Tag Archives: breast reduction

Why is it important to be nicotine free before surgery?

While smoking is detrimental to a person’s health for a number of reasons, it is poses particular problems for patients undergoing surgery.   Nicotine, whether from cigarettes, patches, gum, etc., causes vasoconstriction in the small vessels that we count on to heal newly created wounds.  This is especially true in certain procedures where the normal blood supply is disrupted and the tissues are tightened at the time of closure, such as with a facelift, abdominoplasty, breast lift, breast reduction, and breast reconstruction.


We feel strongly that in certain cases the risk of significant wound healing problems outweighs any benefit we would provide with the procedure.  In these types of cases, we will decline to do the operation unless our patient is nicotine free.  This does not apply to all procedures we perform, so be sure to ask us when this rule applies.


Some patients may choose to go elsewhere for their surgery because of our caution on this issue.  While surgery on patients that use nicotine products can be successful in some cases, we feel the risks of a bad outcome are unacceptably high.


Is breast reduction surgery covered by insurance?

Usually.  When we meet with a patient we discuss their symptoms and history of treatment, exam and measure the breasts, record their height and weight, and take photographs.  After the visit, we will write a letter to your insurance company discussing our findings and ask for a predetermination as to whether the procedure will be a covered under your policy.  Depending on the company, we usually get a response in 1-3 weeks.  Once they have given their approval, we can arrange to get your surgery scheduled. While breast reduction surgery is a covered benefit under most policies, some plans do not provide it as a benefit.  Unfortunately, if your plan excludes coverage of this procedure, there is simply no way we can get around this.  In order to have the operation, you would have to pay for it yourself (many patients do and consider it money well spent) or wait until you change to a different insurance plan that covers the procedure. Sometimes the amount of tissue we plan to remove does not meet the threshold for coverage by your insurance company.  For example, we might estimate that we will be removing 500 grams of tissue (a little over a pound) from each breast at the time of surgery but your insurance company guidelines say 800 grams need to be removed from each side for the surgery to be covered.  In this case, we are in a bind.  If we remove enough tissue to get the procedure covered, the result might be very disfiguring for the patient.  We do our best to avoid this situation by accurately stating the amount of tissue we will remove in our predetermination letters.  In all honesty, there are a few insurance companies that set their threshold for coverage so high that only patients with ENORMOUS breasts could ever qualify.  Fortunately, most insurance companies are more reasonable. If you are denied coverage, the letter from the insurance company will usually give an indication why they have reached this decision.  If it is an “excluded benefit”, then you’re out of luck.  No amount of appeal will change this unless your policy coverage changes.  Sometimes they may request additional information such as records from your primary doctor, chiropractor, physical therapist, etc., documenting your efforts to seek non-surgical relief from your symptoms.  Some companies have requested we call their physician reviewer directly for a phone conference to discuss the patient and we have sometimes (not always) been successful. While it is not really our job to coerce your insurance company into paying for your surgery, we will do our best to accurately convey our findings and opinions and help make the case for coverage when we feel you have a valid claim and help guide you through the process.

Breast-feeding after breast surgery

Patients who are considering breast surgery such as breast augmentation, breast reduction, or a lift often ask us about their ability to breast feed after surgery if they have children.  They want to know if breast-feeding will be possible, and have often heard different answers from various medical practitioners and friends.  The answer depends on the type of surgery being performed and how it will be done.


After Breast Augmentation

In most cases, yes.   Of course that’s the same answer I would give a woman who has not had a breast augmentation.

Most women without breast implants are able to successfully breast feed their babies, but some struggle with inadequate milk production, mastitis, and other problems that may make breast-feeding difficult.

The same could be said for women after breast augmentation.  Because the implants are placed behind the breast tissue, pushing it forward, the glands and ducts that allow for milk production are left intact.  Therefore, although most women are able to breast-feed after surgery, it cannot be guaranteed.


After breast reduction and breast lift (mastopexy) 

As in the case of breast augmentation, the answer is usually yes, but the full answer is a little more complicated.

I always ask patients who have previously had children about their ability to breast feed during the consultation.  I am struck by how many of these patients describe difficulties despite the large amount of breast tissue present.  When I 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, I have only had to perform this type of reduction twice, and both patients were past their childbearing years.

With a breast lift, we typically are removing little to no breast tissue, so the chances of disrupting nerves, milk ducts, or the blood supply to the breast tissue are less than with a reduction.  However, there is still a chance to interfere with breast feeding if a significant reshaping is performed.

In summary, while most patients are able to breast-feed after a reduction, breast augmentation, or breast lift, 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.