When smaller is better

Breast reduction, which is also known as reduction mammaplasty, removes extra breast skin, fatty tissue and glandular tissue to leave a breast in proportion to the size of the individual.  What’s unique about this cosmetic surgical procedure is that is also carries a significant functional component, relieving pain in the back, neck or shoulders often associated with large breasts.  Patients who undergo breast reduction surgery are among the most satisfied in any plastic surgical practice, because the individuals not only look better but feel better as well.

Breast reduction surgery can also be very liberating for women with large breasts, as they are no longer confined to limited bra styles and more significantly, limits on their activities. Many of my patients for reduction complain that they can only play tennis or golf while wearing multiple bras, and even then, they suffer from discomfort in the back and neck.  For many, swimming is out of the question.  Being freed from the extra size and associated weight in their breasts often allows them to return to regular activities and a healthier lifestyle.

Breast reduction can be done at any age, but most surgeons recommend trying to wait until the breasts are fully developed.  So what other qualifications make a woman a good candidate for this operation?  Patients should be in good health, maintain their weight and have a realistic expectation of the potential results of the surgery.  Smoking can delay or even impede healing and should be avoided when considering any elective surgical procedure, including breast reduction.  Being completely candid with your surgeon prior to surgery is critical to a good outcome, as there are many decisions as to size and incisions that need to be made, and patients are best served when they actively participate in those decisions.

The surgery is done through incisions that surround the areola, and often include a reduction in size of the areolar complex in addition to the breast.  The incision then continues down towards the inframammary fold or area where the breast meets the chest wall.  Many surgeons also extend the incision underneath the breast in this inframammary fold to hide the scar and improve the shape of the breast.  Extra skin and breast tissue is removed, ranging from a half-pound to two or more pounds per breast, depending on the individual.  Often the incisions are closed around a small drain which is removed the day after surgery.

Many patients stay in the hospital overnight. Typically, the sutures are absorbable so no further procedure needs to be done on the breast.  Patients go home after surgery with a support bra and need recovery time before resuming normal activities.  Because surgeons have different approaches to the surgery, it is a good idea to see more than one surgeon before deciding on surgery.

Typically, patients are left looking more symmetrical and proportionate and feeling much better, as if a weight has been lifted from their backs. There are risks to the surgery, and it is extremely important to look for a surgeon who has had experience with this operation.  Also, be aware that breast reduction surgery can interfere with certain diagnostic tests on the breast, and that breast feeding can be limited after surgery.  As always, be prepared with these and other questions if you seek a consultation with a plastic surgeon for this surgery.

Because breast reduction surgery improves function and can relieve pain and frequent skin infections, the procedure is often covered by health insurance policies.  One of the most common questions I’m asked is whether insurance will cover the surgery. That depends on a number of factors as well as your particular insurance policy.  The first point to understand is that insurers insist on pre-certification, meaning that they will make a determination as to whether the procedure will be covered by the policy prior to the surgery being performed.  Among the factors they consider are the size of the breasts, whether the patient has documented symptoms of pain and infection that are directly related to the size of the breasts, and what treatments, including weight loss and exercise, the individual has had before considering surgery.  They require a letter from the treating surgeon, supporting documentation from other physicians the patient has seen for related problems and preoperative photographs.   If the criteria they have established are met, then the surgery is covered by insurance.

In the end, breast reduction can be extremely liberating for women bothered by large, heavy breasts and is an option that can provide great relief to appropriate candidates.

Please send any questions or comments to mrosenberg@nwhc.net




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