Reduction mammoplasty (breast reduction) is performed on patients from their early teens through their later years to alleviate the physical problem as well as the psychological burden of large breasts. This operation reduces the size of the breast by removing breast tissue and provides an uplift of the breast itself. This is different than the mastopexy (uplift) which only involves repositioning the nipple and areola higher, reshaping the breast, without removing breast tissue.
Breast reduction and breast uplift surgery overview by John E. Sherman, MD, FACS New York Plastic Surgeon
Indications for Breast Reduction
The patient that seeks breast reduction often complains of back pain, and shoulder pain, as well as breast pain. There are often skin changes in the breast fold due to the constant pressure on the skin. However, the complaints are usually deeper than the skin. Patients who have large breasts that are out of proportion to the rest of the body have limited clothing options, and difficulty exercising. In some patients, this can alter a woman’s self-image.
Age of the Patient
Dr. Sherman has operated on patients from age 12 to age 84 for breast reduction. Among all of our cosmetic and reconstructive patients, they are among the most satisfied with the result of surgery.
In the older patient, the large breast exerts a hanging weight effect, which may make it difficult to breathe and causes severe back problems. In the younger patient, the premature development of the breasts may cause the child to have early difficulty in social settings, because of the self-image problems that are generated. Rarely, massive breast enlargement occurs in the preteen, and surgery is usually recommended.
The breast reduction is usually performed in a hospital as an outpatient, or our fully accredited office-based surgery center. Depending on the amount of tissue to be removed, the operation may take anywhere from 2 to 4 hours. If performed in the hospital, the patient has the ability to spend one night as an inpatient. Dr. Sherman performs this operation at the New York Presbyterian Hospital, Weill Cornell Medical Center, and The Lenox Hill Hospital.
Liposuction and ultrasound liposuction of the breasts
Liposuction alone will not greatly enhance skin retraction after breast tissue is removed. It does however have the advantage of producing virtually no scarring, maintaining nipple sensation, and a relatively easy postoperative course. This type of procedure can be used in a modest reduction and can achieve modest skin retraction.
Breast Reduction Surgery
There are multiple procedures and approaches for a breast reduction. The goal of the surgery is to create a well-proportioned breast while reducing the volume of the breast. There are various techniques that have been described to accomplish the breast reduction. Most involve maintaining the nipple and the areola complex on a pedicle, and transferring this unit to a new position above the breast crease (inframammary fold). Dr. Sherman uses several techniques, depending on the age of the patient, the particular anatomy of the patient, and the goals of the patient.
A free nipple graft is rarely used, and is used when the amount of breast removed is exceedingly large, and the distance that the nipple must be repositioned is exceptionally long. This is usually reserved for older patients or in the case of the preteen with gigantomastia. However, this procedure has the advantage of being shorter in time, and the disadvantage of producing a nipple that is totally devoid of sensation.
The operation can be performed under sedation and tumescent anesthesia, usually not the preferred choice of most surgeons. The breast reduction operations are usually performed under general anesthesia whether in a hospital, or in our office-based facility. Some exceptions may be made.
Although the operation is lengthy, the convalescence is quite limited. Patients are able to return to work in about 5 – 7 days, and resume normal activities in about three weeks after breast reduction surgery. Most patients note that the 1st night there is a modest amount of pain (usually on the pain scale a number 2) that is manageable with medications that are prescribed.
The most commonly asked question is whether patients are routinely transfused during surgery. We have not transfused a patient in over 25 years. Prior to surgery, a complete blood count must be taken on the patient to determine if surgery can be performed without the need for additional blood.
Insurance criteria for breast reduction changes frequently and also may vary from carrier to carrier. In general, if the patient has physical complaints that are referable to the large breasts, and a critical amount of breast tissue is removed, your insurance carrier may reimburse the cost of the procedure. Again, documentation must be made of your physical complaints related to large breasts. This documentation often consists of physical therapy, visits to the chiropractor, and visits to a dermatologist to see if there is skin breakdown below the large breasts.
Our office manager will help you contact your insurance company to help your predetermination of benefits.
Complications are not frequent following breast reduction mammoplasty. Scars may be minimal or noticeable, but certainly are present.
- Nipple sensation may also be diminished or lost,
- wound healing problems including blood supply to the nipple
- Inability to breast-feed
Dr. Sherman will discuss all potential complications with you concerning breast reduction mammoplasty at the time of consultation.
Dr. Sherman does not perform this operation on cigarette smokers. Most of the potential complications are related to cigarette smoke and nicotine. If you are a smoker, you should stop for at least one month prior to surgery. Nicotine patches are not a substitute, and do not significantly diminish the risk of complication.