3 Min Read Plastic surgeons often stress the importance of proportion when discussing the ideal breast size. But what exactly… Read More
Breast reduction surgery, also called a reduction mammoplasty or reduction mammaplasty, is the treatment of choice for women experiencing symptoms related to their large breast size. By removing significant amounts of breast tissue, contouring and elevating the remaining tissue, the procedure can effectively and successful alleviate the associated symptoms and yield smaller, rejuvenated and more comfortable breasts. Not entirely surprising, our happiest patients are those who have undergone this procedure – even more than for breast augmentation. In well over twenty years of practice in Arizona, board-certified plastic surgeon Steven H. Turkeltaub, MD has not had a patient indicate that they regretted their decision. In fact, many have expressed that they should have pursued the procedure years ago and would have avoided all the untoward issues associated with their large breasts.
- Are You a Good Candidate for a Breast Reduction?
- Insurance or Private Pay?
- Techniques for a Breast Reduction
- Your Breast Reduction Procedure
- Recovery from Your Breast Reduction
- Breast Reduction Before-and-After Photos
- Breast Reduction Patient Testimonial Videos
- Frequently Asked Questions
- Additional Information About Breast Reduction
Are You a Good Candidate for a Breast Reduction?
Disproportionately enlarged breasts (macromastia) can be quite debilitating both physically and emotionally. Commonly associated symptoms and findings include neck, back, and shoulder pain, skin irritation, rashes, infections, compensatory postural changes and grooving of the shoulders from bra straps. Women with such large breasts are frequently faced with real challenges and restrictions including in the types and amount of physical activities that they can engage in due to the associated discomfort. Being able to find comfortable, properly fitting bras that provide well needed support as well as clothes that are attractive, complementary and stylish can be daunting tasks.
Women elect to undergo breast reduction surgery in order to alleviate symptoms or address issues that are directly affected by their enlarged breast size. The most common reasons include:
- Breasts that are disproportionately too large
- Neck, back and shoulder pain that are secondary to the weight and traction effect of the weight of the breasts
- Large, pendulous breasts that hang down over the abdomen
- Irritation, pain and indentation of the shoulders caused by pressure from the bra straps
- Chronic rashes or infections between the drooping breasts and underlying skin
- One breast significantly larger than the other
- Limitations in the ability to engage in sports and other physical activities due to the associated breast pain
- Feelings of self consciousness and low self-esteem that are often exacerbated by jokes or ridicule
- Difficulty finding bras that are comfortable, supportive and which can reduce symptoms related to the weight of their breasts
- Limitations in finding clothes that will fit or that women would like to wear
Insurance or Private Pay?
Having health insurance doesn’t guarantee that you have coverage for a breast reduction because many companies have made it an exclusion in their policies. In order to determine whether or not you may be eligible for insurance coverage, your specific policy must be checked. Even when the benefits are offered, most all plans mandate that you meet certain specific criteria or requirements in order to obtain approval for insurance coverage for your surgery. Dr. Turkeltaub and his staff will assist you in trying to obtain insurance pre-authorization.
The particular criteria that must be met do vary among the different insurance companies and even between different policies. Some of the more common ones include:
- Exceeding a minimum specified weight of breast tissue that must be removed from each breast (the exact amount is frequently determined by an index that relates your weight and height)
- Symptoms including neck, back and shoulder pain; skin rashes or infections; grooving of your shoulders; headaches
- Duration of the symptoms
- Failure to respond to pain medications, nerve blocks, etc.
- Failure to respond positively to a course of physical therapy that may need to be at least six months in duration
- Documentation of symptoms and a strong recommendation for surgery by your primary care doctor
- Recommendations for breast reduction surgery rendered by other medical specialists including orthopedic surgeons, neurologists, neurosurgeons and chiropractors
- Meeting several of the above as well as not exceeding a certain body-mass index (BMI) – which is a particular weight for one’s height
If you don’t have insurance coverage or have been denied benefits for a breast reduction, you still have the option of proceeding with the surgery by paying on your own. We offer special package pricing in conjunction with the outpatient center and the anesthesiologist that can make your breast reduction procedure affordable … and a reality!
Techniques for a Breast Reduction
Breast reduction surgery involves decreasing the size of the breasts by removing excess breast tissue and skin along with recontouring and elevating the remaining tissue. The nipple-areola complex, which is usually enlarged and below its normal location is reduced to a more proportionate size as well as elevated to a more ideal, natural position while still remaining attached to the breast tissue. This technique allows for the possibility of being able to breast feed in the future (when relevant) and for preserving some sensation and sensuality of the nipple-areola complex.
In a variation of this procedure, the nipple-areola complexes are physically detached from the underlying tissue and then replaced as “skin grafts” in the appropriate locations after the reduction and recontouring are accomplished. This technique, which is called the “free nipple graft” approach, does offer some significant advantages to select women. A few indications for its usage include massively enlarged or elongated breasts, women who are heavy smokers, patients who are at higher risk medically, women who have or are at risk for impairment of the blood flow within the breasts, and those who want to be extremely small. Disadvantages include loss of sensation and sensuality, inability to breast feed, a variable amount of depigmentation of the areola, and lack of any nipple projection.
The most incisions used in a breast reduction are in the shape of an inverted-T or anchor and extend from around the nipple, down to the crease at the bottom of the breast and then along this crease. With time, complete maturation of the tissues and when performed with meticulous technique, these scars can become relatively inconspicuous.
There are other less common configurations for incisions, often with the intended goal being to minimize the overall scar length. Unfortunately, these approaches often limit the ability to precisely reduce and sculpt the remaining tissues which result in less than desirable breast shapes, create abnormal or asymmetrical nipple positioning, produce scars that can extend below the breast fold and be visible when wearing more abbreviated clothing, and increase the likelihood that a follow-up corrective procedure would need to be performed. In Dr. Turkeltaub’s opinion, the sacrifices you would make just to have shorter incisions are not worth it.
Liposuction breast reduction is a niche procedure that utilizes liposuction in order to reduce the breast size. Because liposuction does not remove glandular breast tissue, the only tissue that is being removed is fat which, therefore, limits its applicability to select few women. Furthermore, because this technique involves no skin resection that would otherwise be necessary to recontour and elevate the breasts, droopy breasts will remain that way. The distinct advantage of this technique is that relatively small breast reductions in women with minimal or no drooping can be accomplished employing a few short incisions (1/4 to 3/8 inch) through which cannulas are inserted in order to facilitate the liposuctioning.
Your Breast Reduction Procedure
Breast reduction surgery is usually done under general anesthesia as an outpatient procedure. Depending on several factors, the procedure usually takes between two to three hours. In order to facilitate obtaining the desired size, shape and greater symmetry, Dr. Turkeltaub will carefully assess you from a variety of angles and positions. He also uses a meticulous closure technique that provides you the opportunity to heal with the best possible scars.
Breast reductions are commonly performed in conjunction with many other cosmetic procedures; for example, as part of a “Mommy Makeover” with tummy tucks, liposuction and facial cosmetic surgery. The advantages include more extensive and cost effective improvements with less total down time and time off of work or school.
Recovery from Your Breast Reduction
A bulky dressing is placed following surgery that provides some compression and comfort for 2 – 3 days. Openings are placed in the dressings to allow you to check the color of your areolas around every four hours to make sure they are getting an adequate blood supply and the blood flow out is good as well. Often there may be a small amount of bleeding or drainage which is of no concern.
During your first postoperative visit, you are placed in a sports type bra which you are to wear day and night for at least 1 week. After that, it is highly recommended that you wear a supportive bra on a regular basis so as to help maintain your breast shape and slow down the rate of drooping that will occur over time. An underwire bra can subsequently be worn if you desire but the timing of this would depend on several factors. For more explicit information on this, you can read Dr. Turkeltaub’s blog post on wearing an underwire bra after breast reduction. If you have drains (which are infrequently used) or any external sutures, these are removed at around 1 week.
Many women expect this to be a painful procedure and are surprised to learn that the opposite is true. The discomfort level is quite tolerable and easily controlled with pain medication. In fact, many of Dr. Turkeltaub’s patients take little or no pain medication and indicate an immediate improvement or resolution of their symptoms resulting from the reduction.
Your breasts initially will be moderately swollen, firm and may appear larger than they ultimately will be. It can take several weeks to a few months for a majority of this swelling to disappear. You can resume virtually all sports, unrestricted aerobic activity or heavy lifting at around three to four weeks. Most of our patients return to work or school within five to seven days.
Breast Reduction Before and After Photos
A vast majority of women undergoing breast reduction surgery were extremely happy with their results and in choosing this course of action. They noted that the procedure resolved most, if not all, of their symptoms. In fact, they are probably our happiest, most satisfied and appreciative patients.
Breast Reduction Patient Testimonial Videos
Frequently Asked Questions
Q: My breasts are very large and cause neck, back, and shoulder pain. Will a breast reduction help resolve my symptoms?
A: By significantly decreasing the size and weight of your breasts and repositioning the remaining tissue, a breast reduction can be very effective and successful in treating these symptoms. In fact, it is Dr. Turkeltaub’s experience that most women experience either a near total or a complete disappearance of these symptoms.
Q: What level of discomfort can I expect following surgery?
A: Despite what we tell our patients beforehand, many are surprised at how little discomfort they experienced right after surgery. Many women will also note instant resolution of their neck, back and shoulder pains even with their initial surgical dressing still on. Realistically, expect the pain level to be mild to moderate in nature.
Q: Will the procedure be covered by my insurance plan or will they consider it to be cosmetic?
A: The answer to this depends upon several factors including your specific insurance plan, bra size, anticipated weight of the breast tissue to be removed, your height and weight, and constellation of symptoms. Common problems that insurance companies look for are neck, back, and shoulder pain, skin irritation, headaches, and failure to respond to non-operative treatments such as physical therapy.
Q: Are there any age restrictions for a breast reduction?
A: Dr. Turkeltaub strongly recommends that his patients wait until they are at least eighteen years of age and that their breast growth has stopped. There are clearly exceptions to this for girls who are younger and that would be determined on an individual basis.
For women in their seventies and eighties, as long as you are in good health, have received medical clearance, are experiencing debilitating symptoms and the benefits would outweigh the risks, surgery can surely be considered.
Additional Information About Breast Reduction from Dr. Turkeltaub
Read more about breast reduction from Dr. Turkeltaub’s breast surgery blog.
Learn More On How a Breast Reduction Can Benefit You
There are many important reasons to contemplate undergoing a breast reduction procedure if you are bothered by large breasts. In some cases, your breast reduction procedure can even be combined with a breast lift. You can contact our plastic surgery center to learn more about the benefits of a breast reduction.
Dr. Steven H. Turkeltaub is an experienced plastic surgeon who performs a large number of breast reductions, helping women who are affected by these issues associated with large breasts.