Breast Reduction

What is a breast reduction?

One of the happiest and most grateful patients in plastic surgery is the patient who has undergone breast reduction (or, reduction mammaplasty). Very simply, breast reduction is designed to reduce the size of large and pendulous breasts that are causing numerous symptoms including back or neck pain, infection in the breast fold, and shoulder grooving from bra straps. Relief of these symptoms is immediate following surgery. Patients frequently describe improved energy and ability to participate more effectively in exercise and sports. 

These procedures may be covered by insurance companies as long as certain criteria are met. There is wide variability in what documentation is required, but most providers require demonstration of conservative measures for several months leading up to the decision for surgery. In addition, the surgeon will need to estimate the weight of breast to be removed. Problems such as recurrent infections or rashes in the breast fold requiring antifungal medication or antibiotics, attempts at weight reduction through diet and exercise, reliance on medication for neck or back pain, photos or other documentation of grooves along the shoulder from bra straps must also be documented. Even then, there are sometimes inconsistencies in authorizing this type of surgery. A letter from the physician to the insurance company or a possible peer-to-peer conversation can sometimes help in case of a denial.

How is breast reduction performed?

Breast reduction is a very old technique that has experienced numerous iterations over the years. The majority of breast reductions in the United States are performed using a Wise pattern technique (or, anchor incision). Using this method, the incisions run around the nipple and areola with a vertical limb down the midline of the lower breast, connecting in a perpendicular fashion with an incision in the inframammary fold. The bulk of the breast tissue is removed through this series of incisions to an approximate size of the patient’s choosing. 

In a vertical breast reduction, the incisions are limited to the border of the areola and a vertical midline incision along the lower breast, down to the inframammary fold. The advantage of this approach is to limit the amount of scarring on the breast while achieving similar reductions in size as with the Wise pattern technique. Liposuction is frequently performed simultaneously to refine the final appearance of the breast.

Yet another commonly used incision style is the circumareolar incision (around the areola). This incision may be used for a limited reduction, although it is more commonly employed for breast lifting. This incision can reposition a slightly downward pointing nipple to a more normal, appealing position. It is more frequently used in conjunction with breast implant placement (augmentation mastopexy).

Other less common methods of breast reduction are used as well including a hockey stick-shaped incision (Lejour technique) and straightforward liposuction in select cases.

Dr. Panossian has extensive experience in all of these techniques and will review the approach most likely to give you the best possible result. During consultation, the feasibility of this particular reduction technique will be assessed for each patient. On the day of surgery, Dr. Panossian will spend a long time precisely measuring and marking the breasts in the standing position prior to entering the operating room.

What is the recovery?

Breast reduction is an outpatient procedure. A family member or friend is required to care for the patient on the day of surgery and for at least 24 hours following surgery. 

The breasts are covered with gauze dressing and an elastic bandage. General discomfort may last a day or two but can be relieved with pain medications. In a few days, the operative dressings will be replaced with a soft bra. This bra is worn continuously for up to four weeks over a thin layer of gauze. Stitches are usually removed in one week following surgery.

It is critical to reduce activities substantially during the first week after surgery. Having a family member or friend to help during this time with daily activities is essential. This first week is critical for the healing process and in the avoidance of postoperative complications. Approximately two weeks after surgery, light walking and similar activities is allowed, but strict avoidance of upper body workouts, heavy lifting, running, aggressive exercise, or sports is advised.

There is usually some loss of sensation in the nipples and breast skin after surgery. This numbness will improve over the next six weeks. Sometimes, the nipples will undergo a period of increased sensitivity as well. In some patients, these sensory changes may last a year or more, and can be permanent.

What are the risks and complications?

Breast reduction is a complex operation but is usually safe when performed by a board-certified and experienced plastic surgeon. Bleeding, infection, and problems with anesthesia are risks inherent to virtually all surgical procedures. These risks can be drastically reduced with strict adherence to Dr. Panossian’s pre-and postoperative instructions.

Breast reduction scars are usually covered within the bra line. An individual’s tendency for keloid or thick scarring is sometimes unpredictable and genetically predetermined. These scars can be treated with either steroid injections or surgical revision, if they should occur. 

Slight asymmetry between the breasts can also occur in relation to breast shape, nipple position, or differences in sensation. In the worst case scenario, the vascularity of the nipple and areola may be compromised and a portion of the nipple-areola complex may die. This is a treatable problem but surgical correction may be necessary. Finally, the ability to breastfeed is affected in most patients since the milk producing portions of the breast are removed.

Dr. Panossian’s staff is available 24 hours a day to answer your concerns and questions regarding pre- and postoperative instructions in order to avoid complications. Patients are encouraged to call immediately in the event of a suspected problem.