Breast Reduction Surgery, or Reduction Mammaplasty, removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body. The procedure enhances the overall appearance of your breasts and helps to alleviate the discomfort associated with overly large breasts.
About the Procedure
Overly large breasts can cause some women to have both health and emotional problems. In addition to self image issues, you may also experience physical pain and discomfort.
The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts is as important an issue to many women as the physical discomfort and pain.
Also known as reduction mammaplasty, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.
Is it right for me?
Breast reduction surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.
Breast reduction is a good option for you if:
- You are physically healthy
- You have realistic expectations
- You don’t smoke
- You are bothered by the feeling that your breasts are too large
- Your breasts limit your physical activity
- You experience back, neck and shoulder pain caused by the weight of your breasts
- You have regular indentations from bra straps that support heavy, pendulous breasts
- You have skin irritation beneath the breast crease
- Your breasts hang low and have stretched skin
- Your nipples rest below the breast crease when your breasts are unsupported
- You have enlarged areolas caused by stretched skin
Your consultation is your time to ask the doctor about the procedure you’re considering, how he thinks it will work for you and any concerns you may have. We suggest you come prepared with your questions on paper so you’re sure not to forget to ask the questions that are important to you.
Questions to consider:
- What is the simplest and safest surgery to help me achieve my goals?
- How is the surgery performed?
- What is the expected length of operation?
- Are other options available?
- What results can I expect, and how long do the typical results last?
- Where will scars be located, and how noticeable will they be?
- Will scars fade over time, and how long will this take?
When you arrive at the office, you will be asked to fill out a few pieces of paperwork. It is very important when asked about medications to put down all medications you take, including any supplements or aspirin-type regimens, since these items can impact your blood clotting and pressure. In addition, you need to be truthful about your use of tobacco and alcohol since this will affect your recovery and incision healing.
Before you see the doctor, a nurse or nurse practitioner will do an initial exam. You may be able to get a number of your questions answered while with the nurse.
Your surgeon will discuss several factors regarding surgery during your initial consultation, including your procedure, location, anesthesia and recovery. In addition, the surgeon will inquire about your concerns, priorities and motivations for pursuing surgery, as well as your fears.
The doctors are sure to address reasonable expectations for the outcome of your desired procedure, and they should explain what is possible and what is not possible.
After your consultation with the physician, you will meet with the practice manager to discuss procedure costs.
In order for your breast reduction to be covered by insurance, it must be a medically necessary procedure. To determine the “minimum required amount” of breast tissue to be removed is the Schnur Sliding Scale. This scale was developed by a plastic surgeon who was studying women who had breast reduction surgery for medical reasons. The patient’s body surface area and average weight of breast tissue removed is incorporated into the chart. If your body surface area and weight of breast tissue removed fall below the 22nd percentile, then the surgery is deemed cosmetic in nature, and therefore not medically necessary. If however, these two factors are above the 22nd percentile, then the operation is considered medically necessary when the appropriate criteria are met. Not sure what your body surface area is (BSA) you can calculate it here.
There are a number of things to do prior to your procedure that will make your recovery as smooth as possible and ease your pre-procedure anxiety.
Your surgeon will give you instructions on what medications to stop taking and when prior to your surgery to prevent any unwanted side effects. Medications you shouldn’t take up to two weeks prior to your surgery include, but are not limited to, aspirin and products containing aspirin, alcohol and herbal supplements. Your surgeon may advise you to take Arnica Montana, Bromelain or vitamins A or K for swelling, bruising and to promote general healing.
It is important to remember to only take a supplement or herbal remedy if your surgeon advises it.
Your Pre-Op Checklist
- Take pictures and make notes to discuss with your doctor. You know what you want, and he knows how to make it possible.
- Make a list of post-op projects and gather what you need.Stop taking blood-thinning medications and supplements two weeks prior to surgery (aspirin, Motrin, fish oils, vitamin E) and don’t take them two weeks after surgery.
- Books to read
- Photo projects
- Vacation planners
- Start using anti-bacterial soap in the shower a few days before surgery and following surgery.
- Remove all fingernail and toenail polish.
- Fill prescriptions you’ll need, including antibiotics and pain medications.
- Purchase over-the-counter eye drops and eye gel for overnight (GenTeal seems best and it is found at major drug stores like Walgreens)
- Pick up Bacitracin for incision areas and Colace to keep your bowels moving during recovery.
- Clear your calendar for a month post-op
- Arrange for caretakers: you, kids, plants and pets need to be taken care of during your recovery. You will not be able to lift, reach, bend over or be too active for some time.
- Prepare your recovery area so your head is elevated. A recliner works wonders for this. Also stock your recovery area with:
- Remote control
- Reading material
- Any other item that will make you feel comfortable during your recovery
- Make a to-do list of things you want to get done prior to surgery and start! You won’t be able to accomplish as much post-surgery. Some items you may want to get done include:You will want to stock up on groceries or cook meals prior to your surgery. Many patients enjoy the ease of frozen meals, yogurt, pudding, fruits, soups and anything else that is easy to prepare.
- Clean the house
- Catch up on gardening
- Give the dog a bath
- Clean the litter box
- Wash your car
- Stock up on ice packs, frozen peas and frozen gel packs. You’ll want to use them early and often on your face, neck and ears. It will definitely feel good and keep the swelling down.
- Pack a receptacle with a lid and towel in your car for the ride home from the hospital just in case you feel nauseous. You may want to add a pillow and blanket, but be sure to set up on the ride home to help with the nausea and swelling.
- Get your hair and nails done since it will be a while before you can do either.
- Prepare Power of Attorney for Medical Care and Advance Directives, just in case. Give copies to your doctor and/or surgical center.
- Breathe and relax! Stress can adversely affect your recovery. Try to remember that you will heal, the soreness will subside and you will look great.
During Your Procedure
Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.
In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.
The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice.
Anesthesia: Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Incision options include:
A circular pattern around the areola
The incision lines that remain are visible and long-lastin scars, although usually well concealed beneath a swimsuit or bra.
A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease
An inverted T or anchor-shaped incision pattern
Removing tissue and repositioning: After the incision is made, the nipple which remains tethered to its original blood and nerve supply is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.
Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).
Closing the incisions: The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are long-lasting, but in most cases will fade and significantly improve over time.
Results: The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.
The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction.
Your better proportioned figure will likely enhance your self image and boost your self-confidence.
However, over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.
When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.
A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.
Recovery is an important part of any surgery, and you must take the doctor’s orders to heart if you want to heal as quickly as possible.
You will be given specific instructions that may include: how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in overall health, and when to follow up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery? When will they be removed?
- Are stitches removed? When?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?