A vertical incision is made on the breast and around the NAC (like a lollipop). This incision pattern can be used with all grades of ptosis.
What Is Breast Reduction Surgery?
Breast reduction is removal of excess breast tissue and skin to reshaping of the breast to relieve discomfort due to overly large breasts. The results are a smaller and lifted breast that is more proportional to your body.
Variations of the Procedure
Breast reduction surgery, also known as reduction mammoplasty, is a procedure to remove excess breast tissue and skin from overly large breasts. The results are a breast that is proportional to your body and more lifted.
Reducing large breasts is more than improving the look of your breasts. You may have physical pain and discomfort in the neck and back. Posture can be affected, it may be difficult to wear certain clothing or find bras that fit and are supportive enough, and you may have dents in your shoulders from bra straps. You may also have frequent rashes under and/or between the breasts. If the discomfort is directly due to the weight of your breasts, a reduction will help relieve this pain.
The limitations of a breast reduction is that it will lift the breast but it will not fill out the superior pole (upper) of the breast. A breast reduction will give you a smaller version of the breasts that you already have.
During your consultation you may hear your surgeon discuss a “pedicle”. A pedicle is the tissue of the breast that is left behind and that supplies blood flow to the nipple. The main two types of pedicles are a superomedial pedicle and an inferior pedicle. The choice of pedicle is based on your anatomy and on surgeon preference.
The nipple and areolar are kept for most breast reductions. For patients with excessively large breasts or in a redo-breast reduction, it may require a free nipple graft. A free nipple graft is where the nipple and areola are removed from the breast tissue underneath and placed in its new position as a skin graft.
How is the Procedure Performed?
Breast reductions are performed in a surgical center or hospital under general anesthesia with licensed anesthesiologists. The technique used for your breast reduction is determined during your pre-operative consultation with your surgeon and depends on the size and shape of your breasts. The length of the surgery also depends on the size and shape of your breasts. All of your incisions are closed with sutures that dissolve so you will not have to remove any sutures after surgery. You can usually go home the same day after the surgery.
For medically indicated breast reductions where a large amount of tissue is removed or if you have medical conditions, you may need to stay overnight for monitoring. Some patients require the use of drains after surgery. This will be discussed before your surgery. You will be placed in a compression garment after your breast reduction which you will need to wear for the first 6 weeks. It is recommended that you do not wear any bras with an underwire until 3 months after surgery.
Limitation, Risks, and Complications
Risks of the procedure include allergies to tape, suture material, skin ointments, or injected medications, bleeding, blood clots, breast asymmetry, contour and shape irregularities, changes to nipple or breast sensation, seroma (fluid accumulation), poor scars, partial or total loss of the nipple and areola, skin changes, firmess or lumps in the breast tissue scar, poor wound healing, pain, and infection. After breast reduction surgery, you may need small revisional surgeries. All breast tissue that is removed is sent for evaluation by the pathologist to check for breast cancer cells.
What to Expect During Your Consultation Visit
During your initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion. If you have pictures of how you would like your breasts to look after surgery, please bring them and have them easily available.
Once we identify your concerns and surgical goals, we will discuss all of the treatment options that are available to you. Every patient is unique and we will develop a tailored surgical plan that addresses your specific goals. In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details such as your family breast cancer history. It is very important that we obtain accurate information in all of these areas as it may impact the outcome of your surgery. If you have had a recent mammogram or other breast imaging, please have it sent to the office prior to your first appointment with your surgeon.
While discussing different treatment options, we will examine your breasts and take measurements of your breasts and evaluate your skin quality and the location of your nipples and areolas to help us plan your surgery. Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.
After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.
Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.
Breast Reduction FAQs
Am I a good candidate?
Good candidates for breast reduction are in good health and do not smoke. It is also important to have realistic expectations for the surgery. A breast reduction will change the way that you hold your body, the way clothing fits, and will change your outward appearance. A medically indicated breast reduction will make your breasts smaller so if the goal is for the breast to be more lifted and not smaller, a breast lift is a better option.
What is the difference between a breast lift and breast reduction?
A breast lift (mastopexy) lifts the breast while a breast reduction reduces the size of the breast and lifts it. If you are happy with the size of your breasts in a bra but would like for them to be lifted, a breast lift would be the best procedure to address this. The scars are similar between the two procedures because most of the differences in the surgery occur under the skin.
How do I know what type of breast reduction is right for me?
The type of reduction you should undergo is dependent on the shape and size of your breasts. In general, the more skin and breast tissue that has to be removed, the more extensive the incisions. During your consultation, your surgeon will discuss all the options and give you recommendations.
Will insurance cover my reduction?
This is dependent on the benefits of your insurance plan. In general, if you have a documented medical reason for having a breast reduction and have a large amount of breast tissue to remove are reasons for a medically-indicated breast reduction. Usually this requires a referral from your primary care doctor.
Can you reduce the size of my areolas?
Yes! This is part of the procedure. The average width of the areola is about 4cm and we will reduce the areola to this size. We do not do any changes to the nipple.
How young is too young for a breast reduction?
This depends on many factors. It is best to wait until the breasts are fully developed, but if excessively large breasts are causing significant emotional and physical distress, we can do the breast reduction at a younger age.
What if I gain or lose a lot of weight?
Extreme weight gain or weight loss may cause changes to the breasts, leading to changes in your results. If you are planning to lose a lot of weight, you should wait until your weight has stabilized for at least 6 months. Also, if you are in your child-bearing years and are planning to have children soon, it is best if you wait to have a breast reduction if you can. Your breasts will change during pregnancy and that may result in permanent changes to your breasts.
Will I be able to breastfeed after breast reduction surgery?
There is a risk that you will not be able to breastfeed after surgery. If you require a large reduction that needs nipple grafts, you will not be able to breastfeed.
What is the difference between a plastic surgeon and a cosmetic surgeon?
A plastic surgeon is a surgeon that has gone through accredited surgical training. Dr. Shah and Dr. Farber are both board-certified in plastic surgery by the American Board of Plastic Surgery. This means they have completed accredited plastic surgery training and have undergone rigorous quality and safety evaluation including written and oral exams. The American Board of Medical Specialties (ABMS) recognizes the American Board of Plastic Surgery as an approved medical specialty board.
Cosmetic surgeons may or may not have official surgical training and are not trained in an accredited plastic surgery program. The ABMS does not recognize any boards with “cosmetic surgery” in its name. While there may be cosmetic surgeons that are able to produce consistent and safe results, there is no board-certification standard that can assure that a cosmetic surgeon is competent in the procedure performed.