BREAST REDUCTION (Reduction Mammaplasty)

 Background
 Patient Groups
 Patient Concerns and Planning
 Preparing for Surgery
 The Operation
 Recovery
 At Home
 Office Visits and Follow-up
 Outcome and Complications
 Case Histories (Before and After)

BACKGROUND
If you are considering a breast reduction it is important to understand the various presentations of heavy enlarged (hypertrophic) breasts which confront the Plastic Surgeon who is recommending various TECHNICAL OPTIONS. The changes in the female breast that lead to significant and excessive enlargement can be due to genetic and developmental events and can include adolescent hormonal surges, medication, childbirth, general advancing age, and marked weight gain. When the size of the breasts become unwieldy, leading to symptoms such as breast pain, under-breast rashes, nerve tingling, shoulder, neck, and back pain, the Plastic Surgeon is sought to assist the patient in a relief of these issues by volume reduction surgery, which at the same time attempts to restore a more appealing shape to the reduced breasts. This site is devoted to a look at minimal scar breast reduction, with special reference to the periareolar scar approach which can be applied to a wide array of breast shapes and sizes of a of a mild to moderate degree.

For excessive breast size termed gigantomastia, it may be necessary to utilize other methods which include the Vertical Mammoplasty, Wise or Free Hand T Scar Mammoplasty, or Reduction Mammoplasty where the Nipple is Removed and Replaced as a Graft (Free Nipple Graft). When the patient has thin elastic skin and fatty-type breasts, the surgery can be more challenging and subject the breasts once again, to the forces of nature and to the series of physiological changes that naturally occur over the course of a woman's life. To this end the plastic surgeon must carefully explain to the patient what is to be expected in terms of shape, and degree of scar placement to achieve the desired results.

Historically, the performance of a breast reduction for symptoms has been a benefit offered by most insurance companies, however, in recent years many patients are excluded from coverage on the basis of insufficient weight of breasts to be considered for surgical removal. Various charts and graphs have been developed to help surgeons, patients, and insurance carriers understand what constitutes breast reduction for medically necessary reasons. Often a patient of smaller stature and slender frame may have moderate sized breasts that require only 300 to 400 grams of breast tissue to be removed in order to improve symptoms. A patient who is tall and has a heavy frame may require reductions of 500 grams to 1500 grams per breast to provide significant relief. Patients who may require 150 to 450 grams of reduction at any body size may experience marked improvement in breast weight and symptoms, but are excluded by most insurance companies.

With an increasing number of patients presenting to our Practice who may have been denied coverage and do not meet the stringent insurance benefit requirements, these patients became candidates for minimal scar reduction techniques which would be aptly suited for the smaller breast hypertrophies. The use of reduced scar methods for both breast lift and reduction is not new, and fundamental techniques were developed over 30 years ago, but only now are becoming popular as plastic surgeons gain familiarity with the more exacting technical demands of these procedures With further experience, the plastic surgeon becomes more adept in applying a reduced scar approach to a wider range of patient candidates for breast reductions less than 600 grams per breast. Ongoing work in the field continues to find the single best method for every patient, but it is best to select the best method for each individual patient. The periareolar method leaves a simple circle around each areola for each breast. The early appearance of the breasts operated with this method is often temporarily compressed and flattened with some pleating around the areolae. In time this improves dramatically. Even with minimal scar approaches, a certain percentage of patients will develop more than minimal scarring around the areolae. Revisions can still be performed to honor the circular pattern and not lead to placement of other scars to provide corrections when indicate.