One of the most satisfied patients in plastic surgery is the one who has had a breast reduction. People who don't have large breasts don't understand the tremendous inconvenience and pain associated with them. The average person thinks that large breasts are a blessing; something that most women want. Little did they know that large breasts can actually be a significant handicap. Often, they prevent the woman from wearing normal clothing, cause back and neck pain, make it difficult or impossible to exercise, and a whole host of other problems.

After a breast reduction, the patient feels as if a burden has literally been lifted off of her shoulders. Gone are the bra strap marks across the shoulder, the rashes, and the burden of carrying around all that extra weight. It is a tremendous relief.

Not uncommonly, the patient with large breasts can also be overweight. It is best for these patients to try to lose as much weight as possible for several reasons. Not only because losing weight is healthy but because it makes the operation technically easier. Another reason is that an insurance company may not pay for a breast reduction in a patient who is significantly overweight. Often, an insurance company will refuse to pay anyway and the patient is forced to pay for it herself. The only way to find out is to have the procedure pre approved prior to the operation. It is safe to say, though, that if the procedure is mostly cosmetic, insurance will not pay for it.

There are several ways to perform a breast reduction. Most experienced plastic surgeons advocate the short scar breast reduction. This type of breast reduction is somewhat more technically difficult but has the huge advantage of leaving a shorter scar and it also creates more breast projection and cleavage.   It is important to point out that this procedure is not just a reduction procedure but it is a cosmetic procedure as well, or at least it should be. Breasts are very important to most women and it is important to add an artistic quality to the reduction so that a sexy, feminine result is obtained.

Despite the fact that many doctors have the ability to perform breast reduction with a shorter than normal scar, a scar is inevitable. The scar goes completely around the areola and then travels down the breast to the level of the fold underneath the breast. If your breasts are exceptionally large a short scar within the fold may be necessary. This is very unusual. The scar usually becomes quite red the first 2 months after the operation but fades within 1 year. The patient considering breast reduction must be prepared to accept the scar as a trade off for lighter, perkier, more attractive breasts. The reality is, these scars are not noticeable even when wearing highly revealing clothes.

Benefits

The benefits of breast reduction are physical, mental, and cosmetic. If done properly, breast reduction can simultaneously remove excess breast tissue and provide you with breasts that you can have a pride in instead of a burden. There are many reasons for breast reduction. Here are a few.

• Reliefs back and neck pain.
• Reliefs rashes underneath the breast.
• Reduces weight so that exercise and other activities are easier.
• Improves breathing and bad posture.
• Removes shoulder grooving from bra straps.
• Makes clothes fit better.
• Repositions nipple into a more youthful location.
• Provides a breast lift as well as breast reduction.

Are you a good candidate?

In general, patients that are good candidates for breast reduction know it before even reading this web site. They are plagued with the problems outlined above. Quite often the biggest question is whether a breast reduction or a breast lift is needed. Both procedures involve lifting and shaping the breast. The reduction also involves removal of a significant amount of tissue as well. This will be evaluated during your consultation. Usually, however, the patient knows whether or not the procedure is a cosmetic one. In order to qualify as a breast reduction, the insurance company usually requires a certain amount of breast tissue be removed.

Here is a summary of problems plagued by patients who need a breast reduction.

• Do you have back or neck pain caused by large breasts?
• Do you have persistent rashes below the breasts?
• Are you unable to exercise because of your large breasts?
• Do you have grooves in your shoulders from bra straps?
• Are your breasts way out of proportion to the rest of your body?
• Are your breasts large and droopy?
• Are you self-conscious and/or unhappy about your large breasts?

If you answered yes to any of the above questions a breast reduction is probably worth while.

Possible complications

The most common complication after breast reduction is asymmetry. It must be pointed out, however, that all breasts have some asymmetry. A breast reduction, in fact, can do a lot to correct asymmetry but it is unreasonable to expect both breasts to be exactly identical.

Another potential complication is inadequate reduction or over reduction. Your doctor should spend a great deal of time before the operation finding out exactly what size you would like to be to avoid this. Some women would like to be as small as possible. There is a limit to how small they can be made without compromising blood supply and safety.

A complication that has already been discussed but must be emphasized is really not a complication. It is the fact that a scar is a requirement in order to achieve breast reduction. Over time the scar will fade but will never go away completely.

After breast reduction, there is a significant likelihood that breast-feeding will not be possible. Also possible is the loss or a decrease in sensation to the nipple. Usually sensation does return but this cannot be guaranteed. Other complications that must be considered, but are possible with any operation, are the risks of infection, wound healing problems, fluid or blood collection, and contour irregularities.

Do's and Don'ts prior to surgery

• Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within three weeks of surgery. Your doctor will go over this more thoroughly prior to the procedure.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help you sleep.

• Smoking. It is important that you do not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. It also affects your airway, therefore, making anesthesia much more difficult.

• Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. Please discuss all medications with your plastic surgeon and the anesthesiologist.

• Washing. It is a good idea to wash the surgical area thoroughly the night before and the morning of surgery. This includes cleaning crevices such as the belly button and any folds in an effort to prevent infection.

• Arrival. It is best to arrive on time so everything goes smoothly. Please be sure to have someone else drive you home.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly concerned. Excessive worrying can actually be detrimental and you should discuss this with your doctor prior to surgery so that something can be prescribed to make sure you remain calm.

Anesthesia

The anesthesiologist will discuss with you what type of anesthesia is best for you prior to the procedure. He/she will take into consideration your medical history, the procedure, and your personal wishes.

Normally, general anesthesia is required when performing breast reductions to make sure the patient is completely comfortable throughout the procedure.

After the procedure

The procedure itself will take about 3 hours.  

Immediately. You will immediately notice a big difference in breast shape and size. Right after the operation you will be watched for 1 or 2 hours and encouraged to walk around. You will be given as much pain medication as necessary both immediately after the operation and for the entire post operative period. You may have tape around your breasts as well as a surgical bra on. Most likely you will have drains to prevent fluid from collecting under the skin. They will be removed at your first post operative visit. You may wash the surgical bra as necessary.

That evening. It is recommended that you take it easy. You can walk around, eat, but not too much more. It is very important not to move your arms too much so that bleeding is not started. Aggressive arm movements should not be done within the first 4 weeks after the procedure. You should take as much pain medication as necessary and try to go to sleep early. It is best if you sleep with your head and chest slightly elevated to promote proper lymphatic drainage

First 48 hours.  You can take a shower the day after surgery. Just be gentle. Take the surgical bra off and just let the water run over your breasts. Do not move your arms much. When you are done with the shower put the bra back on. The incisions will continue to ooze for about a week, therefore gauze will be necessary. Do not worry about the drains. Just pin them back to your bra so they are supported. We will show you this prior to leaving. Be sure to take your antibiotics.

First week. At about day 3 you can move around normally. Just continue limiting movements of your arms. The bruising and swelling will go away in about 2 to 3 weeks. Your first postoperative visit will be 1 week after the procedure. Your drains will be removed at this time.

Beyond. Swelling will not completely resolve for about 6 months but the majority of it will be gone by 3 weeks. You can start moving your arms aggressively at 6 weeks at which time you can start working out with your arms. The scar will look the worst at 6 to 8 weeks but it will fade over time.

Recovery time

Some people with sedentary jobs go back to work after 1 week. If your job, however, requires aggressive arm movements it may take as long as 4 weeks to return to work. Most people return to work after 2 weeks.