Breast Reduction

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.

There are multiple techniques for breast reduction surgery:

Vertical breast reduction
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.
Inverted T scar
This uses the traditional Wise (anchor) pattern which is also used for breast reductions. This is good for severe droop and size of the breast and for patients with poor skin quality.
Liposuction only
In patients who have little excess skin, good shape and lift of the breasts, good skin quality, breasts with mostly fatty tissue, and are looking for a small reduction in size, liposuction only may be an option. Liposuction can also be combined with a regular breast reduction to reduce the amount of fatty tissue to the side of the chest and to shape the breast. Liposuction is usually not covered by insurance.

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.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

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.

How to Prepare for Your Surgery

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications before your surgery:

Medications with generic names that end in “-pril”, “-sartan”. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon will make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze or ointment over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery. More specific instructions will be provided during your pre-operative visit.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

temperature greater than 100.5 F
bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
increasing pain that is not controlled on oral pain medications
increasing redness or size at the surgical site
your drain is not holding suction
if your incisions come apart
Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

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.

What other procedures can be done with a breast reduction?

Other procedures like a Mommy Makeover that already includes a procedures like a Tummy Tuck and liposuction.

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio and Austin area, and our friendly team members are here to help you and will reach out promptly.

References

Meet Our Surgeons

Dr. Amita Shah

Dr. Amita Shah is a double-boarded Plastic and Reconstructive Surgeon. She specializes in breast and body aesthetic and reconstructive surgeries including microsurgical procedures such as the DIEP flap. She is also a general plastic surgeon that operates from head to toe for aesthetic procedures and cancer and trauma reconstructions. Dr. Amita Shah is known for her innovative approach to plastic surgery, incorporating the latest techniques and approaches to achieve the desired outcomes for her patients.

Professional affiliations:
Membership in American Society of Plastic Surgeons
American Medical Association
American Burn Association
American College of Surgeons, Fellow
Texas Medical Association and Bexar County Medical Society
Plastic Surgery Research Council
Candidate member of the American Society of Aesthetic Plastic Surgeons

Learn More About Dr. Shah »

Dr. Scott J. Farber

Dr. Scott J Farber is a board certified, fellowship-trained Plastic and Reconstructive Surgeon with a sub-specialty in Cranio-Maxillofacial aesthetic and reconstructive plastic surgery. He is one of only two surgeons in the San Antonio area with this specialized fellowship training. Besides having impeccable surgical acumen and technical skill, Dr. Scott J Farber has a natural eye for beauty and balance — an instinctual talent that cannot be taught.

Professional Affiliations:
American Society of Plastic Surgeons
American Society of Aesthetic Plastic Surgeons
American College of Surgeons
Association of Military Surgeons of the United States
Texas Medical Association and Bexar County Medical Society

Learn More About Dr. Farber »