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Breast Reduction Surgery
What is breast reduction surgery?
Breast reduction is a procedure performed by plastic surgeons to reduce the size of women's breasts by removing skin and underlying fat and glandular tissue. Usually, this involves both reduction in mass of tissue and repositioning of the nipples and surrounding areolas. This procedure is also often referred to by the technical name reduction mammaplasty.
Most women who have breast reduction surgery do so not for aesthetic reasons but to correct serious physical discomfort associated with having large, heavy breasts — chronic back and neck pain, painful gouging in the shoulders from brassiere straps and difficulties participating in athletics and other physical activities.
Poor posture, low self esteem and difficulties finding clothes that fit comfortably are other issues that may be related to large breasts and that are often resolved by breast reduction. Although each case is different, it is not unusual for a breast reduction procedure to reduce a woman's breasts from DDD or DD cup size to C or B cup.
When it is done for defined medical reasons, such as pain and gouging, breast reduction surgery is covered by most health insurance plans (you should check with your insurer as to its guidelines and obtain prior approval, however). A similar procedure called breast lift removes only skin in order to raise sagging or drooping breasts. As a purely cosmetic procedure, it is rarely covered by insurance.
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How frequently is breast reduction surgery performed?
According to the American Society of Plastic Surgery, just under 100,000 patients underwent breast reduction surgery in the United States in 2001.
In addition, more than 18,000 men underwent breast reduction surgery — a procedure usually intended to create a smoother chest contour — as well. It represents about one percent of cosmetic procedures for men. Except where specifically indicated, this article's focus is on breast reduction in women.
Studies have shown breast reduction surgery to have one of the highest patient satisfaction rates among cosmetic procedures. And some 97 percent of women who underwent it indicated they would have it again.
Although breast reduction usually is not done until the patient's breasts are fully developed, it is successfully performed across the age spectrum, with patients from teenagers to women in their 70s and older.
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What should I know before deciding to have breast reduction surgery?
Breast reduction surgery is a highly successful procedure, but it does carry with it some risks and possible drawbacks.
- Scarring. Your breast reduction will result in permanent scars on your breasts from the incisions necessary for removal of tissue. The surgeon will make every effort to minimize scars, and will seek to make sure they are in the least visible position possible — around the areola and straight down the lower side, and along the bottom crease. The scars are almost always in locations that are covered by brassieres, and usually allow wearing of low-cut tops.
Although the scars will be red and swollen in the beginning, they will usually fade considerably over time. Patients who smoke will experience more noticeable scars due to the way in which nicotine interferes with healing.
- Breast Feeding. Another drawback for some women is a strong possibility of not being able to breast-feed after breast reduction, since some milk ducts leading to the nipple may have to be removed in the course of the surgery.
- Loss of Feeling. There also may be a loss of sensation in the nipples and areolas associated with the need to move them, since the surgeon may have to cut nerves in order to relocate them. Often, this loss of feeling is temporary, but it can be permanent.
- Asymmetric Breasts. Since it takes a year or more for your breasts to assume their final shapes, there is also a possibility of ending up with breasts that are different sizes or that hang differently.
- Nipple Position. It is possible that one or both nipples may end up out of position on the newly reshaped breast. Loss of a nipple, either partial or complete, is rare but very possible.
- Potential Complications. You should also keep in mind that breast reduction is a surgical procedure and every medical professional will tell you that any surgery carries with it very small-but-possible risks of complications such as allergic reaction to anesthesia, bleeding and infection.
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What are the steps in having breast reduction surgery scheduled?
Since every case is different — both in physical concerns and in conceptions of what is desirable in breast size and shape — you also want a physician with whom you can talk frankly about your expectations and likely outcomes for your surgery. Don't be afraid to ask questions.
You and your surgeon should talk about issues that may affect your procedure, such as the current size and shape of your breasts, your desired result in terms of size and shape, the condition of your skin, the type of anesthesia to be used, where the nipple and areola will be positioned, and the prospect of scarring and other possible side effects.
During your consultation, your doctor will measure your breasts and likely take photographs of them. They will be useful as reference during the surgery and may also be necessary for insurance approval. He or she may order a mammogram to screen for breast cancer.
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How should I prepare for my breast reduction surgery?
You should prepare for your surgery by making sure you don't take certain vitamins or aspirin, ibuprofen or other blood-thinning analgesics for at least two weeks before your procedure.
If you use any herbal remedies, they may need to be discontinued before your surgery. If you smoke, you should also stop for at least three weeks before and three weeks after your surgery, as nicotine interferes with blood supply to your capillaries and can interfere with healing of the nipple area.
Although breast reduction surgery usually does not involve a need for a transfusion, you may want to have blood drawn in advance to have available in case a transfusion is needed.
You will be asked not to eat or drink after midnight of the night before your surgery, and to follow other dietary restrictions.
As with any surgery or hospitalization, you should make sure you have a family member or friend to drive you home after you are discharged.
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What happens during the surgery?
Before your procedure, your surgeon will meet with you and, while you are in a standing or sitting position, use a surgical pen to outline the planned incisions. As indicated earlier, you will receive general anesthesia that will put you to sleep for the entire procedure. The surgery usually takes between three and four hours.
While specific techniques may vary, breast reduction generally begins with incisions that circle the areolas and extend straight down the underside of each breast and along the crease where the breasts hang against the chest (a pattern often described as "anchor-shaped").
After excess tissue and skin have been removed, the nipples and areolas are moved up to their new locations. Remaining skin on the sides of each breast is brought together below the areola and joined to create a smaller, firmer breast. Usually, the nipples and areolas remain connected to their blood vessels and nerves. In some cases in which the breasts are very large, they may have to be completely removed and grafted on at their new locations. The result of this will be permanent loss of sensation in the nipples and areolas.
Following the surgery, your breasts will be covered with gauze dressings and small drainage tubes may be placed in each breast to allow for drainage of blood and fluids for a few days. You may be wrapped in compressing bandages or you may be given a special surgical brassiere to begin wearing. Most patients stay overnight in the hospital, but it is conceivable that you can be discharged on the same day.
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What can I expect following surgery?
Your bandages will be removed in a day or two, but your breasts will be bruised and swollen for several weeks and you will be asked to continue to wear the surgical brassiere until these problems subside. You'll feel pain for the first few days, and your doctor will prescribe medications for that. Your stitches will be removed in one to three weeks. You'll continue to feel pain for at least a week when you cough or move the wrong way, your breasts may continue to ache periodically after that, and you may feel occasional shooting pains for several months.
The swelling that follows surgery may also cause loss of sensation in the nipples and skin, but this usually goes away after several weeks. In some cases it can last for as long as a year and in some instances can be permanent.
You should try to avoid physical exertion, reaching and stretching or heavy lifting for several weeks. You should avoid sexual activity for at least two weeks — sexual arousal tends to cause the breasts to swell, which interferes with healing. At first, menstruation may cause your breasts to swell and hurt, as well. You can expect to return to work — assuming it's not too strenuous — in about two weeks.
It may take as long as six months to a year for your breasts to achieve their final shape, and, as was the case before surgery, they can continue to fluctuate in their shape with hormonal and weight changes. Scars left from the incisions will remain swollen and red for several months, but usually fade to thin white lines over time.
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Frequently asked questions
How does breast reduction differ from breast lift?
Breast reduction involves removal of excess skin, glandular and fatty tissue and relocation of the nipples and areolas, whereas breast lift involves only the removal of skin in order to eliminate sagging and drooping and establish a firmer shape.
How does breast reduction surgery for men differ from the procedure for women?
Breast reduction surgery for men may involve removal of glandular tissue through an incision, but often relies on the use of liposuction techniques to suck out fatty tissue through a vacuum tube. Following surgery, the chest is wrapped with gauze and drainage tubes may be placed in each breast.
Male breast reduction surgery patients will also need to wear chest garments for several weeks, but should experience less soreness than women. They can expect to return to work in two weeks.
What are the guidelines for health insurance coverage of breast reduction surgery?
As indicated, breast reduction surgery based on therapeutic medical issues is frequently covered by your health insurance. You should check out your insurance company's guidelines before scheduling the surgery, as some companies make coverage conditional on the amount of reduction to be done compared to overall body weight. Your physician will counsel you about insurance requirements and will contact the insurance company and provide a letter certifying its medical necessity.
If my breast reduction surgery is not covered by insurance, how much does it cost?
The average cost for breast reduction surgery for a woman is $10,000. For a man, it is $4,000.
Does breast reduction surgery affect the value of subsequent mammograms?
Scarring can make mammograms more difficult to read clearly following breast surgery, but this can be compensated for. Your surgeon might order a mammogram for you before your surgery to screen for cancer prior to the procedure. A post-operative mammogram will be necessary following your procedure to serve as a baseline for comparison for subsequent mammograms.
If the scars from my breast reduction surgery remain unsightly, is there anything that can be done?
Your cosmetic surgeon may be able to improve their appearance with techniques such as scar revision or laster surgery. You'll have to talk with your surgeon about this. Use of creams containing vitamin E may be helpful in preventing scarring.
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For additional information
You can find additional information about breast reduction surgery at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations.
Likely sources include:
The American Society of Plastic Surgeons
www.plasticsurgery.org
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