Breast reduction, or reduction mammoplasty, is a surgical procedure performed on women whose breasts are very large for the size of their body. This procedure reduces the overall size of the breasts through the removal of excess skin, fat, and breast tissue. Because large breasts tend to sag, breast reduction is frequently combined with a breast lift, which counteracts the effects of gravity to place the breasts in an elevated position on the chest. The overall goal of breast reduction is to leave the patient with smaller, lighter, and more proportionate breasts.
Are You a Good Candidate?
You might be a good candidate for breast reduction if you are:
- Healthy and at your ideal weight.
- Over 18 years old with breasts that have stopped growing.
- Suffering from conditions related to large breasts such as neck, shoulder and back pain.
You may NOT be a good candidate of you are:
- Pregnant or plan on breastfeeding in the future.
- Overweight or obese.
- Have serious medical problems (heart, blood, etc)
- Psychologically unstable.
Breast reduction is only appropriate for adult women who have carefully assessed their reasons for undergoing plastic surgery and have realistic expectations for the results of their procedure.
Incision Decision: Which is Best For You?
There are different types of incision methods used for breast reduction procedures. The type that is appropriate for your situation will depend on the amount of reduction desired, the composition of breast tissue, and your personal preferences regarding the placement of incisions. The most common methods include:
- Anchor Method: requires an incision shaped like a circle around the nipple and areola, which is then continued vertically down the breast until it meets the crease underneath the breast and continues horizontally across the underside of the breast. While this involves the longest incision, it also provides the surgeon with complete access to the underlying breast tissues, allowing for the most drastic changes in breast shape and volume.
- The Lollipop or Vertical Method: Involves a circular incision around the nipple and areola which continues vertically down the breast until it meets the crease underneath the breast.
- Donut Method: Only requires a circular incision around the nipple and areola. This procedure is known for the least incidence of scarring, although surgeons are somewhat limited in the amount of tissue they are able to remove.
The Procedure: Step-by-Step Guide
Breast reduction surgery typically takes one to two hours per breast depending on the extent of the procedure. It is performed in a hospital or state accredited surgery center on an outpatient basis. Patients are given general anesthesia during the procedure. The following provides a basic overview of how breast reductions are performed.
- The patient is anesthetized
- The surgeon makes an incision around the areola and in some cases straight down to and along the natural breast crease. This incision outlines the area from which breast skin, fat, and breast tissue will be removed. If the breasts are very large, the nipples and areola may need to be removed and repositioned.
- The surrounding skin is brought down and together to reshape the breast.
- Sutures close the incision, giving the breast its new contour.
- Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.
In some cases, liposuction is used when there is a large volume of fat to be removed. A breast reduction may also be performed with a breast lift, in which the strategic removal of excess skin allows the breasts to sit higher on the chest. This may require the repositioning of the nipple in a more natural position on the chest.
Some possible risks associated with breast reduction surgery include:
- Anesthesia complications
- Difficulty breastfeeding
- Blood clots
- Excessive firmness of breast
- Fat necrosis, which is dead fatty tissue deep in skin
- Loss of sensation in areola and nipples
- Breast Asymmetry
- Skin discoloration
- Possible revision surgery
Before moving forward with surgery, be sure to discuss the potential risks with your surgeon.
What to Expect During Recovery Time
If you are considering breast reduction, it is important to understand that the recovery process can take several months and even longer to see the final results.
In the initial days following your procedure, it is important to follow the surgeons post operative instructions. This will ensure the healing process goes smoothly. Failure to follow these instructions could lead to a lengthy recovery and possible complications.
Upon waking up after surgery, patients can expect to feel tired, groggy, nausea, and sore. Some of these symptoms are related to the anesthesia and other related to the actual surgery itself. Other side effects include discomfort, redness, bruising, reduced nipple sensitivity, and swelling. You can expect the breasts to be very tender and sore, especially for the first few days. Your surgeon will most likely prescribe pain medication to help with this. It is normal to have dull pain continuing for several weeks after surgery.
In most cases, a compression garment or surgical gauze will already be placed over the breasts before you wake up. You will probably have sutures and fluid drainage tubes, both of which will be removed in about a week. It is important not to disturb the incisions or sutures during this time.
Sleeping may be difficult following your surgery. Many patients also find it difficult to bathe, as they must wait until the sutures have been removed and cannot lift the arms above the head. Because of this, you may want to arrange for a friend or hairstylist to help you wash your hair for the first few weeks.
Breast reduction is a surgical procedure, and because of this patients should expect some scarring from the incisions, although the size, position and appearance of scars varies from patient to patient. The incisions required, will depend on the amount of tissue being removed among other factors. Over time, these incisions should fade into the surrounding skin.
Tips to Reduce Swelling
Many patients find that post-operative swelling obscures the results of their surgery for up to a month. This swelling may even cause the breasts to look misshapen. Swelling will subside gradually as the breast tissue heals, although there are a few ways to speed the breast reduction recovery process. Here are a few tips to reduce swelling after surgery:
- Drink plenty of fluids to stay hydrated
- Maintain a proper, low-sodium diet
- Get plenty of rest and ease into daily activities gradually
- Avoid medications that may interfere with the recovery process. Tell your doctor about any medications you are taking.
A compression garment must be worn over the breasts at all times for the first few weeks after breast reduction. The purpose of this surgical garment is to reduce the recovery time by controlling swelling, bruising, and other side effects. It also holds the breast tissue in place, allowing it to become accustomed to the new contours. During recovery, it is important to avoid underwire bras or those that do not provide enough support for the breasts.
When To Call Your Doctor
If any of the following symptoms occur it could be a sign of a complication. In this case, it is recommended that you call your surgeon immediately and go the nearest emergency room as soon as possible.
- Uncontrollable vomiting
- Loss of consciousness
- Temperature above 105 degrees F
- Blood in urine
- Severe swelling (aside from normal swelling)
- Blackening of the skin (not to be mistaken with bruising)
Getting Back to Your Normal Routine
Most patients plan to take one to two weeks away from work and other obligations to recover. For the first few days, you will need help completing your daily activities. Gradually, you may ease back into your normal routine, although actions such as lifting your arms above your head, heavy lifting, or bending over should be restricted. Strenuous exercise must be avoided for six weeks.
The amount of tissue removed and the length of incisions can affect the healing time. The breasts may not settle into their final shape, size, and position for up to six months, although the initial results of the procedure will be apparent within a week or two. Following breast reduction, the breasts will appear smaller, lighter, and less droopy than before surgery. However, weight gain, pregnancy, and aging can cause further changes in the size or appearance of the breasts.
What Does Breast Reduction Cost?
With most breast reductions, there are three basic fees involved with surgery. They include:
- The surgeon’s fee
- Anesthesia fee
- Surgery center fee
The average plastic surgeon’s fee for breast reduction is about $3,400 to $4,000. This does not include the facility fee or anesthesia fee which typically bring the cost to between $5,000 and $8,000.
There may also be some miscellaneous fees, such as medical tests, medication, compression bras or other post-surgery garments used during the breast reduction recovery. It is important for prospective patients to understand each of these fees in detail, and to be sure that the surgeon’s quote includes all of these costs, not just the surgeon’s own fee.
Some other factors influencing the cost include the extent of the procedure, choice of surgeon and where you are located.
For example, surgeries involving the removal of a significant volume of breast tissue, or those that involve a breast lift as well as reduction, will be more expensive. In addition, while most breast reductions are performed as an outpatient procedure, if it is necessary for you to stay overnight more fees could be incurred.
Besides factors related to the procedure itself, your choice of surgical facility will also influence the cost. Surgical prices vary greatly from each city; fees tend to be higher in large cities as opposed to less populated areas. Different surgical facilities may also charge different fees even within the same metropolitan area.
In most cases, the surgeon you choose will also have an impact on the final cost of breast reduction. For example, a highly qualified plastic surgeon with 20 years experience may command a higher fee than their less experienced counterparts with the assumption that they will be better at ensuring your procedure goes smoothly and you achieve the best possible results. While this can be true, its not always the case which is why its important to do your research. However, the first criteria to ensuring a successful outcome is to select a board certified plastic surgeon.
Will It be Covered by Insurance?
Although most cosmetic surgery procedures are not covered by insurance, in some cases the breast reduction may be. This is particularly true in cases where overly large breasts are causing neck and back pain or other health issues. Before scheduling surgery, check your insurance policy to find out which expenses you will be responsible for. Your doctor may need to provide documentation before the insurance company will approve your procedure. In addition, there may be restrictions regarding the surgical technique used or other details of your procedure. While not all breast reduction procedures will be covered, it is worth checking with your insurance provider.
Additionally, many clinics offer affordable financing plants for patients who are paying out-of-pocket. If cost is a concern, ask your doctor about financing during your consultation. There is no need to forgo breast reduction surgery solely for financial reasons.