A question that many women have who are either considering a breast reduction or have already undergone one is “When can I start wearing an underwire bra?” Some are under the impression that they are not suppose to wear one any more following surgery; others have heard recommendations that involve widely differing periods of time. This can be decidedly confusing.

What is the right answer?

Well, there really is not one absolute, definitive answer. (Even this sounds vague!) One of the reasons for this is that there are no evidence based studies in the medical literature which identify one specific period of time following breast reduction surgery that is better than any other to start wearing an underwire bra again. Consequently, each plastic surgeon determines his or her own protocol based on a variety of factors including experiences with their patients. Some may recommend waiting at least 3 or 4 weeks whereas others may suggest 2 to 3 months or more.

What is my protocol for wearing an underwire bra following a breast reduction?

Upon removal of their operative dressing a few days after surgery, my patients are placed in a sports bra which they will wear for a couple of weeks. After this, they can wear any comfortable but supportive bra which they like and which includes an underwire bra. The purpose is to help to maintain the improved shape of their breasts for a longer period of time by counteracting, to some extent, the relentless forces of gravity.

With normal postoperative healing, the incision along the crease at the bottom of the breast will be inflamed and even tender for several months. During this period of time, an underwire bra may be somewhat uncomfortable to wear. As a result, most patients will wait at least 2 to 3 months before being wearing one on a regular basis.

For more information on breast reduction surgery or for any other plastic surgery procedure that I perform or to schedule your free consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

It doesn’t take a rocket scientist to realize the detrimental effects that large, heavy breasts (macromastia) have on a multitude of levels. When it comes to sports, particularly competitive ones, the impact can be enormous (coincidentally metaphorical). For example, when was the last time that you saw an elite female runner competing in the 100 yard dash?

What about the high jump?

Thought so!

Most of these superior athletes from the neck down are seemingly androgynous. It is very rare to see the likes of an Anna Kournikova (tennis) particularly in certain sports.

There is a somewhat publicized case (at least by her “adoring” male fans) of an elite female athlete who underwent a breast reduction in order to improve her ability to compete as well as to alleviate severe neck and back pains. This involves the Romanian tennis star Simona Halep who also was the junior champion at the 2009 French Open at the age of 18. Though her 34DD breasts significantly enlarged her appeal and following, they were fatiguing, painful and physically limiting.

Tennis star Simona Halep before breast reduction surgery

Halep underwent a breast reduction in 2009, reducing her breast size from a 34DD cup down to a 34C. It is no coincidence that following surgery, her world ranking has improved by 450 spots – now at 57th in the world. She states that she is faster and much more agile than she was prior to her breast reduction and no longer experiences any neck or back pains.

After breast reduction surgery

Simona Halpe runs faster, has greater agility and is a more competitive tennis player following her breast reduction surgery

On the down side, with her reduced breast size she cost her some of her male fan base …!

If you have any questions regarding breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please feel free to call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

An example of the substantial results than can be obtained with breast reduction surgery is illustrated with the following patient of mine. This is a 29 year old woman who was experiencing severe neck, back and shoulder pains directly related to the enormous size of her breasts for which she wore 36G bras (photos A, C and E). They also prevented her from engaging in anything more than mild physical activities such as sports and aerobics.

A.) before - frontal view

B.) after breast reduction

C.) before - side view

D.) after breast reduction

E.) before - oblique view

F.) after breast reduction

Even at her relatively young age, she already had deep grooves of her shoulders from the bra straps digging into her skin (photo G).

G.) groove of right shoulder

Her decision to pursue breast reduction surgery was an easy one. The technique employed involved an anchor shaped incision where the nipple-areola complex was kept attached to the tissues but reduced in size and elevated to the appropriate position. Five pounds of breast tissue were removed during the procedure.

The results from her reduction mammoplasty are seen in photos B, D, and F and are quite dramatic. There has been total resolution or her neck, back and shoulder pains and is now able to participate in sports and engage in other very physical activities which she was unable to do for years. She is now wearing “C” or “D” bras rather than tent sized “G” bras and is no longer feels self conscious about her breasts. (In fact, she is quite proud of them right now.) As an added bonus, despite the substantial size of the reduction, she has retained some sensation of her nipples.

If you would like additional information regarding breast reduction surgery or any for any other other plastic surgery procedure that I perform or to schedule a consultation, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

For the more than 23 years that I have been practicing in the Scottsdale and Phoenix areas, I have been routinely informing and warning my smoking patients of the substantially elevated risks that smoking has on many surgical procedures and their outcomes. The chemicals in cigarettes cause a constriction (narrowing of the diameter) of the blood vessels in the tissues which results in a decreased blood supply to the tissues and therefore less of the vital oxygen and other nutrients important for cell survival and healing. For areas that have undergone surgery, this can directly translate into delayed or improper healing or worse – lack of survival of some tissues which may then require the need for corrective reconstructive procedures such as skin grafting.

Though I do make my patients aware of the risks that smoking has on their health and surgery, for certain procedures I do request and many times demand that they at least stop smoking for a specific period of time prior to their scheduled date because the impact from such smoking can be far more severe. The breast procedures at substantially higher risks for healing problems such as skin necrosis (where the skin turns black and dies) include primary (immediate) breast reconstruction, secondary breast reconstruction in those who have had radiation treatments, breast reductions and breast lifts.

Patients having these procedures are instructed to stop smoking starting one month prior to their surgery until at least two to four week postoperatively. It takes but a few cigarettes just prior to or after surgery to jeopardize the healing process. Chronic smokers who are able to stop smoking during this period of time do better than those who continue even at reduced levels.

To put this in even clearer perspective and provide additional motivation, I ask my patients whether it worth the prolonged healing time, expenses, inconveniences, compromised aesthetic results and the possible need for additional surgery just to continue smoking. Stated this way, most will make a serious effort to quit.

For more information on any plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

However, in women with extremely massive breasts, this may not be possible if a free nipple graft breast reduction procedure is selected. This technique does provide for the most predictable and aesthetic outcome including size but does necessitate the removal and then replacement of the nipple-areola complexes as skin grafts. Consequently, there will be some deterioration of its structure and appearance.

What are the most common sequelae that are seen? The projection of the nipple usually is minimal and there may only be an outline of its location. The areola itself is thinner and not domal shaped. In darker complected women, there can be partial loss of pigmentation yielding a variegated pattern that may be either temporary or permanent.

One such example of the appearance of a nipple-areola complex following a free nipple graft reduction mammoplasty can be seen below. Pigmentation has been maintained as has some of the projection of the nipple. This result should not be considered to be representative of all outcomes with this procedure.

Example of the appearance of the nipple-areola complexes following a free nipple graft breast reduction.

For more information on breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a complimentary cosmetic consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A vast majority of the patients that see me in consultation for breast reduction surgery exhibit indentations of their shoulders as a consequence of the weight of their breasts causing their bra straps to dig into their shoulders. The more massive the breasts and the longer a woman waits to undergo a breast reduction, the deeper these grooves may be.

In the photos below of a patient who saw me in consultation for breast reduction surgery, you can see the prominent indentations of the shoulders. Interestingly enough, the deeper groove is situated on the right, the same side as the much larger breast. These invariably persist even long term after successful surgery.

Woman with shoulder indentations seeking breast reduction surgery. The deeper groove on the right is also associated with the larger right breast.

Right shoulder. Deeper indentation here associated with the larger right breast.

Left shoulder. Indentation here is not as deep due to a smaller breast on this side.

If you would like to obtain more information on breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Fortunately, the solution to this problem is straightforward and long lasting: pursuing a breast reduction. With a significant decrease in the size and weight of the breasts along with their elevation and removal of excess skin, most if not all of the annoying symptoms can be alleviated. Then, all one would need when participating in vigorous activities is just one well fitting sports bra.

Many of my breast reduction patients over the years have told me that following their surgery, they were able to engage in sports symptom free which they could not do previously. This made them extremely thrilled. In addition, they also confided that it was much easier to lose their excess weight now because they could exercise more vigorously and comfortably.

For more information on breast reductions or any other plastic surgery procedure that I perform or to schedule a consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

It would be ideal if mammograms could detect all occurrences of breast cancer but they do not. A fairly small percentage of breast cancers as well as pre-malignant lesions do escape detection but can be identified pathologically – from the specimen. This is why all breast tissue that is removed by the procedure is assessed by a pathologist.

A few studies have been performed over the years to determine the exact incidence of these “occult” breast cancers that can only be identified pathologically. The results indicate that the percentage is around 0.16% to 0.40% or up to 4 cases per thousand women. Nevertheless, these women are very fortunate because the early identification of their tumors translates into extremely high cure rates. If not for their initial desire for a breast reduction, they might not have had these cancers detected until a much later date at which point the prognosis would not be nearly as favorable.

The following patient exemplifies this scenario. She was a 39 year old woman wearing a 34G bra seeking a breast reduction. There were no abnormal detected masses on breast examination, her mammogram was unremarkable and there was no family history of breast cancer. Despite this, the breast tissue sent for pathological evaluation revealed the presence of early breast cancer.

Her treatment then consisted of bilateral mastectomies with immediate breast reconstruction. The photos below included her preoperative appearance, immediately following her breast reduction and then the final results after reconstruction.

Before breast reduction - Frontal view

Before breast reduction - Side view

Immediately following breast reduction - frontal view

Immediately following breast reduction - Side view

After breast reconstruction - in bra

After breast reconstruction - Frontal view

After breast reconstruction - Oblique view

After breast reconstruction - in bra

Following breast reconstruction - Side view

Following breast reconstruction - in bra

If you would like more information on breast reduction, breast reconstruction, information on any other cosmetic surgery procedure or to schedule a complimentary consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

What are some of the reasons to undergo a breast reduction for cosmetic reasons? These can involve situations where the breasts are large but not so gigantic that they would be associated with discomfort but they are bigger than the woman desires or attract unwanted attention or comments. By reducing their size they will be more to the woman’s sought after body image and would be less conspicuous.

Another reason to pursue a breast reduction for aesthetic reasons is where the breasts are both droopy (ptotic) and larger than desired. In this scenario, they are not large enough to cause symptoms or to qualify for insurance coverage. By decreasing their size, tightening the skin envelope and lifting the tissue, smaller, perkier and more youthful appearing breasts can result.

This last scenario can possibly be considered also to be a breast lift (mastopexy) with a small reduction. There can be confusion at times as to what constitutes a breast reduction of which a lift is usually an intrinsic component versus a breast lift with a small reduction. Both procedures usually involve the same incisions. The difference lies in the amount of breast tissue that is removed. Though there is no specific amount that distinguishes between the two, some consider removal of less than 300 grams per side to warrant being called a lift with a small reduction.

Either way, the results are smaller, lifted and perkier breasts.

For additional information on breast reduction surgery, breast lifts or other breast procedure or to schedule a consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

What are the criteria that insurance companies require that you meet? These will vary from plan to plan and often are very stringent and difficult for many women to meet. You may need to have your symptoms explicitly documented such as neck, back and shoulder pains, negative effects on your posture, limitation of activities, skin rashes and even deep grooving of your shoulders from your bra straps. Some also mandate that you need to be below a specific weight for your height, have completed an extended course of physical therapy which did not resolve your symptoms, and that your plastic surgeon expects to remove a volume of breast tissue per side that exceeds a certain weight in grams. Letters from your primary care physician and other healthcare personnel strongly recommending this procedure are often needed as well.

If a breast reduction is not a covered benefit or your insurance company has denied authorization for the procedure, it may not be the “end of the world”. You still can elect to undergo the surgery but will have to pay for it out of your own pocket. Many of my patients do pursue this course of action because the symptoms from large breasts are so uncomfortable and limiting and the surgery is so effective in addressing them.

My office can help you to make this procedure a more affordable reality. We have package pricing available that significantly discounts your costs over what you would otherwise face in a hospital setting. For payment, not only do we accept several credit cards but we also offer you financing options from several companies that may meet your specific financial needs.

You can call my office at 480-451-3000 to obtain further information regarding a breast reduction or other procedure, insurance issues, financing options, or to schedule a consultation.

Steven Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona