Woman that needs breast reduction surgery rubbing her painful back

Breast Reduction Surgery: Top Things To Know In 2021

Surgeries

What Is Breast Reduction Surgery?

Breast reduction surgery reduces the cup size and overall weight of the breast and has the added benefit of lifting the breast to a more youthful, “perky”, and aesthetically pleasing position on the chest. There are many benefits to breast reduction surgery.

Benefits Of Breast Reduction Surgery
decreased back and shoulder pain
decreased breast pain associated with stretched nerves
relief of rashing under larger, sagging breasts
more proportionate breast for body type
improve symmetry by reducing the larger breast more
reduced areolar size to fit the new, smaller breast size
lifted breasts, increased “perkiness” and firmness
physical activity and exercising easier to do
easier to fit into standard bras and clothing styles

To qualify as a good candidate for breast reduction surgery you should have relatively large breasts for your body type (generally C-cup or larger), be in stable or good overall medical health, and have medical issues related directly to large cup-size including:

  • back pain
  • shoulder pain
  • neck pain
  • breast pain
  • skin rashes in the breast folds
  • bra-strap pain and grooving

Who’s Not A Candidate For Breast Reduction Surgery?

Even if you meet the above criteria, you may not be a good breast reduction candidate if:

  • you are on blood thinners that you can’t stop for medical reasons
  • you are anemic
  • you have significant medical conditions like and unstable heart condition
  • you smoke cigarettes

Smokers are considered particularly risky candidates for breast reduction surgery because of the effect that nicotine has on the blood flow to skin can interfere with proper healing of a breast reduction and lead to severe wound breakdown, skin loss, and even loss of the tissue that makes up the nipple and areola. Many reputable surgeons completely exclude cigarette smokers from breast reduction surgery candidacy.

Hand hold a lit cigarette with smoke coming off
Smoking can cause devastating healing complications with breast reduction

Preparing For Surgery:

Preparation for breast reduction surgery includes:

  • a routine check-up with your primary care physician to ensure stable overall health
  • blood work and other tests to rule out underlying health issues
  • a mammogram, if you haven’t had one recently
  • discontinuation of blood thinners such as Aspirin, Coumadin, Xeralta, and others (these medications should only be discontinued with the approval of your physician)
  • ceasing all nicotine inhalation for at least 6 weeks prior to breast reduction surgery
  • ensuring that you have at least a few days of support at home for a significant recovery process

Breast Reduction Surgery Cost:

Breast reduction surgery costs will depend on obtaining coverage for the procedure through your insurer. In the United States and Canada, breast reduction surgery can be covered by health insurance once a patient meets the threshold of confirming that the procedure is required for medical reasons. Your surgeon and insurer will need to work together to obtain approval for your breast reduction coverage. The process is generally quite straight forward in Canada and includes an application, provided by your doctor, to the provincial ministry of health. In the United States, the process can be more lengthy and convoluted and can vary significantly depending on your insurer and your policy. Here’s a snapshot of what the process generally looks like in the USA:

  • first, contact your insurer to make sure that breast reduction is not absolutely excluded from your coverage
  • prepare for your consultation by documenting which health problems you feel having large breasts is causing you so you can report these to your surgeon
  • your chosen surgeon will use your consultation in part to determine if it is their professional opinion that your breast size is the cause of medical/health problems
  • if deemed a candidate for insurance coverage, an application will be made to your insurer
  • the above process can take months from start to finish

What If Insurance Coverage Is Denied?

If you are denied coverage by your insurer, there is generally an appeal process in which supporting documentation from other healthcare providers can be very useful. This includes documentation regarding neck and back pain from physical therapists, orthopedic specialists, and dermatologists that can back-up the general concept that large breast volume is the cause for health issues. If you have already seen healthcare specialists about problems that you feel are related to your large breast size, having copies of supporting documentation from them on-hand when you visit your surgeon in consultation can be very valuable in terms of obtaining insurance coverage on an expedited time frame.

In the case that you are unable to obtain insurance coverage, breast reduction cost will be in line with many other substantial body contouring procedures with a range somewhere around $5,000 on the low end up to $15,000 or more on the high end depending on factors such as geographic location and the popularity of your chosen surgeon. Recent data from the American Society of Plastic Surgeons indicates an average cost of breast reduction of $5,475 in the United States, but additional fees including anesthesia and others are sure to bring the total cost up by a thousand dollars or more.

IN THE USA, BREAST REDUCTION COST IS OFTEN COVERED BY INSURANCE IF DEEMED MEDICALLY NECESSARY

The Breast Reduction Process:

All but the most minor, small volume, breast reductions are done under general anesthesia. The procedure is done either in a hospital or private clinic operating room. Your surgeon will typically take measurements of your breasts and make skin markings on your chest just prior to surgery:

The surgical breast reduction process involves the following steps:

  • removal of skin, fatty tissue and breast tissue that make up the breast volume (in accordance with the markings drawn on your breasts)
  • adjustment of the nipple and areola to a higher position on the chest wall
  • careful cessation of bleeding
  • formation of a smaller, lifted, and firmer breast shape by closure of the surgical incisions using layers of stitches and/or skin staples

(WARNING: GRAPHIC MEDICAL CONTENT)

Breast Reduction Technique. WARNING GRAPHIC MEDICAL CONTENT (video credit: Dr. Ariel Rad)

Breast Reduction Surgery Techniques:

There are three main variations of breast reduction techniques:

Liposuction Alone

With this technique, incisions are very minimal because breast volume reduction is accomplished by means of liposuction alone. Small (about 1/4″) incisions allow introduction of the liposuctions cannula which suctions tissue out of the breast to reduce its size. Candidacy for this type of breast reduction is limited. You may be a candidate for a breast reduction by liposuction alone if:

  • you only need minimal volume removed
  • your breasts have good skin tone and are sagging minimally (generally younger patients)
A candidate for liposuction only breast reduction surgery
Moderate breast size with minimal sagging can be a candidate for liposuction-only breast reduction

Lollipop, Vertical Technique

This technique uses two incisions on each breast: one around the perimeter of the areola and another extending from the 6 o’clock position of the areola vertically down to the breast fold. This procedure has become increasingly popular over the past couple decades because it doesn’t involve a breast crease incision making overall scarring less, and possibly reducing recovery time and wound healing complications. Many patients find the initial shape of the breast “top-heavy” and the vertical incision often appears very pleated and bunched. With time, both breast shape and incision line pleating reliably improve, making the lollipop breast reduction a very popular technique among plastic surgeons. Good candidates for a lollipop or vertical breast reduction have breasts that need:

  • moderate to large volume reduction
  • moderate to significant lifting
A candidate for lollipop breast reduction surgery
Large breast size with moderate sagging can be a candidate for a lollipop breast reduction

Anchor-Pattern, Inverted-T Technique

Three separate incision lines are used to perform this breast reduction technique which together form a pattern resembling and anchor or inverted “T”. These incisions are around the perimeter of the areola, another extending from the 6 o’clock position of the areola vertically down to the breast fold (similar to the lollipop lift) and a third incision line horizontally across the breast fold. This type of breast reduction is generally done for patients that:

  • have large to very large breasts needing major reductions
  • have very significant sagging of the breasts
A candidate for anchor pattern breast reduction
Very large breasts with major sagging usually need the anchor-pattern breast reduction

Breast Reduction Recovery:

Breast reduction recovery usually takes 4 to 6 weeks when healing goes smoothly and without complications. Larger-volume reductions may take longer to recover fully. Most breast reduction surgeons will send patients home the same day as the surgery. Patients with pre-existing conditions may benefit from an overnight stay in the hospital or surgical facility.

Patients will usually go home with soft dressings on the breasts and possibly a sports-type bra on. A prescription for pain killers and antibiotics is usually provided upon discharge home. The first few days after surgery can be uncomfortable and your use of the shoulder and arm area may be limited by discomfort making getting out of bed, eating, and self-care difficult to do alone. Showering can usually begin after around three days, but your surgeon will usually have their own protocols for this and other aspects of the recovery period. Most patients will feel much more themselves after about 1 week with range of motion around the shoulders, chest, and arms increasing dramatically over the first 7-14 days. Jobs that are more physically intensive and exercising may need up to 6 weeks before being resumed fully.

RESUMING STRENUOUS PHYSICAL ACTIVITY TOO EARLY CAN LEAD TO WOUND HEALING COMPLICATIONS AND POOR SCAR OUTCOMES

Breast Reduction Side Effects:

Breast reduction is a significant surgical procedure with up to a 95% satisfaction rate. As with every surgery, breast reduction can have side effects and complications. Larger volume breast reductions in patients that are quite overweight or have pre-existing medical conditions or are smokers are more at risk for complications. A simplified way to understand breast reduction side effects is to look at them as cosmetic and non-cosmetic:

possible cosmetic breast reduction side effectspossible non-cosmetic breast reduction side effects
unsatisfactory breast shapeanesthesia complications and side effects
pigmentation changes to the breast skinhematoma (blood collection after surgery that may need urgent treatment)
breast asymmetrybleeding during surgery
nipple-areola asymmetry or malposition on breast moundloss of sensation to the breast and/or nipple and areola (temporary or permanent)
unsatisfactory scarring delayed healing
loss of portions of skin around the incision lines (more common in large volume reductions and in smokers)
partial or complete loss of the nipple and areola (more common in large volume reductions and in smokers)
deep vein thrombosis (blood clot)
inability to breast feed

Revisions:

The most common breast reduction side effect that leads to a revisionary procedure is unsatisfactory scarring. Most breast reduction techniques involve a substantial amount of scar length which can degrade the perceived esthetic outcome of a breast reduction if poor scarring such as hypertrophic, keloid, or widespread scars develop. One study published in the prestigious plastic surgery journal, Plastic and Reconstructive Surgery, has reported up to a 15% incidence of thick, red, and raised hypertrophic scars, particularly with anchor-pattern procedures.

Breast Reduction Scars:

Breast reduction scarring is truly a case where both quantity and quality play major roles in overall scar outcomes. The number of incisions used is one factor, but the quality those incisions heal with is equally, if not more important. As with all surgical procedures, a complex array of variables including skin tone, ethnicity, and others contribute to an individual patient’s likely scar outcomes. Additionally, the technique of surgery and post-operative healing also contribute to final scar quality. Take some time to read our article on scars from breast reduction surgery to learn a lot more about this crucial aspect of breast reduction surgery.

Breast Reduction Before And Afters: How To Use Them

Breast reduction before and after photos can be very useful to gain insight into your potential breast reduction results if used correctly, but can also be deceiving when they are not. Results with respect to scar quality, breast shape, breast volume, and symmetry depend very much on characteristics specific to a given patient going into surgery including skin quality, pre-operative breast size, and degree of sagging. As such, focus on before-photos that most resemble your body type, breast size, and degree of sagging when considering which breast reduction before and after photos most likely pertain to you.

WHEN BROWSING BEFORE AND AFTER BREAST REDUCTION PICTURES, LOOK FOR PATIENTS WITH SIMILAR BREAST VOLUME AND SAGGING QUALITIES TO YOURS

Conclusion:

Breast reduction surgery is a popular surgical procedure both because of the lifestyle improvements it provides and the aesthetic benefits it provides. The satisfaction rate for the procedure has been reported to be as high as 95% amongst patients that have undergone and healed from the procedure. The procedure is also covered by many insurance plans for individuals that can show that the procedure is being done primarily for medical reasons such as back pain, neck pain, and shoulder pain. Breast reduction surgery places a significant number of incisions on the breast in most cases. People that are averse to the idea of any scarring on the breasts or who have a history of forming problematic scars such as keloids may not find the procedure as satisfying.

Medical References:

Schumacher HH. Breast reduction and smoking. Ann Plast Surg. 2005 Feb;54(2):117-9. doi: 10.1097/01.sap.0000146878.14207.9d. PMID: 15655457.

Shermak MA, Chang D, Buretta K, Mithani S, Mallalieu J, Manahan M. Increasing age impairs outcomes in breast reduction surgery. Plast Reconstr Surg. 2011 Dec;128(6):1182-7. doi: 10.1097/PRS.0b013e318230c467. PMID: 22094737.https://pubmed.ncbi.nlm.nih.gov/15655457/

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