Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight of large breasts. These include back pain, neck pain, skin rashes, skeletal deformities, and breathing problems. Bra straps may leave grooves in the shoulders from excess weight. Unusually large breasts can make a woman or a teenage girl feel extremely self-conscious, and many women may alter the type of clothing they wear to hide large breasts. Large breasts may even prevent a woman from participating in sports or exercise activity.
Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. The procedure also repositions the nipple and areola (the darker skin surrounding the nipple) to a higher level, raising the level of the breast on the chest wall. Breast reduction also reduces the size of the areola.
The goal of breast reduction surgery is to give women smaller, better-shaped breasts in proportion with the rest of their bodies. By removing the breast excess weight the symptoms mentioned above will be relieved.
Most health insurance companies will cover the cost of a breast reduction if certain criteria are met. Patients must have symptoms of pain and reduced physical activity. Insurance companies also require surgeons to remove a minimum amount of tissue, usually 500 grams.
If you’re considering breast reduction, this page will give you a basic understanding of the procedure. Dr. Zemmel will answer all of your questions in detail at your initial consultation.
Candidates For Breast Reduction
Breast reduction can be performed for physical relief and cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. Many women have tried pain medicines such as Aleve or Motrin to relieve the symptoms without effect. Other women desire smaller breasts to improve the shape of their bodies.
Breast reduction usually is not performed until a woman’s breasts are fully developed. However, in certain rare cases it can be done at an earlier age if breasts are extremely large and are causing serious physical or mental discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results.
Breast reduction is not recommended for women who intend to breast-feed.
You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration. However, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin.
Safety is Dr. Zemmel’s number one concern. All patients will undergo a rigorous pre-operative physical exam to determine whether or not they are fit for breast surgery.
Planning Your Surgery
During you consultation please discuss your expectations honestly with Dr. Zemmel.
Each woman has a different view of the ideally shaped breast. Dr. Zemmel will listen very closely to your opinions and will try to understand your desires.
Dr. Zemmel will examine and measure your breasts taking in account:
- Your starting breast size
- The distance from your collar bone to your nipples
- Your height and weight
- Your chest wall size
- The shape of your breastbone
- The elasticity of your skin
- The size and shape of your nipples and areola
Dr. Zemmel will then recommend a procedure to fit your goals. Typically, breast reduction is performed by using two different techniques depending on how much breast tissue and skin needs removal.
If a moderate amount of skin and tissue require removal then a vertical breast reduction pattern may be used. This technique uses an incision that goes around the nipple/areola and then straight down to the breast fold. It takes the shape of a “lollipop.” If a large amount of tissue needs removal then Dr. Zemmel will perform a Wise pattern breast reduction. This technique includes the incision around the nipple/areola and the vertical incision, but also uses a horizontal incision hidden in the breast fold. This pattern takes the shape on an “anchor.”
You should also discuss where the nipple and areola will be positioned; they’ll be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.
Dr. Zemmel will photograph your breast for reference during surgery and afterwards. The photographs may also be needed in the approval process of your insurance coverage.
He will also discuss the other variables that may affect the procedure, such as your age, any prior history of breast disease, any family history of breast disease, and your overall health. Dr. Zemmel may also require you to obtain a recent mammogram.
Dr. Zemmel will describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result.
He will also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it’s medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have your surgeon write a “predetermination letter” if required.)
Preparing For Your Surgery
Safety is Dr. Zemmel’s number one concern. Every patient undergoes a thorough pre-operative examination to make sure they are fit for surgery. Dr. Zemmel will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
Where Your Surgery Will Be Performed
Breast reduction surgery is usually performed in Dr. Zemmel’s office-based operating room. Dr. Zemmel’s operating room is a critical component of the quality of his care. The facility has the full accreditation by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Smaller-volume liposuction is usually done on an outpatient. However, if a large volume of tissue will be removed, or if breast reduction is being performed in conjunction with other procedures, an overnight stay in a hospital may be required.
Type Of Anesthesia
Breast reduction is nearly always performed under general anesthesia. You’ll be asleep through the entire operation. You will be unaware of the surgery and completely pain free.
As mentioned above, Dr. Zemmel typically uses one of two techniques for breast reduction. If a large reduction will be performed, Dr. Zemmel will use an “anchor” shaped incision that circles the nipple/areola, extends downward, and follows the natural curve of the crease beneath the breast. In smaller reductions a “lollipop” shaped pattern will be used. This involved an incision that circles the nipple/areola and extends downward, but does not continue into the breast crease.
Dr. Zemmel removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the nipple/areola, shaping the new contour of the breast. Dr. Zemmel may use liposuction to recontour the area where the breast meets the armpit area. This provides a smoother transition between the breast and chest wall.
All incisions are closed with fine absorbable sutures. Dr. Zemmel believes this will give the best scar possible.
Surgery Carries Some Uncertainty & Risk
Breast reduction is not a simple operation, but it’s normally safe when performed by a qualified Plastic Surgeon. With any surgery, however, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia.
Breast reduction surgery does leave noticeable, permanent scars. The original size and shape of your breast will determine the type of reduction procedure you will need. Regardless of the type of operation Dr. Zemmel performs, the scars will be covered by your bra or bikini bathing suit. Remember, it is impossible to remove excess skin without leaving a scar. Despite an excellent operation, the procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples.
Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. The nipple and areola can be reconstructed but this requires an additional procedure.
Women who smoke are at a higher risk for all complications. Poor healing and wider scars are also more common in smokers. Dr. Zemmel may choose not to perform the surgery if you are a heavy smoker.
You can reduce your risks by closely following Dr. Zemmel’s advice both before and after surgery.
Dr. Zemmel will go over these issues is great detail during your consultation. Remember, most surgeries go fine without any problems. Complications occur only in a small minority of cases.
After Your Surgery
After surgery, you will be wearing a surgical bra over gauze dressings. You may feel some pain for the first couple of days especially when you move around or cough and some discomfort for about 1 week. Dr. Zemmel will prescribe medication to lessen the pain. The bandages will be removed the day after surgery, and Dr. Zemmel will check the incisions to make sure everything is healing well. Two days after surgery you will be able to bathe. You will continue wearing the surgical bra for one to two weeks until the swelling and bruising subside. Dr. Zemmel will then advise you to wear a soft sports bra for 2 to 3 weeks until the wound obtain full strength. You then will be able to wear a new bra.
Getting Back To Normal
Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.
Dr. Zemmel will give you detailed instructions for resuming your normal activities. Most women can return to work (if it’s not too strenuous) and social activities in about 10 days. You will have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about four weeks.
Your New Look
Although much of the swelling and bruising will disappear in the first few weeks, it may be six months before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.
Dr. Zemmel will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that breast reduction surgery leaves permanent scars. They often remain lumpy and red for several months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.
Of all plastic surgery procedures, breast reduction results in the quickest change in body image. Most patients feel relief of the physical discomfort of large breasts almost immediately. Many of Dr. Zemmel’s patients report improvement in neck and back pain as soon as the day after surgery.
Over time, your body will look better proportioned, and clothes will fit you better. However, as much as you may have desired these changes, you’ll need time to adjust to your new image. Be patient as the healing process will take several months.