Are you naturally endowed with large breasts that you love, or do you have breasts so large that they cause you discomfort? Some women develop large breasts at puberty and remain large breasted, while other women’s breasts increase in size with pregnancy or with the natural weight gain that occurs over time as we age. When large breast size starts to cause neck, back, and shoulder problems, you might be a candidate for surgery to reduce the size of the breasts.
Breast reduction surgery removes extra breast tissue, fat, and skin and can significantly improve your quality of life by relieving pain and creating a more ideally proportioned figure. In addition to reducing the size of your breasts, your Restore SD surgeon will reshape and reposition your breasts so that any sagging (ptosis) that is a result of large heavy breasts is corrected. The goal of breast reduction surgery is to create natural looking, youthful, and proportionate breasts that allow you to dramatically improve your quality of life. Many women who undergo breast reduction surgery can’t believe that they didn’t do it years earlier! It is one of the many breast enhancement procedures offered at Restore SD Plastic Surgery.
The Best Candidates
- Have large breasts that are not proportionate to your frame
- Struggle to find clothes that fit properly and are flattering
- Have persistent bra strap grooving and have trouble finding a bra that fits and supports you
- Wear two sports bras to exercise or feel limited in your ability to play sports
- Experience rashes or skin irritation under your breasts
- Are self-conscious about the large size of your breasts
- Are not taking blood thinner medications or using nicotine products
- Are healthy and a stable weight
Breast reduction surgery has the highest satisfaction rate of all plastic surgery procedures. For most women, the relief of symptoms is immediate and they never look back!
If you are actively breastfeeding, recently stopped breastfeeding, or a young woman whose breasts who are not fully developed, this is not the best time for surgery. We recommend waiting nine months after breastfeeding is finished before undergoing breast surgery to allow the lactational changes to stabilize and minimize the risk of complications. Those who are actively trying to lose weight should also postpone surgery until weight loss is completed since weight changes after surgery will impact your results. Because many people get caught in a vicious cycle of exercise/can’t exercise due to breast related symptoms, please let us know if you need a weight loss consultation or a referral to a trusted nutritionist or personal trainer.
Breast reduction surgery is often considered therapeutic and may be covered by insurance. Each insurance plan has its own specific criteria and your Restore SD surgeon will work with you to determine your coverage status. A pre-determination or pre-certification may be required for insurance coverage, so please allow enough time in your planning to deal with the necessary insurance requirements.
Breast reduction surgery can be safely performed as an outpatient procedure in several ways. The most common techniques offer a consistent and reliable method of reduction that alleviate your symptoms and are tailored to your body and goals.
Anchor Incision Breast Lift:
The most frequent technique employed by Restore SD surgeons is the “anchor-type” incision pattern utilizing a superior-medial pedicle. The anchor pattern includes an incision around the areola (pigmented area around the nipple) that extends vertically down and connects to a horizontal incision that is hidden in the lower breast crease. Using the anchor pattern to remove excess skin and breast tissue allows for maximal tissue to be removed and for powerful reshaping of the breast. The superior-medial pedicle provides a consistently healthy tissue base for the nipple and areola. Although there are other pedicle options, we feel this preserves the upper fullness of the breast and cleavage thus creating an aesthetically pleasing natural appearance. This technique is best for women who require more than 500- 800 grams of tissue removal or have a great deal of excess skin.
Vertical Breast Lift:
Another common technique is the vertical breast reduction. This is also referred to as a short-scar or limited-scar breast reduction. This surgery limits the incisions to a “lollipop” type incision. The incision extends around the areola and vertically down. It does not include the horizontal lower breast crease incision. It also preserves the nipple and areola on a superior medial pedicle, preserving the desired upper pole of the breast. This technique is best for women who may need smaller reductions in size and have minimal skin excess. Your Restore SD surgeon will take measurements and have a detailed discussion with you about the best technique for your body and breast type.
Liposuction is the third technique available for reducing the size of a large breast. It is performed through very small incisions and is effective in women who have minimal skin excess and good skin elasticity as well as breast tissue that is soft and not fibrous. Most often liposuction is used as an adjunct to one of the above techniques. It is a great option for addressing those annoying side boobs! Liposuction as an adjunct to breast reduction may not be covered by insurance and your Restore SD surgeon will discuss treatment options with you as part of an individualized plan.
Breast reduction surgery is performed under general anesthesia to offer maximum comfort and safety. We perform all surgeries at an accredited outpatient surgery center or hospital. The surgery usually takes 2 – 3 hours depending on your starting breast size and individual surgical plan. Your Restore SD surgeon will carefully mark planned incisions to properly reposition your nipple and areola and determine the amount of tissue to remove prior to surgery and review the final plan with you to ensure there are no last-minute questions and confirm your goal size. After anesthesia is administered, your surgeon will make incisions and remove the excess breast tissue while carefully preserving the blood supply to the nipple and areola. Once the tissue is removed the incisions will be closed using absorbable suture. There will be no external sutures to remove later. Drains are not typically used unless liposuction was a significant part of the procedure. Surgical dressings are applied and you will be placed in a post-surgical compression bra. At Restore SD Plastic Surgery, your postoperative pain control and comfort are very important to us. We typically use Exparel, a long-acting pain medication, that is injected near the end of surgery and is designed to decrease pain as well as the amount of strong narcotic pain medication needed during recovery.
After surgery is completed you will be able to go home with a responsible adult. Ideally, this loved-one or friend will be able to stay with you during the first few days of recovery. Your breast-related back pain is typically relieved right after surgery but some surgical pain is expected and will be treated with pain medications. Initially, the area around the nipple and most of the breast skin is numb but sensation returns over the next few months. Most women can return to work after 2 weeks. Normal daily activities like showering, eating and light activity such as walking can be resumed within 24 hours after surgery. Some post-operative swelling is normal and generally resolves within the first 4-6 weeks after surgery. You should refrain from intense physical activity for 4 weeks. During the recovery period, you will have follow-up with your Restore SD surgeon and will be guided back to your usual activities. Most complications occur from getting too active too early, so select a surgical date that allows an appropriate amount of time to heal and gradually return to your more vigorous activities.
The Combined Procedures
As mentioned in techniques, traditional breast reduction surgery is commonly combined with liposuction as a means to further sculpt and define your chest. This cosmetic procedure can improve results in the patient with breast tissue and localized fat that extends on the lateral chest wall (side boobs).
Breast reduction surgery can also be safely combined with other body contouring procedures such as abdominoplasty (tummy tuck), liposuction of other body areas, upper arm lift in massive weight loss patients, and fat grafting.
- What happens at my breast reduction consultation?
When you arrive at Restore SD Plastic Surgery to discuss breast reduction surgery, your Restore SD surgeon will perform a detailed examination as well as review your medical history and any medications you are taking. If you are over 40 years of age or have a strong family history of breast cancer a recent mammogram will be requested. At your consultation, you will have photos taken with our Vectra 3D imaging system and discuss treatment areas and options while viewing your photos series. With our state of the art Canfield software, potential surgical results can be viewed and adjustments can be made, helping you to visualize possible outcomes.
- What is the difference between breast reduction and breast lift (mastopexy)?
Breast reduction is a therapeutic operation designed to alleviate symptoms of neck, back, and shoulder pain. Because of its therapeutic nature, it is usually covered by insurance providers. All insurance companies have specific criteria for breast reduction and require a defined weight of tissue to be removed in order to be covered. A breast lift is a cosmetic operation that improves the appearance of the breast but has no intended benefit to alleviate symptoms. The incisions and techniques used are very similar.
- Why should I choose Restore SD Plastic Surgery for my breast reduction surgery?
The surgeons at Restore SD Plastic Surgery have over a decade of experience with cosmetic and reconstructive surgery. Drs. Douglas and Gallus are both board certified by the American Board of Plastic Surgeons and active members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. In addition to being fully credentialed, we take the time to listen to your goals and partner with you to develop the best and safest surgical plan that will optimize your results and leave you looking and feeling your best.
- How do I choose a surgeon for breast reduction surgery?
It is important to ask if your surgeon is Board Certified by the American Board of Plastic Surgery. As Board Certified plastic surgeons at Restore SD, we have years of training and expertise in breast surgery that cannot be imitated by short courses and alternative certifications. Ensure that your surgeon is proficient in breast surgery and capable of handling any complications that may arise. The American Board of Plastic Surgery is one of 23 members of the American Board of Medical Specialties. These specialties represent the traditional core of fully trained specialists. Alternative boards have cropped up over the last several years to lend legitimacy to incompletely trained or poorly trained practitioners. Accept nothing less than a surgeon certified by the American Board of Plastic Surgery and who is a member of the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).
- Can I breastfeed after breast reduction surgery?
Studies have shown that women who have undergone breast reduction surgery are still able to breastfeed at a rate that is similar to women who have not had surgery. If you have a baby after breast reduction surgery, we encourage you to try breast feeding if that is important to you. Pregnancy and breastfeeding have unpredictable effects on breast size and shape so many of the secondary breast reduction surgeries we perform have been done after having children.
- What about my nipples? Are they removed? Will I have sensation after breast reduction?
Nipples are important! They are not removed in most (99%) of breast reduction surgeries that we perform although that is a common question. If your areolas are larger than average (>40-45mm diameter) the areola will be reduced as part of the surgery. The nipple and areolar are placed at the aesthetically ideal point on the chest, which usually means they are lifted as a part of the surgery. When you wake up from surgery, although you will have some post-operative discomfort, most women don’t feel sensation in their breasts. Over the next few weeks to months, sensation to the skin and nipple areolar complex returns. Women with very large breasts can have decreased sensation preoperatively, often this doesn’t change with the surgery. Some women can have permanently decreased nipple sensation after surgery.
- How long do the results of breast reduction surgery last?
Breasts will continue to settle after surgery and succumb to the same gravitational pull we all share on this planet. As you age, your breasts will gradually droop over time although it should be at a decreased rate due to the smaller size of your breasts. Breast volume does not usually change unless there are significant fluctuations in weight or pregnancies. In general, most women enjoy the benefits of breast reduction surgery for many years. Some may want a small cosmetic touch up down the road and some may never require or want any other breast surgery.
- How much time off work should I take after breast reduction surgery?
Depending on your profession, you should expect to take 2-3 weeks off from work. You will not be able to drive while taking narcotic pain medication. You will need a ride home after having general anesthesia and have a friend or family member stay with you for the first night and a day or two if possible.
- How do I minimize post-operative scarring after breast reduction surgery?
Unfortunately, scarless surgery does not yet exist. Your Restore SD surgeons will educate you about scar management postoperatively. A surgical scar will take 9-12 months to fully mature. Your scar will go through changes during the healing process and your Restore SD team will help you manage this part of your recovery. This can consist of sun avoidance (no topless beaches for 9-12 months!) scar massage, scar cream, and fractionated laser treatments.
- What should I do to prepare for breast reduction surgery?
If you have close friends or relatives who have had breast reduction surgery – start there! A personal story of their journey may guide you to questions to ask your surgeon and having someone with a shared experience is invaluable. Educate yourself by reading our procedure page and viewing our educational videos. Other sources of information include RealSelf and WebMd. Remember to wear a button down front-opening shirt on the day of surgery so that your post-operative experience does not include wrestling a shirt over your head!
- I am a smoker – can I have breast reduction surgery?
At Restore SD Plastic surgery, we want to deliver safe, consistent, and reproducible results. Smoking tobacco or using any nicotine products has adverse effects on wound healing. Your risk of nipple loss, infection, and prolonged incision healing are much higher if you use nicotine. We recommend a nicotine free period of 8 weeks prior to surgery and at a minimum 4 weeks post operatively. We have a simple urinary nicotine test that we complete in the office to help you on your journey to a safe and gratifying surgical experience with us.
- I have Diabetes – what do I need to know about breast reduction surgery?
If you have diabetes it is important to work with your medical team to maintain an ideal HbA1C. Diabetes can increase your risk for prolonged wound healing and certain types of infections. Surgery can be safely performed but requires a coordinated effort from patients, surgeons, and medical doctors to attain outstanding results. There are some instances where your Restore SD surgeon may want to postpone surgery until your diabetes is under better control.
- How soon can I travel after having breast reduction surgery?
Having surgery means a commitment to an appropriate recovery. We recommend scheduling your surgery at a time that allows enough time to recover and gradually return to your normal activities. Flying, driving long distances, or leaving the immediate area are not recommended until you have been cleared by your surgeon. If you have specific travel needs or require advice for emergency travel soon after a procedure, please let us know and we will be glad to discuss the details with you.