Aaron Stone M.D.

Dieting & exercise unless they are performed in excess to affect hormone levels will have little or no effect on breast gland volume. Though they may lead to a decrease in overall body fat they cannot spot reduce breast size and cannot lead to a consistent decrease in breast size in all cases. Different surgical procedures can be used to reduce breast size depending on a specific patient’s needs and the surgeon’s experience. Since the very large breast can give rise to multiple medical problems surgical breast reduction may be covered by health insurance. It is not a cosmetic procedure per se. In order to have health insurance cover the surgery you need to read your policy and plan to fulfill the coverage criteria over the number of months stated in the policy. This will likely require doctors’ visits to treat rashes, physical therapy for back pain, possibly a mammogram etc. and these will need to be documented in your medical records.

In breast reduction or reduction mammoplasty the surgical procedures used employ an incision around the nipple possibly with an incision along the skin crease under the breast. Circumareolar or donut breast lifts and circumareolar breast reductions can only be performed to lift the nipple about 3cm. If you try to do more the outer donut circumference becomes too much greater than the inner donut circumference. This leads to a corrugated skin surface around the nipple-areola complex that can be quite disfiguring. It will also flatten the breast peak in the front to back direction. For elevation in the 3 to 6cm range a vertical incision/scar under the nipple areola complex is required to take up this excess skin (lollipop approach or vertical scar excision). For even greater elevation of the nipple another incision must be made along the infrabreast crease (anchor or inverted T approach) to avoid leaving corrugated skin at the midpoint of this crease which is also unsightly. Severe corrugation can also create healing problems.

Liposuction has been used for breast reduction but is only of use if the excess breast tissue is composed mostly-entirely of fat (which is not always the case) and the skin is sufficiently elastic to shrink after liposuction. This skin only exists in younger patients who incidentally have more breast gland tissue than breast fat tissue. Liposuction also damages the tissue so that it may not be possible for a pathologist to examine the removed tissue in the search for possible cancer cells.

Both cases were performed using the anchor or inverted T and inferior pedicle approach. This approach can give a good result in an African American as well as a blonde haired blue eyed individual.

Read Dr. Stone’s blogs about breast surgeryTypes of Breast Lift – Mastopexy
Fat Injections to Reconstruct Breasts or Increase Breast Size
Massive Weight Loss and Breast Reduction Surgery
Breast Implants and Body BuildingA Natural Look with Breast Implants

Breast reduction surgery can enhance your appearance and your self confidence. Realistic expectations are important to be happy with any surgery. As each patient is an individual, different results can be expected in each patient.

Alternatives
Liposuction has been used for breast reduction but is only of use if the excess breast tissue is composed mostly-entirely of fat (which is not always the case) & the skin is sufficiently elastic to shrink after liposuction. Elastic skin only exists in younger patients who incidentally have more breast gland tissue than breast fat tissue. Liposuction also damages the tissue so that it may not be possible for a pathologist to examine the removed tissue in the search for possible cancer cells. In some morbidly obese patients weight loss through diet and exercise or weight loss surgery can reduce breast size but even if it does so it usually is not a sufficient reduction and leaves one with excess skin.

Risks
As with any type of surgery there is the risk of infection or bleeding. Additionally risks associated with this surgery are skin scarring, asymmetric breasts, complete or partial loss of the nipple complex, difficulty breast feeding, loss of nipple sensation and further decrease in breast size if there is marked weight loss after surgery. The most frequent complication is skin loss at the junction of the vertical and horizontal limbs of the inverted T closure when that closure is used. In most cases that is treated with dressings changes until it heals.

Benefits
The main benefits are relief of symptoms of macromastia such as shoulder bra strap grooving, rashes under the breasts and neck, back and shoulder pain. That is why health insurance covers the surgery when you met their policy coverage criteria.

Recovery
Automobile driving can be resumed after 1 week, sex after 2 weeks & athletics after 4 weeks. The most important part of recovery is exercise and activity restrictions for 3 to 4 weeks after surgery after which patients rapidly return to their pre-surgery exercise routines. Most of the bruising & swelling resolves in 2 to 3 weeks. A bra should be worn 24 hours a day for 4 to 6 weeks as a splint.

To minimize the effects of scarring silastic sheeting should be worn over the scars or scar taping should start beginning about 2 weeks after surgery for up to 6 or more months.

The operation does not increase the risk of or confer immunity from breast cancer but can make its detection more difficult therefore regular breast self examinations are important after complete recovery.

Dr. Aaron Stone

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