Breast Reduction

Introduction

What is Breast Reduction Surgery?

When a patient’s breasts are larger than their frame can support (macromastia) it can cause a variety of symptoms, such as pain and compression in the neck and spine. Breast reduction, or reduction mammoplasty is a procedure intended to decrease the size of the breast and help alleviate these and other symptoms by reducing the size of the breasts while maintaining a natural breast shape.

Who is a candidate for breast reduction?

Some women choose to undergo breast reduction because they are dissatisfied with the size of their breasts – which can cause discomfort or pain in the neck and back. They may have difficulty shopping for clothing or suffer from rashes under their breasts. Candidates for breast reduction should be mentally and physically healthy and at a relatively stable weight for best long-term results. Tobacco use is strongly discouraged as it can slow healing and lead to complications from surgery.

Fact: Most women with macromastia or large breasts require at least 500gm of tissue in each breast to be removed during breast reduction in order to eliminate their symptoms.

Options and Variations

There are two major considerations when Dr. Raj plans a breast reduction.

First, it is important to determine the skin incision pattern because to accommodate or cover the smaller breast, the overlying skin envelope will need to be made smaller.

Common incision patterns and techniques for breast reduction include:

Vertical Incision Method (Lollipop Breast Reduction, Keyhole Reduction)

Some patients are candidates for this method of breast reduction, where an incision is made around the border of the areola and then vertically down from the areola to the breast crease. Also commonly used as a breast lift procedure, the vertical incision method is appropriate for women who only require a moderate amount of tissue reduction.

Inferior pedicle technique (anchor pattern, inverted-T incision, Wise pattern)

The most common approach to breast reduction, an incision is made around the perimeter of the areola, vertically down the center of the breast and then horizontally along bottom seam of the breast where it meets the abdomen. The nerves and blood supply to the nipple are maintained by keeping the nipple and areola connected to the tissue in the lower portion of the breast while it is repositioned.

These techniques pose a low risk of losing sensation in the nipple and gives women a positive chance at still being able to breast feed, once their breasts have healed.

Secondly, the manner in which the breast tissue will be reduced also has to be planned. Some tissue must be preserved to maintain blood flow to the repositioned nipple. This helps maintain sensation and preserve lactation capability.

Initial Consultation

Dr. Raj evaluates each patient’s medical histories and carefully listens their concerns to determine if they are a candidate for surgery. Patients are encouraged to be frank and ask as many questions as needed to ensure that they are comfortable to proceed with cosmetic surgery. He will then provide a detailed description of the procedure covering the risks, benefits, and ideal outcomes and conduct a thorough examination. Specific measurements are taken and the ultimate goal size is determined.

The Procedure

Description of procedure

The specific procedure ultimately depends on how much tissue needs to be removed in a breast reduction. Another important consideration is how much the nipple needs to be elevated. A breast reduction always lifts the nipple or transposes it to a more normal position above the inframammary fold.

During most breast reduction procedures, once the patient is under anesthesia Dr. Raj will:

Make an incision around the areola and down each breast. Most commonly he will use the anchor pattern based on the amount of tissue to be removed but may use other incisions.

Remove excess breast tissue, fat and skin according to the surgical plan.

Reshape the breast to create a natural appearance and re-position the nipple in its new location. Every effort is made to maintain the sensation and function of the nipple. In some rare circumstances, the nipple may need to be removed and relocated.

The patient is then closed with sutures, skin adhesives, or medical tape.

Blockquote – While some breast reduction procedures may be supplemented by liposuction, liposuction alone isn’t enough to treat the symptoms of macromastia.

Before the procedure

Before the procedure, patients are given clear instructions on how to prepare for the procedure and what medications to avoid. Patients may need pre-operative testing to be completed and older patients will be required to obtain a mammogram. Typically, patients who are healthy and are non-smokers are good candidates for the procedure.

The day of the procedure

The procedure is done at an accredited surgery center or at a hospital. On the day of surgery, Dr. Raj will perform markings to plan the breast reduction technique such that the nipple will be in a more appropriate position. Afterwards, under general anesthesia, Dr. Raj will perform the procedure which will take about 2-4 hours depending on the complexity and extend of the breast reduction. Most patients can go home the same day after the procedure.

After the procedure

Patients are given detailed instructions on the recovery process.  Dr. Raj recommends patients wear a support bra for 2 weeks after the procedure. They can apply soft pads or gauze over the incisions. It is normal to have bruising and swelling the first week of the procedure but that will subside with time. Patients will feel immediate relief and will noticeably have less back pain or neck pain.

All sutures are dissolvable and do not require removal. Patients can resume their normal exercise regimen 4 weeks after the procedure once the wounds have sufficiently healed. After one month, Dr. Raj teaches different techniques and modalities to minimize scarring.

Limitations, Risks, and Possible Complications

  • Unfavorable scarring (wide or darkly pigmented scars)
  • Infection
  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Risks of anesthesia
  • Bleeding (hematoma)
  • Poor wound healing or wound breakdown
  • Breast contour and shape irregularities
  • Skin discoloration, permanent pigmentation change
  • Swelling and bruising
  • Asymmetry of breasts
  • Fluid accumulation (seroma)
  • Excessive firmness of the breast
  • Potential inability to breastfeed
  • Potential loss of skin/tissue of breast where incisions meet each other
  • Potential, partial or total loss of nipple and areola
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Fatty tissue deep in the skin could die (fat necrosis)
  • Possibility of revisional surgery

 

FAQ

Q: What are the symptoms of macromastia?

A: The symptoms are neck pain, back pain, shoulder pain, headache, grooving from bra straps, poor posture and spinal alignment, rashes underneath breast.  Some patients have psychological issues such as depression or anxiety.  Some women have difficulty fitting into clothing or exercising.

Q: How Long Will the Results Last?

A: The results of a breast reduction last long as there are no major weight fluctuations. Immediately after the procedure, patients report resolution of their symptoms. This is maintained as long as the breasts are the same size.

Q: Is this a common procedure?

A: This procedure is one of the most common procedures performed each year, with nearly 100,000 performed in the United States alone each year.

Q: Does Dr. Raj use drains?

A: No, Dr. Raj does not use drains in breast reductions because there are studies showing that there is no different in outcomes between patients who had drains versus ones who did not.

Q: Do patients go home after the surgery?

A: Yes, most patients go home after the surgery. Some choose to stay overnight at a surgery center or a hospital.

Q: Is breastfeeding possible after breast reduction surgery?

A: Yes most women are able to breastfeed after the procedure. Only a few women with this procedure have difficulty breastfeeding. In rare situations where the nipple is removed and placed as a graft, breastfeeding will not be possible.

Q: Can teenagers have this procedure?

A: Yes, some teens have macromastia or gigantomastia and have very severe symptoms i.e. pain, rashes, difficulty exercising. If teenagers obtain parental consent, they can undergo breast reduction surgery.

Q: When can a patient resume normal activities after a breast reduction?

A: Most activities of daily living can be resumed immediately after a breast reduction. Dr. Raj recommends patients do not perform any heavy lifting or strenuous activity such as exercise for one month after the procedure. Most patients can return to school or work one week after the procedure.

Q: Where is the surgery performed?

A: The procedure can be performed at an accredited surgery center or a hospital depending on the patient’s preference.

Q: Can Liposuction Be Used with this procedure?

A: Liposuction by itself does not provide an adequate reduction. In some cases it is a useful adjunct with a breast reduction to remove excess tissue in the axilla (armpit).

Q: What happens to the breast tissue that is removed?

A: This breast tissue is sent to a lab to be evaluated by a pathologist to ensure the tissue is normal and does not have evidence of any disease or cancer.

Q: What size will I be after a breast reduction?

A: This depends on the patient’s initial bra size. Dr. Raj will evaluate you during the initial consultation and give you an idea of what size you will be after the procedure.

Q: Is Breast Reduction Surgery covered by my insurance?

A: Some insurance companies cover the procedures but it really depends on each patient’s individual plan. We recommend all patients discuss the details of their policy with their insurance company. We also recommend they inquire about their deductible and out of pocket costs before scheduling surgery. Our staff can guide patients on the insurance process, please reach out.

Q: What If the breast reduction makes the breasts too small?

A: We recommend waiting at least 6 months before judging the final result. If the breasts are still too small, Dr. Raj can place implants or perform fat grafting to increase the size of the breasts.

Q: What scars will I have?

A: This depends on the type of procedure or technique used. Patients typically have a scar around the areola and then one that runs vertically along the breast. There is also a scar along the undersurface of the breast in the infra-mammary fold. These scars are well hidden. Dr. Raj makes every effort to minimize the scars.

Why choose Dr. Raja Mohan?

Patients choose Dr. Raj to handle their breast reduction surgery for a variety of reasons.

He is knowledgeable and personable and is known for both candor and compassion.  He really cares about his patients and it shows his interactions with them and in the quality of patient care he provides.  Dr. Raj studies and teaches alongside the brightest surgeons and doctors in the industry as a peer and leader. This means that his patients are always able to benefit from advancements at the edge of science and surgery.
Ultimately, however, all roads end with the outcomes, and the reason most people choose Dr. Raj is because he delivers amazing results that speak for themselves.

Schedule a Consultation

If you want to learn more about breast reduction surgery and whether or not it’s the right procedure for you, please call (469) 301-1725 to schedule a consultation with Dr. Raj Mohan, board certified plastic surgeon serving the Dallas-Fort Worth Metroplex. He operates in Arlington, Grapevine, Southlake, Dallas, Plano, Frisco, Irving, and Coppell.