Breast Reduction

Today's society has placed a high value on moderately large, shapely breasts, but those patients with "more than their share" know that massive breasts can be a curse. These breasts can be made smaller and more comfortable with a safe and predictably attractive outcome through breast reduction surgery.

Patients with large breasts complain of neck pain, back pain, bra strap grooves, rashes under their breasts, and occasionally arm tingling and shortness of breath. All of these symptoms may be improved by breast reduction surgery. In order for this procedure to be covered by one's insurance policy, the patient, in general, must be within 10-15% of their ideal body weight, have all of the above symptoms, and have failed conservative treatments such as Motrin and physical therapy. These guidelines are bent often, but the insurance companies do not like to spend their dollars on this "cosmetic" procedure. They frequently stall and are slow in approving this procedure. We will help in anyway we can, but in the end, the insurance companies pay more attention to their customers than they do the doctors because they have a contract with the customers who pay their premiums every month. The physicians have no such contract; therefore, have less 'power' with the insurance companies. So you may have to push them to get the procedure done.

Timing the Procedure

"I am absolutely delighted with my results from breast reduction, tummy tuck and hip liposuction. Dr. Graper has a wonderful bedside manor, is honest with what I could expect and has exceeded all of my expectations with what he has done for me. I am only 3 weeks post op and everyone who sees me tells me how great I look! I can not say enough great things about him or his amazing staff!" – Jennifer

Timing of the breast reduction procedure is important with respect to pregnancy. Ideally the patient should wait until after they are through having children to have any breast reduction procedure. Scheduling a breast reduction procedure in this fashion permits the good postoperative breast size and shape from being damaged by pregnancy changes. Obviously, it is not reasonable to ask an 18 year-old single woman, with painful symptoms of large breasts, to wait 10 to 15 years until she is sure she has completed her childbearing career. But it is important to discuss timing with a 28 year-old married woman who is considering having children soon, so she can achieve the best possible long term results and not destroy her pretty, new breasts with a pregnancy.

All breast reductions remove extra skin and breast tissue, but there are two main ways to handle the nipple. The main procedure leaves the nipple attached to the breast at all times. The other more seldom used procedure removes the nipple as a skin graft and then replaces the nipple after the breast has been reduced. Ninety-five percent of breast reductions are done leaving the nipple attached. This breast reduction procedure demands that the final appearance of the breast be larger to accommodate the volume of tissue required to bring blood supply to the retained nipple. This technique has the advantage of maintaining nipple sensation in eighty percent of the patients, and usually the ability to breast feed postoperatively. The disadvantage is that in very large breasted patients (DD and greater), the breast cannot be made reliably less than a C cup and occasionally the nipple can have difficulty healing.

The nipple graft technique is indicated for very large breasted ladies who want to be smaller than a C cup. It is also good for older patients and those who have little nipple sensation pre-op. There will be no sensation in the grafted nipple and no ability to breast feed postoperatively. For dark-skinned patients, there may be some temporary or permanent depigmentation of the nipple color. The incisions on the breast are the same, no matter which technique is chosen. Patients will be guided through this decision with the help of their doctor.

The breast reduction procedure is done at an outpatient surgery facility, under general anesthesia, and requires approximately four hours to complete. Most patients stay overnight and go home the next day. Breast Reduction patients experience soreness, but significant pain is unusual. There are usually no sutures to be removed and breast reduction patients can shower after 2-3 days postoperatively. The usual return to work date is 2-3 weeks after breast reduction surgery, and patients may resume moderate exercise after three weeks.

Potential Risks

Like any other plastic surgery, postoperative bleeding and infection are possible complications, but are rare after breast reduction. As noted above, there is normal nipple sensation in 80% of patients, but 20% have decreased or no sensation in their nipples after breast reduction surgery. There is no procedure to improve this condition if it occurs. Healing of the tissues can be delayed if the reduction is on a very large breast or if the patient is over 50 years old, a diabetic or a smoker. If wound healing is impaired, we keep the area clean and moist and allow tissues to heal on their own. This involves the nipple itself in less than 1% of the cases. Small asymmetries, where the breasts are not exactly the same shape or size, are not uncommon, but large differences in the breast are unusual and would, of course, be corrected.

Breast reduction patients are some of the happiest patients because not only do they feel so much better, but they also look better as well. Even though the breasts have incisions after surgery, they look much more attractive than the misshaped, large, droopy preoperative breasts without incisions. Our breast reduction patient's clothes fit and they can actually enjoy normal lives at the beach, pool or gym. This is a great plastic surgery procedure with high patient satisfaction for the right candidate.