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Breast Reduction

What Is The Procedure For Breast Reduction Surgery?

Last modified: 
20/03/2012 - 12:25

Contributing Author: Guy Slowik FRCS

How To Prepare For Breast Reduction Surgery

A woman who is considering breast reduction surgery should consult a plastic surgeon. She should talk openly with the doctor about her reasons for wanting a breast reduction and what she expects from the operation.

The surgeon will describe the procedure in detail, and discuss the possible complications, as well as what surgery can and cannot achieve. Breast reduction surgery does leave scars, but they can usually be covered by clothing or a bathing suit.

First Consultation With The Surgeon

At the first meeting in the office, the plastic surgeon will

  • conduct a complete physical examination and take a medical history
  • examine and measure the breasts
  • photograph the breasts (These photographs can be used for reference during and after the operation. They may also be useful in placing a health-insurance claim.)

Nice To Know:

Q. Is breast reduction surgery covered by insurance?

A. If the procedure is deemed medically necessary because of neck or back pain, some insurance plans will cover it. They usually require that a minimum amount of fat be removed to qualify, often in the range of 500 grams (the equivalent of 1.1 pounds), depending on height and weight. The doctor usually must write a "predetermination letter" to the insurance company beforehand to confirm that it will be covered.

A woman whose breasts become tender just before her period should be careful not to schedule her consultation appointment at that time.

Most women are advised to have a mammogram or breast x-ray before the surgical procedure. Because the size, shape, and mass of the breast will be changed, it is also advisable to get another mammogram six months to a year after the procedure.

The doctor should also discuss individual factors that might influence the decision to have the procedure, such as age, previous plastic surgeries, and the condition of the breasts. The doctor will explain where the surgery will be done and what kind of anesthetic will be used.

Nice To Know:

Q. I am thinking of having breast reduction surgery but I'm not sure how to go about finding a good surgeon. How do I find a qualified plastic surgeon?

A. Professional organizations, such as the American Society of Plastic Surgeons, can provide a list of certified plastic surgeons practicing in your area, but word of mouth is sometimes best. Ask women who have had breast reduction surgery how they found their surgeon and whether they were happy with the results. Primary care physicians can also make recommendations. Check a surgeon's experience and credentials. Most public libraries carry the Directory of Medical Specialists, a reference that can be used to check the credentials of any referred physician.

It is also acceptable to ask surgeons directly about their qualifications, the number and complication rates of breast reduction surgeries they have performed, and the cost of the surgery. These questions should be addressed at the first consultation.

Nice To Know:

Q. I'm thinking of having breast reduction surgery, but I'm worried about breast cancer. Will breast reduction make it more likely that I will develop breast cancer?

A. No. The operation does not increase the risk for cancer, nor does it interfere with routine screening techniques for finding breast lumps later. In fact, some women may find that having mammograms is easier after breast reduction, and lumps may be easier to find when breasts are less massive.

The tissue removed during reduction surgery will be examined under a microscope for signs of cancer, so in some ways, the operation itself is like a giant biopsy. Fat removed by liposuction is also examined under a microscope. Recent studies have shown that women who had breast reduction surgery actually had a slightly lower rate of breast cancer than did other women.

Coincidentally, the same study found that women who had the operation also had somewhat lower rates of lung, cervical, and digestive cancers.

Nice To Know:

When a woman is thinking of having nose surgery, the cosmetic surgeon often uses computer imaging to show her what her nose will look like after the procedure. This type of computer imaging isn't used with breast reduction surgery. Instead, the desired size of the breast and areola are decided during a discussion between patient and surgeon.

Preparing For The Operation

Breast reduction surgery is usually done in the hospital, and the patient is usually asked to arrive about an hour before the procedure is scheduled. She will be given a general anesthetic, which means that she will sleep through the entire operation. The procedure usually takes from two to four hours and requires an overnight stay in the hospital.

  • Patients are usually given guidelines about eating and drinking before the surgical procedure. They are generally asked not to take aspirin, ibuprofen, vitamin E, gingko biloba, or other medicines and supplements that thin the blood during the two weeks before the operation.
  • A patient who smokes may be asked to stop for a period of time before the operation. Smoking reduces the amount of oxygen available to body tissue and, as a consequence, slows healing and increases scarring. Women who are heavy smokers are sometimes advised not to have the procedure because of poor blood supply to the skin.
  • On rare occasions when a great deal of breast tissue is removed, blood transfusions may be required during or after the operation. Some patients may be advised to have their own blood drawn and "banked" before the operation in case a transfusion is needed.

Nice To Know:

If you intend to lose weight, it may be best to do it before having breast reduction surgery. Weight loss after the procedure may cause the breasts to lose mass and droop.

The Operation

The most frequently used breast reduction procedure is performed through an incision that circles the areola and passes down the lower central part of the breast; then curves sideways in the natural skin crease at the base of the breast. The incision is shaped somewhat like an anchor, so it is called an "anchor shaped incision"

  • Excess tissue, fat, and skin are removed through this incision.
  • The nipple and areola are moved into their new position.
  • The skin that was once above the nipple on both sides of the breast is brought down and around the areola, giving the breast a new shape and contour.

In most cases, the procedure leaves the nipples and areolas attached to their blood vessels and nerves. But if the breasts sag very low and the skin and tissue supporting them is stretched, the surgeon may have to remove so much tissue that it will be necessary to cut the nipples and areolas completely away from the breast. After the removal, the nipple and areola are grafted back onto the breast in a higher position. When the nipple and areola have to be moved in this way, the patient is likely to lose feeling in them.

The incision is closed with stitches. Depending on the amount of bleeding, a small drainage tube may be left in the wound that will be removed in a day or two.

  • The operation is usually performed with general anesthetic, which means it takes place in an operating room while the patient is unconscious.
  • Usually an overnight stay in the hospital is all that is necessary.
  • Some cases may require as long as five days in the hospital.
  • Some patients will be able to go home the same day.

If the breasts are not too stretched, reduction can sometimes be done by liposuction, a technique in which fat is sucked out of the breast through a tube attached to a vacuum. Liposuction, which can be done through tiny incisions, causes very little scarring and allows faster recovery. However, because the breast is not repositioned, it may sag more after fat is removed.

Sometimes liposuction is used along with reduction surgery to remove fat from around the armpits.

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Breast Reduction

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.