Breast Reduction (Reduction Mammoplasty)

Overview:

Breast reduction, also known as reduction mammoplasty, is a surgical procedure that involves removing excess fat, tissue, and skin from the breasts to achieve a smaller, lighter, and more aesthetically pleasing bustline. This procedure can help reduce the physical and emotional discomfort associated with large, heavy, or pendulous breasts.

Common Questions and Answers

Breast reduction, also known as reduction mammoplasty, is a surgical procedure that involves removing excess fat, tissue, and skin from the breasts to achieve a smaller, lighter, and more aesthetically pleasing bustline. This procedure can help reduce the physical and emotional discomfort associated with large, heavy, or pendulous breasts.

Here are some of the most common questions and answers about breast reduction:

Who is a candidate for breast reduction?

• Ideal candidates for breast reduction are women who are in good physical and emotional health, have realistic expectations, and are dissatisfied with the size, shape, or position of their breasts. Women with large, heavy, or pendulous breasts may experience physical symptoms such as neck and back pain, skin irritation, and posture problems, as well as emotional discomfort such as self-consciousness, insecurity, and embarrassment. Breast reduction can help alleviate these symptoms and improve quality of life.

How is breast reduction performed?

• The surgeon typically performs breast reduction under general anesthesia or intravenous sedation, and the procedure can take from two to five hours, depending on its extent. The most common technique involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease under the breast. The excess tissue, fat, and skin are removed, and the nipple-areola complex is repositioned to a higher, more youthful position. The surgeon reshapes and sutures the remaining tissue to create a smaller, lighter, and more aesthetically pleasing bustline.

Are there any risks and complications of breast reduction?

• As with any surgical procedure, breast reduction carries certain risks and complications, including bleeding, infection, hematoma, scarring, loss of sensation in the nipple-areola complex, asymmetry, and dissatisfaction with the final result. You can minimize these risks by choosing a qualified and experienced plastic surgeon, following all pre- and postoperative instructions, and communicating openly and honestly with your surgeon about your expectations and concerns.

What is the recovery time after breast reduction?

• The recovery time after breast reduction varies from person to person and depends on several factors. These factors include the extent of the procedure, the patient’s overall health, and the surgeon’s instructions. Most patients need to take one to two weeks off work to rest and recover. They may also experience some swelling, bruising, and pain that can be managed with pain medication. Strenuous physical activity, including lifting and exercising, should be avoided for at least four to six weeks after the surgery to ensure proper healing.

What should I expect during the consultation?

• During the consultation, your plastic surgeon will examine your breasts, ask you about your medical history and any previous surgeries, and discuss your goals and expectations for the procedure. You should also provide your surgeon with a list of any medications or supplements you are taking, as well as any allergies or health conditions that may affect your surgery. Your surgeon will also explain the different techniques, risks, and benefits of breast reduction and help you choose the best option for you.
• During your initial visit, you’ll also need to provide a complete medical history and Dr. Baumholtz will perform a physical exam and a careful evaluation of your breast tissue and the skin overlying your breasts. He’ll also take photos of your breasts to help guide the surgery.
• Be ready to provide complete information about your health and the health of close family members (including parents and grandparents), as well as a list of any medications or dietary supplements you’re taking and any prior surgeries you’ve had.
• If you smoke or take aspirin or other nonsteroidal anti-inflammatory medications, you’ll need to stop for a few weeks prior to surgery to promote healing and reduce the risk of bleeding.
• If you plan to lose a significant amount of weight or you plan to become pregnant in the future, you’ll need to discuss that as well since weight loss and pregnancy both can affect the size of your breasts and the results of your procedure.
• Depending on your age and health history, your surgeon may ask you to see your primary care doctor in preparation. The surgeon may require some patients to have an EKG to evaluate the heart, a chest X-ray, or a mammogram in addition to blood tests or other lab work.

How will my breasts look after the surgery?

• After the surgery, your breasts will be smaller, lighter, and more aesthetically pleasing. The incisions will be closed with sutures, and you will be wrapped in bandages to help minimize swelling and support the new shape of your breasts. You should expect some swelling, bruising, and discomfort, which can be managed with pain medication and rest. Your plastic surgeon will provide you with specific postoperative instructions to follow, such as wearing a supportive bra, avoiding certain activities, and managing any pain or discomfort you may experience.

Can I breastfeed after breast reduction?

• Breastfeeding after breast reduction is possible, but the surgery does not guarantee it. During the surgery, the surgeon repositions the nipple-areola complex to a higher, more youthful position and may partially or completely remove the milk ducts and nerves that control the sensation and function of the nipple-areola complex. The ability to breastfeed depends on several factors, such as the extent of the procedure, the patient’s individual anatomy, and the surgeon’s technique. If you plan to have children and breastfeed in the future, it is important to discuss this with your plastic surgeon and consider alternative options, such as a breast reduction with nipple preservation.

How long will the results last?

• The results of breast reduction generally last long, but various factors like weight changes, pregnancy, hormonal fluctuations, and aging can affect them. To maintain the best possible results, it is important to follow a healthy diet, exercise regularly, and avoid exposing your breasts to the sun or other sources of ultraviolet radiation (such as tanning beds). If you experience any changes or concerns, it is important to contact your plastic surgeon and schedule a follow-up appointment.

What is the recovery time for breast reduction?

• Recovery time after breast reduction surgery varies from person to person, but most people return to work and normal activities within a few weeks. You should expect some swelling, bruising, and discomfort in the days following the surgery, which can be managed with pain medication and rest. Your plastic surgeon will provide you with specific postoperative instructions to follow, such as wearing a supportive bra, avoiding certain activities, and managing any pain or discomfort you may experience. You should also expect follow-up appointments with your plastic surgeon to monitor your progress and address any concerns or questions you may have.

Will I have scars after the surgery?

• Yes, breast reduction surgery will result in scars. The location and size of the scars depend on the technique used, as well as the size and shape of your breasts. Some common incision patterns include the anchor-shaped incision, the vertical incision, and the circumareolar incision. Your plastic surgeon will discuss the options with you and choose the best technique for your needs and goals. With proper care, most scars will fade over time and become less noticeable, but they will not disappear completely.

Can I combine breast reduction with other procedures?

• Yes, breast reduction can be combined with other procedures, such as a breast lift, a tummy tuck, or liposuction. This is known as a Mommy Makeover, and it can help address multiple areas of concern in a single surgical session. However, it is important to keep in mind that combining procedures will increase the overall risk and recovery time, as well as the cost. Your plastic surgeon will discuss your options with you and help you choose the best plan of action to meet your goals and expectations.

How much does the breast reduction cost?

• The cost of breast reduction varies depending on several factors, such as the extent of the procedure, the surgeon’s experience and reputation, the location of the practice, and the specific techniques used. The cost typically includes the surgical fee, anesthesia fee, and any necessary medical supplies, but it does not include preoperative laboratory tests, postoperative garments, or prescription medications. Some insurance companies may cover the cost of breast reduction if it is deemed medically necessary, but it is important to check with your insurance provider and understand the specific requirements and limitations. Your plastic surgeon can provide you with a detailed cost estimate during the consultation.

How should I prepare for breast reduction surgery?

• To prepare for breast reduction surgery, you should follow the instructions provided by your plastic surgeon, which may include:
• Stop smoking or using nicotine products at least 4-6 weeks prior to the surgery, as smoking can slow down the healing process and increase the risk of complications.
• Avoid taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and other blood-thinning medications for at least two weeks before and after the surgery, as these can increase the risk of bleeding and bruising.
• Avoid drinking alcohol for at least 24 hours before and after the surgery, as alcohol can dehydrate your body and affect the healing process.
• Arrange for someone to drive you home after the surgery and to stay with you for the first 24-48 hours, as you will not be able to drive or operate heavy machinery due to the effects of the anesthesia.
• Purchase a supportive bra and any other necessary medical supplies, such as gauze, sterile saline solution, and surgical tape, as recommended by your plastic surgeon.
• In addition, you should communicate openly and honestly with your plastic surgeon, discuss your goals and expectations, and ask any questions you may have about the procedure, the risks, and the benefits. By preparing thoroughly for breast reduction surgery, you can increase your chances of a successful outcome and minimize the risk of complications.

What happens during a breast reduction procedure?

• Breast reduction in San Antonio is performed on an outpatient basis at a hospital or surgical center and using general anesthesia. On the morning of your surgery when you shower, don’t use lotions or perfumes on your skin. Be sure to wear loose, soft, comfortable clothing to make it easier to dress following your procedure. When you arrive for surgery, Dr. Baumholtz will take your vital signs and go over your surgery with you once more, answering any questions you may have about the procedure or your immediate recovery. Then Dr. Baumholtz will use a special marker to make lines on your breasts indicating where the incisions will be placed.
• Breast reduction surgery often combines two related procedures – decreasing the size of the breast and bringing the nipple into a better, more youthful position on the breast.  Most breast reduction surgeries use three incisions to remove excess tissue and then reposition the areola and nipple higher on the breast. The areola may reduce in size too. The surgeon makes one incision around the perimeter of the areola, a second incision down the center of the breast from the areola to the crease under the breast (the inframammary fold), and a third incision horizontally along this fold. Other incision patterns may be used depending on your breast size and shape, how much your breasts sag, the amount and type of tissue being removed, the location of your areola and nipple, and other factors. Once the incisions are made, Dr. Baumholtz will remove excess breast tissue and skin from each breast, making sure to “even out” the size of the breasts so they’re more or less similar in size. Although he’ll aim for symmetry between the two breasts, absolute “mirror images” isn’t realistic, nor is it natural-looking. In fact, Dr. Baumholtz is fond of saying that while he can make “good-looking sisters,” only Photoshop and Mother Nature can make identical twins.  Next, he’ll reshape the remaining tissue and move the areola and nipple to a higher position when needed to create a more uplifted, youthful profile. In some rare cases, he’ll place drains (small tubes) in each breast to drain excess fluid away from the breasts to prevent pressure from building up behind the incisions.
• The surgeon will close the incisions and apply a surgical dressing, followed by a simple surgical bra or a special wrap designed to apply gentle compression. In most cases, breast reduction in San Antonio takes about two to three hours, and the medical staff will discharge patients after spending some time in a recovery area for monitoring and observation. You’ll need to arrange to have someone drive you home and stay with you for at least the first night following your procedure.

What can I expect during my recovery from breast reduction surgery?

• After your surgery, the medical staff will move you to a special recovery area. As the anesthesia wears off, you may feel some discomfort. Pain medication can help keep you comfortable. Before discharging you, the surgeon will give you specific instructions about how to care for your incisions sites and any drains that may be in place.
• Your surgeon will prescribe a compression garment to help reduce swelling and promote optimal healing, and they may also give you a prescription for antibiotics to take.
• The surgeon will place restrictions on your activity after the breast reduction surgery, and you should avoid strenuous activities or lifting anything heavier than about 10 pounds for about six weeks.
• You should also avoid raising your arms above your head. You may need to have someone help you bathe and wash your hair initially. Until your incisions completely heal you’ll need to avoid baths (as well as hot tubs and swimming pools) and take showers instead.
• You should walk every day to prevent clots from forming.
• You should expect to feel sore and tender in the chest and upper arms for several days, and bruising can take one to two weeks to subside. You may also have some numbness or itching around the incisions.
• You’ll increase your activity slowly over time. You’ll return to full activity at about six weeks postop. At this time you can also go shopping for new bras. Wearing your compression garment as directed, drinking plenty of water, and walking during recovery can help reduce swelling.
• It’s also important to elevate your head and back when sleeping during recovery to reduce both swelling and discomfort. Between three months and a year after your procedure, all swelling will resolve and you’ll see the final position of your breasts.

Is there a non-surgical or small incision solution?

• There are a few situations where this would be an appropriate option. For a few women who have fatty breasts without significant sagging and who only want to achieve a small reduction, liposuction alone may be enough to achieve an improvement in breast size and appearance.
• Liposuction typically is appropriate for only a small number of women who want a small change in breast size and would only be appropriate for someone who still has have very resilient and elastic skin, and whose nipples and areolas don’t need repositioning.
• Liposuction results in fewer (and smaller) scars than a complete breast reduction procedure, but it does nothing to improve sagging.
• Surgeons may also use liposuction to reduce excess fat along the sides of the torso and the back.
• Liposuction is also a reasonable solution for revision breast reduction where the blood supply may be unknown from prior surgery. This option can only reduce volume and does not involve any changes to the nipple position or skin. Removing volume may result in increased drooping.

Does insurance cover breast reduction?

• Insurance may cover breast reduction if they deem it medically necessary. Insurance companies typically consider breast reduction medically necessary if the patient experiences physical symptoms, such as back pain, neck pain, or shoulder pain, or emotional distress, such as self-consciousness or embarrassment, due to the size and weight of their breasts. To determine whether your insurance policy covers breast reduction, you should check with your insurance provider and provide them with a letter of medical necessity from your plastic surgeon. The letter should outline the medical indications for the procedure and explain how it will improve your quality of life.

What are the risks and potential complications of breast reduction?

• Like any surgical procedure, breast reduction carries some risks and potential complications, including:
• Bleeding
• Infection
• Scarring
• Changes in sensation or numbness in the nipples and breast tissue
• Poor wound healing
• Asymmetry or unevenness in the size or shape of the breasts
• Loss of breast tissue or nipple sensation
• Need for revision surgery
• It is important to discuss the risks and potential complications of breast reduction with your plastic surgeon. Your plastic surgeon will guide you through the steps they will take to minimize them. Your plastic surgeon should also provide you with a detailed explanation of the postoperative care and recovery process, including any necessary follow-up appointments and any potential signs or symptoms of complications that you should be aware of.
• In addition, you should follow all of the preoperative and postoperative instructions provided by your plastic surgeon, attend all of the scheduled follow-up appointments, and communicate openly and honestly with your plastic surgeon if you experience any concerns or complications. By doing so, you can reduce the risk of complications and ensure a smooth and successful recovery.

What are the results of breast reduction like?

• The results of breast reduction are usually visible immediately after the surgery. It may take several weeks or months for the swelling to subside and for the final results to become apparent. The results will depend on the extent of the procedure, the specific techniques used, and your individual anatomy, but most patients experience a significant improvement in their breast size, shape, and symmetry, as well as a reduction in the physical and emotional symptoms associated with large breasts.
• It is important to keep in mind that the results of breast reduction are not permanent. Your breasts may continue to change over time due to aging, weight fluctuations, hormonal changes, and other factors. You should discuss the results of breast reduction with your plastic surgeon. It is important to understand the long-term expectations and limitations of the procedure.