Breast Reduction

Breast reduction (reduction mammoplasty) is our most commonly performed reconstructive procedure of the breast. It is one our favorite operations because it not only is very successful at relieving the back, neck and shoulder pain caused by heavy breasts, but patients also feel it significantly improves their appearance. We take great pride in using our cosmetic skills to give patients the best possible result to this functional operation.

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Best candidates

We have successfully performed this operation on a very wide range of patients. The ages of our reduction patients ranges from teenage years to patients in their 70’s. Of course, we want our patients to be generally healthy and at a stable weight. Especially on younger patients, we want the breast development to be stable. If you recently have given birth, we want to wait at least 6 months after you have quit breast-feeding before performing surgery so that the breast size and shape can stabilize.

The problems associated with large breasts

While full breasts may be considered attractive, excessively large breasts may cause several problems. Most patients complain of chronic pain in the upper back, neck, and shoulder areas caused by the excessive weight of the breasts. While medication, physical therapy, chiropractic manipulation and other conservative measures are often helpful in the short term, they usually don’t provide long term pain relief. Other symptoms we see in our patients include rashes beneath the breasts, skin breakdown, lower back pain, and headaches. Patients often find these symptoms limit their ability to exercise and make everyday tasks in their home and jobs more difficult. Over time, the weight of the breasts may cause curving of the upper spine (kyphosis) and deep grooves in the shoulders because of bra straps. Many patients are referred to our office by their primary care provider, chiropractor, or physical therapist when they continue to experience these symptoms despite treatment.

In addition to these physical symptoms, there is certainly a less tangible but certainly important reason many patients consider breast reduction surgery. Women may find their excessively large breasts make it difficult to find properly fitting clothes and bras. Many are embarrassed by their appearance, and avoid clothing and activities (swimming pools, etc.) that make their breasts more apparent. Ironically, very large breasts may sometimes make breast-feeding more difficult. While these problems are generally not recognized by insurance companies as medical justification for surgery, we understand how significant they can be for many patients.

Insurance coverage

Because multiple studies have demonstrated significant physical benefits which result from breast reduction surgery, most insurance companies will consider the procedure a medically necessary procedure and therefore eligible for coverage. During your consultation we will ask you about your symptoms and your previous treatment and perform a physical examination that will include examining your back, neck, shoulders and breasts. We will take measurements of your breasts to help us determine the approximate weight of breast tissue we will remove during surgery. Of course, we want to remove enough breast tissue to relieve your symptoms but still leave enough to give your breasts adequate size and an attractive shape. Photographs will also be taken for documentation.

If you are interested in undergoing surgery and obtaining insurance coverage, we will then write a pre-determination letter to your insurance company that includes your symptoms, physical findings, photographs, any supporting documents, and our approximation of how much breast tissue will be removed. Depending on your company, this process can take 1-4 weeks. Once we have approval we will finalize your date for surgery.

Insurance companies differ on their threshold for coverage so it may not be possible for us to tell you with certainty on the day of your consultation whether your surgery will be a covered procedure. But because of our familiarity with this procedure (we have performed hundreds of breast reduction operations) we can usually give you a good idea as to whether coverage is a possibility.

The surgery

We perform breast reduction surgery in the operating room at the Lawrence Surgery Center or Lawrence Memorial Hospital under general anesthesia. Prior to surgery we will make markings on your breasts with you in the standing or sitting position that will help guide us in your tissue removal in the operating room. The procedure itself generally lasts around 3 hours. Once we remove the tissue and reshape your breasts, we place suction drains in your breasts that will remain overnight. The incisions are sewn up using stiches underneath the skin that will dissolve with time. Dressings are placed and you are placed in a surgical bra. All tissue removed is sent to the pathology lab to make sure there are no abnormalities in the breast tissue.

Immediately after surgery you will be in the recovery area of the surgery center or hospital. After a few hours, many patients find that they feel well enough to go home. We will have you return to our office the following day to change your dressings and remove your drains.

Some patients may need to stay overnight for observation if there are issues with nausea, pain control, slow to wake up, etc. In that case, we will see you the morning after surgery, change your dressings and remove your drains while you are still at the hospital or surgery center. You will be sent home with detailed instructions for your care, diet, activities, showering, and other care as well as medication to control your pain.

Recovery

Most patients are on their stronger pain medication for the first 3-4 days then are able to transition to non-narcotic pain medication. Every patient is a bit different, of course. We have had patients who never took a single pain pill while others have required narcotic medication for one to two weeks. The most common comment we hear from patients regarding their recovery is, “This wasn’t as bad as I expected!”

Patients are able to drive once they are off their pain medication. We keep you in a surgical bra for a week or so and then have you switch to a sports bra. Patients that work desk/clerical jobs are usually able to return to work in 7-10 days, while we advise those that work more strenuous or active jobs to wait a full 2 weeks before returning to work. Walking is encouraged during your recovery period and we will ease you back into your usual exercise routine.

Combination procedures

Breast reduction can be performed in conjunction with other procedures in many patients. In a single trip to the operating room (and single recovery period) we can not only reduce the size of the breasts but also perform other procedures, both cosmetic and functional, that you may have been considering. Examples of procedures we have performed along with reduction include:

If you are considering adding any of these procedures to your breast reduction surgery, please let us know. If we feel you are a good candidate, we will certainly be happy to combine these procedures when appropriate.

Common questions

Can I have a breast reduction before I have children?

Many women do. Although in an ideal world we would wait until after childbearing years, which can change the shape, size and consistency of breast tissue, sometimes this just isn’t practical. Consider a 20-year-old woman with very large breasts who already has significant problems with upper back, neck and shoulder pain. We advise them that breast reduction may interfere with breast-feeding and their breast size and shape may change following childbearing, but few are willing to wait 10-20 years for surgery to relieve their symptoms. As long as they can understand and accept these risks, we think they are good candidates for surgery even if they may have children later.

Can I breast-feed after breast reduction?

In most cases, yes. Studies have shown that about 80% of women who are able to breast-feed before surgery are also able to do so afterward.

We always ask patients who have previously had children about their ability to breast-feed during the consultation. We are struck by how many of these patients describe difficulties despite the large amount of breast tissue present. When we warn patients about the possibility that a breast reduction operation may interfere with breast-feeding, most are willing to accept this potential loss. To paraphrase these patients, “If you think my breasts are big now, you should have seen me when I was pregnant! I’m not going through that again.”

Since breast tissue is actually removed during the operation, the technique used during the operation may affect the ability to breast feed afterward. We utilize a technique that has proven to be reliable in preserving the nerves, ducts, and blood supply to the nipple, and therefore most patients are able to breast-feed successfully after surgery.

Rarely, the breast is so large that we must actually remove the nipple completely from the breast and place it back on as a graft. When we anticipate this will be required, we tell our patients preoperatively that they will not be able to breast-feed after surgery. In almost 18 years of breast reduction surgery, we have have used this technique very rarely, and these patients were past their childbearing years.

In summary, while most patients are able to breast-feed after a reduction we cannot guarantee it. If this is a risk you are unwilling to take, it might be better to delay your surgery until after you are finished having children.

What size will I be after surgery?

We avoid making promises regarding bra cup sizes that will be achieved after
surgery, as cup sizes vary by manufacturer and are really impossible to measure accurately on the operating table. Talk to us about what you desire and we will do our best to achieve that size based on the limitations imposed by your breast size and shape before surgery. Most large breasted women are able to be brought down to a full c-cup range and still maintain a well-shaped proportional breast. However, on very large breasted women even this amount of reduction may be difficult to achieve and still maintain a good breast shape.

What if my weight changes significantly after surgery?

Changes in weight will change the size of the breasts as well. Usually, these changes are fairly proportional. As you get smaller or bigger overall, your breasts will change with you, also getting smaller or bigger. 10-20 pound fluctuations in weight generally will not significantly affect your result.

However, we have seen patients who underwent successful breast reduction surgery many years ago then later experienced massive weight loss (100+ pounds) develop significant deflation of their breasts. These patients have come to us desiring correction, which may involve a breast lift or even implant placement to restore the appearance of their breasts. If you are considering such massive weight loss, it would be safer to wait until you have achieved your desired weight before undergoing breast reduction surgery.

Does obesity affect breast reduction surgery?

We routinely perform breast reduction surgery on patients who are classified as obese and have developed techniques which have led to better outcomes for our patients.  However, obese patients do face a higher incidence of complications.  For more information, please read our discussion of Breast Reduction Surgery and Obesity.

Quick fact

A study performed on our breast reduction patients indicated that 98% reported significant or complete improvement in their symptoms of back, neck, and shoulder pain after surgery.

5 Reasons why you should have your breast reduction performed at Lawrence Plastic Surgery:

  • Experience– We have hundreds of happy patients and great results after performing this procedure for over 20 years . We do this operation often and do it well.
  • Accredited facilities– We only perform this operation at Lawrence Memorial Hospital or the Lawrence Surgery Center.
  • Insurance coverage– We contract with most insurance companies and are familiar with their policies regarding breast reduction surgery. In fact, we have helped them shape some of these policies. We will help you work through this coverage and reimbursement process.
  • Surgeon certified by the American Board of Plastic Surgery
  • Personal attention from a friendly staff– Your surgical experience depends not just on the surgeon, but also the nurses and office staff they work with. We have a great staff that will help you through the entire process.

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