be made aware that permanent numbness is a real possibility. Last but not least, contour irregularity is a concern. When the nipple areolar complex is repositioned, it can scar unevenly. One side may have a slight tilt and the other side may not. Most often this contour irregularity corrects itself over the 3 to 6 months following surgery. In cases that this does not happen, the nipple/areolar abnormality can be corrected with local anesthetic in the office setting.
How painful is the procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain. Most of the pain seen with breast reduction is due to the bruising and the swelling involved. In fact most complain more about the soreness and aching sensation than actual pain. To help with the pain, we regularly give patients oral and intravenous pain medicines in the post-operative period. Upon their discharge from the hospital, we supplement this with oral pain medication. It must be noted here that at the time of the surgery, the incisions are infiltrated with local anesthetic medication that lasts six hours, in an effort to help with post-operative pain.
How long do I have to take off from work?
Great question. Most often I suggest to patients that they consider taking about 1 to 2 weeks from work. Let me elaborate. Once the operation is completed, the area involved becomes swollen and in many cases becomes extremely bruised. This area then slowly goes through healing. I ask most of my patients to start walking by day#2. I ask them to stay away from exercise at the gym for about 4 weeks. I believe this prevents the development of excessive swelling. As for work though, most patients are fairly comfortable in returning by week 3. However, this does depend on what type of work the patient does.
Can I combine this procedure with any other procedure?
Yes and no. Like any surgical procedure, there are limits
to what can be done and what is safe. As for the yes, it can
be combined with some other procedures. Multiple other procedures
like an abdominoplasty, or liposuction are routinely done
along with reduction. Any procedure that may be too long or
too arduous and place the patient at risk for significant
bleeding or significant anesthetic exposure would have to
be deferred and done in two stages. Please understand I say
this without knowing exactly what you, the patient, may have
in mind. I can only speak from my experience.
Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body and
their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local plastic surgeon.