Breast Reduction

Mississippi Gulf Coast Board Certified Plastic Surgeon

Women with large breasts experience more than dissatisfaction with image.  They may experience physical pain and discomfort. Overly large breasts and the weight of excess breast tissue can cause pain and physical conditions that impair a woman’s 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. If you have large breasts that limit your physical activity and cause pain, breast reduction may be right for you. Breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with a woman’s body and to alleviate the discomfort associated with overly large breasts. In general, breast reduction surgery will not only correct the functional symptoms associated with large breasts, but will also result in better proportioned breasts, enhancing a woman’s body image and self-confidence.

Breast reduction is a surgical procedure to reduce the size of large pendulous breasts that are disproportionate to a woman’s body and can cause physical pain. Technically called reduction mammaplasty, breast reduction improves breast size, shape, and the associated conditions of large breasts that include:

  • Back, neck and shoulder pain caused by the weight of excess breast tissue
  • Shoulder discomfort and indentation from bra straps that support heavy, pendulous breasts
  • Restricted physical activity due to breast size and the associated discomfort
  • Skin irritation beneath the breast crease
  • Sagging, stretched skin and a low breast profile where, when unsupported, the nipple rests below the breast crease
  • An enlarged areola (the dark skin surrounding the nipple) caused by stretched skin

Breast reduction can be performed unilaterally (on one breast) or bilaterally (on both breasts). It is generally considered a reconstructive procedure and may be covered by health insurance when it is performed to relieve medical symptoms. Many insurers define breast reduction surgery as reconstructive based on the amount of tissue that will be removed. However, pre-certification is often required for reimbursement or coverage. Breast reduction surgery can be performed at any age; however, it is best performed when the breasts are fully developed. Because significant amounts of breast tissue are removed, breast reduction surgery may impair the ability to breastfeed. Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations. In general, good candidates for breast reduction are women of relatively normal, stable weight whose breasts development is complete. Breast reduction is best performed on:

  • Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
  • Non-smokers
  • Individuals with a positive outlook and specific goals in mind for improving their physical symptoms, breast size, and shape

The Consultation

A consultation with your plastic surgeon is the first step to learn how breast reduction can improve the appearance of your breasts and relieve pain, discomfort and any associated symptoms you may have resulting from large, pendulous breasts. A consultation is designed to fully educate you about breast reduction in a non-pressured environment and will include:

  • A discussion of your goals and an evaluation of your individual case
  • The options available in breast reduction surgery
  • The likely outcomes of a breast reduction and any risks or potential complications
  • The course of treatment recommended by your plastic surgeon

Your plastic surgeon also will answer your questions.

Your surgeon, your choice

Choosing to have cosmetic or reconstructive plastic surgery is an important decision; so is selecting a plastic surgeon. Consider these important guidelines:

  • BOARD CERTIFICATION – Not all physicians who perform plastic surgery or who use the title plastic surgeon are board-certified in plastic surgery.
    • The American Board of Plastic Surgery (ABPS) and The Royal College of Physicians and Surgeons of Canada certify physicians in plastic surgery of the face and entire body. To be certified by either board, a plastic surgeon must:
      • Graduate from an accredited medical school
      • Complete a minimum of five years of surgical training following medical school, including an accredited plastic surgery residency program
      • Pass comprehensive written and oral exams
  • PRIVILEGES: Your surgeon should have operating privileges at an accredited, local hospital for the same procedure you plan to have performed; even if that surgeon suggests your procedure be performed in an accredited office-based surgical facility or at an ambulatory surgery center.

Evaluation

Overall health and personal outlook can greatly impact the outcome of breast reduction surgery. These will be carefully evaluated in consultation with your plastic surgeon. The success of your procedure, safety, and overall satisfaction require that you:

  • Honestly share your expectations
  • Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco, and drugs
  • Be candid about any history of breast cancer in your family and your personal breast health
  • Commit to precisely following all of your plastic surgeon’s instructions

Safety

By making the decision to consult with your plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety. Dr. Dees is certified by The American Board of Plastic Surgery. This certification designates surgeons who are specifically trained in plastic surgery of the face and entire body.

 

Breast reduction is more commonly performed through incisions with surgical removal of excess fat, glandular tissue, and skin that contribute to large, pendulous breasts.

  • The most common approach is a keyhole incision pattern.  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. The vertical incisions are brought together to reshape the now smaller breast. Non-removable 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.
  • There are alternative incision patterns that may be recommended depending on the amount of tissue and skin to be removed and the quality of skin elasticity.
  • One is a circular pattern around the areola.
  • Another is a racquet-shaped pattern with an incision around the areola and vertically down to the breast crease.
  • Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast.

In any case, the incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra. In some cases, excess fat may be removed through liposuction in conjunction with excision techniques. If breast size is largely due to fatty tissue and excess skin, liposuction alone may be used for breast reduction. In every case, the technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, and patient and surgeon preference.  

Before beginning the process, Dr. Dees recommends that you research breast reduction on the American Society of Plastic Surgeons website to ensure that you completely understand the procedure along with the facts that the surgery delivers different results for each patient. The first step in the process of getting a breast reduction begins by simply picking up the phone to call Dr. Dees’ office to schedule your free initial cosmetic consultation. During this consultation, you and Dr. Dees will go over the surgical techniques that are best for you. A personalized reduction plan will be agreed upon and photos will be taken. After you have the necessary information and Dr. Dees is comfortable with your knowledge of the reduction plan, you will return home and spend time reviewing the information in order to decide if the surgery is right for you. If you decide to proceed, call the office to schedule your surgery. Once your surgery is scheduled, it is important to organize your life, job, school, and family. Recovery times vary from patient-to-patient; therefore, it is recommended that you be prepared in advance. Approximately two-to-three days prior to surgery you will have a preoperative office visit. After you are cleared for surgery, Dr. Dees will give you written preoperative instructions, prescriptions, and order an evaluation by the anesthesia department at the surgery center. Lab work may be required. Fees will be paid at this time. On the day of your surgery, you may take a preoperative oral sedation before arriving at the outpatient surgery center. This will require you to have someone drive you to and from the surgery. Upon your arrival at the center, you will complete any required paperwork, verify all of your information, and give your final consent for the surgery. Before surgery can begin, you will have one final anesthesia evaluation. After you are cleared for surgery, an IV will be started and medication will be given. Once the procedure is complete, the healing process begins, which will vary from patient-to-patient. You will be in recovery for at least two hours. After you are released from the anesthesiologist, given post-operation instructions and a follow-up appointment time, your driver may take you home.

Post-Op

Once your procedure is completed, dressing or bandages may be applied to your incisions, and an elastic bandage or support bra will 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 that may collect. Before being released, you and an accompanying family member, friend, or caregiver 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 risk of infection
  • Specific concerns to look for at the surgical site or in overall health
  • When to follow-up with your plastic surgeon

Progress and healing

Initial healing will include swelling and discomfort at the incision sites. Discomfort is common and can be controlled with medication. A support bra may be recommended around the clock for the first few weeks. It is important to keep the incision sites clean. You will be instructed to engage in light walking as soon as possible to minimize the potential for blood clots and other complications. Follow all instructions carefully; this is essential to the success of your outcome. Healing will continue for several weeks as swelling dissipates and breast shape and position settle. Continue to follow your plastic surgeon’s instructions and attend follow-up visits as scheduled.

Results and outlook

The final results of breast reduction will appear over the next few months as breast shape and position continue to settle. Incision lines are permanent scars, but they will improve over time and can be hidden under most swimsuits. Your new breast size should free 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. Breast reduction is considered permanent although, over time, your breasts may continue to change due to weight fluctuations, aging, and gravity.

This material is provided by the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery. It is not intended to make any representatives or warranties about the outcome of any procedure and is not a substitute for a thorough, in-person consultation with a board-certified plastic surgeon.

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