Steve Fallek (Plastic Surgeon & Medical Director, Face Focus Medical Spa, New York City) gives expert video advice on: How is a breast reduction procedure performed?; Who can get a breast reduction?; Is a breast reduction painful? and more...
What is "breast reduction"?
A breast reduction is a procedure where both skin and breast tissue are removed from the patient. This is different from a breast lift where only skin is removed, or breast augmentation where patients don't have sufficient volume. Breast reduction usually occurs in patients that have significant breast tissue and can be anywhere from a size C cup all the way up.
How is a breast reduction procedure performed?
Breast reduction usually addresses two major concerns patients have. They are extra skin and extra breast tissue, and a breast reduction removes both of those areas. In general, there are three different types of incisions or scars that are associated with a breast reduction. For smaller patients, you may be able to get away with what we call the periareola, around the nipple incision. For the majority of patients, though, breast reduction involves either a lollipop incision - an incision around the nipple and then straight down - or the anchor or reverse T incision, which is around the nipple, straight down and then in the inframammary crease or crease area.
Who can get a breast reduction?
Breast reduction is classically for patients that have concerns about the size of their breasts; usually patients a size C or above. For many patients, they're uncomfortable with the size, and they're also having back, shoulder and neck pain and they're uncomfortable with the size of their breasts. Patients who want breast reduction surgery also don't like the way that they look in clothing.
Who should not get a breast reduction?
If a patient has concerns about the size of her breast, then a breast reduction is an excellent choice for them. And the recipients of breast reduction surgery are some of the happiest patients that we have in plastic surgery. Questions are raised in terms of teenagers and what would be an appropriate age for doing a breast reduction, if a teenager or a young child has enlarged breasts. Unless there is a strict, medical condition causing this, then in general it's better to wait until the patient is mature to do the breast reduction, and then the case can be discussed both with the patient and the parents.
Is a breast reduction painful?
The great thing about a breast reduction is that when patients wake up from surgery most of the pain is gone. By that I mean by neck pain, back pain and shoulder pain. Those are usually the complaints that patients have, and when they wake up and the breast tissue is removed, they feel much better. There's going to be some incisional pain after breast reduction, where the scars are, but in general those patients are much happier after surgery.
What are the risks and complications of breast reduction?
The most common concerns and complications associated with breast reduction are asymmetry. That would be the fact that the right and left breast don't match perfectly. For most patients, there is a general asymmetry of the breasts even before surgery. Other concerns about breast reduction surgery are regarding the scarring or the incision sites, and what those scars will look like. Other complications include potential nipple loss or partial nipple loss, where there can be some loss of the skin of the nipple. Also, there can be skin necrosis, or loss of the skin, involved in the breast reduction. However, in general, most of these complications heal without much of an issue.
What should I expect after breast reduction surgery?
Immediately after breast reduction surgery, if you had complaints of back or shoulder pain, most of that pain will be gone. Over the course of the next couple of days to weeks, you'll have your dressings changed by your plastic surgeon and he may put bacitracin - or what we call xeroform or protective gauze - around your nipple area to keep it moist and comfortable. In terms of the incisions, there's really not much to do. Your doctor will have you stay in a bra or wearing some sort of support for at least a month if not two months after breast reduction surgery. You'll also be expected to stay off of your front when you're sleeping.
What post procedures should I follow after a breast reduction surgery?
Your doctor will determine what post-operative care he wants after breast reduction. In general, it will require you to be in a bra or wear some sort of support for at least a month - maybe two months - as the breast shape really takes its final development, which can take up to six months
Will I have to take time off from work after breast reduction surgery?
I usually suggest that patients take at least a week off from work after the breast reduction surgery. If you need to go back to work earlier that may be an option. You'll be wearing a bra and support so that's usually not a problem. If you work at home that could probably take place in a day or so after breast reduction surgery.
Will my insurance pay for my breast reduction?
Breast reduction is really a gray area between both cosmetic and reconstructive surgery. Because it is considered a medical procedure by some, medical insurance may cover breast reduction. Now that is going to depend on your symptoms prior to breast reduction. Are you having back pain, neck pain, shoulder pain prior to breast reduction? Are you having some rashes underneath your breast prior to breast reduction? Have you been to a chiropractor or an orthopaedic surgeon to determine whether or not you are having back pain from a large breast or from something else? With this documentation, you may want to bring this up to your plastic surgeon and to your health insurance company to see whether or not they will cover breast reduction. For many insurance companies there is also a minimum requirement which is about 5 grams of breast tissue that needs to be removed from both breasts during the breast reduction surgery. This is usually the equivalent of a big C or D cup.
Can I get other plastic surgery procedures at the same time as receiving a breast reduction?
It's very common to have a breast reduction and other body surgery at the same time. On the other hand, if you have a significant amount of breast tissue that's going to be removed, your plastic surgeon may choose not to do another procedure at the same time, because he may not want to have you undergo significant anesthesia time and significant tissue removal.