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Breast Reduction for Women

San Francisco Breast - Breast Reduction Pages


What are the Indications for Breast Reduction?

Breast Reduction Procedures (Reduction Mammoplasty) Breast Reduction is performed when the breasts are too large. Male breast enlargement is termed Gynecomastia, and male breast reduction is called Gynecomastia Reduction Surgery.

For women, the term for large breasts is Macromastia or sometimes Gigantomastia. Reduction Mammoplasty, or Reduction Mammaplasty, is the medical term for female breast reduction surgery, but it is usually referred to as simply breast reduction surgery.

There are many reasons why Breast Reduction Surgery is performed. Breast reduction is performed frequently for women with one or more of the following symptoms:

  • Breast pain - Traction in the upper breast is caused by gravity pulling the breasts' mass downward. Aching within the breast parenchyma, may be caused by compromised circulation and vascular congestion.
  • Neck pain - Often, lower neck pain is caused by the weight of the breasts twisting the chest forward and compensatory extension of the cervical vertebrae, straining the neck muscles.
  • Back pain - Normally, upper back pain is from the breasts' torque flexing the thoracic vertebrae forward and straining the parhtmlinous muscles. Sometimes, the lower back can also be affected.
  • Shoulder Rutting - Weight on the the bra strap can cause a groove to form between the neck and the shoulder. This rut may remain well after the bra is removed, and become permanent.
  • Rash beneath the breasts - The moist environment caused by skin on skin under the breasts can lead to a chronic rash, especially in the summer months.
  • Infections - Rashes or chronic irritation beneath the breasts can lead to infections. Fungal and bacterial infections are both common. Recurrent skin infections can lead to permanent discoloration and scarring beneath the breasts.
  • Inability to Fit into Clothing - Disproportionate breasts make it difficult to find bras and tops that fit properly. Custom bras and garments may be necessary.
  • Limitation in Movement - Large breasts get in the way. They also limit activities such as running and sports due to discomfort with motion.
  • Embarrassment - Breasts which are out of proportion can be a source of embarrassment and undesired attention.

Breast Reduction Before and After Pictures (Reduction Mammoplasty)

Breast Reduction Video Presentation

Breast Reduction Patient Information from Dr. Joseph A Mele, III, MD, FACS

Breast Reduction Surgery and Breast Development

Breast Reduction Surgery is a cosmetic plastic surgery procedure that reduces, tightens and lifts the breast to diminish your physical discomfort and embarrassment, and increase your physical activity. The Reduction Mammoplasty does this in two ways. It reduces the amount of weight on the chest and the torque on the back by reducing breast tissue mass. Also, it firms and tightens the breasts by removing the excess breast skin and lifting the the breast tissue.

The timing of Breast Reduction Surgery depends on your health and your age. Since the Reduction Mammoplasty is elective surgery, it is important that you are in good health. If you have pre-existing medical problems, they should be well controlled, and Dr. Mele may ask you to see your doctor prior to surgery to be certain that the conditions are optimal for a safe and predictable breast reduction.

  • Puberty: Frequently, macromastia becomes apparent at puberty. This may present a dilemma if the breast enlarge rapidly early in puberty. Breast reduction can be safely performed at a younger age; however, the breast may continue to develop, necessitating a second surgery. For this reason, when the symptoms can be tolerated, breast reduction surgery is delayed until the breast's growth has stabilized.
  • Pregnancy: Breast can also enlarge with pregnancy. Most frequently this is followed by shrinking (atrophy) of the breast after pregnancy, when breast feeding stops. This is one of the main reasons why Breast Augmentation is so popular. Sometimes, however, the breast remain large after pregnancy, and breast reduction surgery is needed. It may be beneficial to wait until childbearing is completed before having breast reduction surgery. This allows the size of the breasts to stabilize, and allows for a more predictable result.
  • Breast Feeding: Another reason to delay Breast Reduction Surgery until after child bearing is for breast feeding. Breast reduction surgery, by it very nature, involves removing breast tissue. Techniques such as the Inverted-T Breast Reduction, detailed below, preserve the milk ducts between the nipple and the breast tissue; however, it may not be possible for you to breast feed after breast reduction surgery.
  • Menopause: Breasts can also enlarge later in life. There is no age that is too old for breast reduction, but medical problems do become more frequent as we age. For your safety, you may be required to have a full medical history and physical examination completed by your primary care doctor prior to surgery. Other specific tests and laboratories may also me requested.

Breast Reduction Videos

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Breast Reduction Surgery (Reduction Mammaplasty)

  • Inverted-T, Keyhole or Anchor Breast Reduction

    This is the most frequently performed breast reduction surgery in the United States. It is similar to the breast lift of the same name; however, unlike a lift, breast tissue is removed. Removing breast tissue allows for a reduction in size and weight, resulting in a reduction of symptoms. While individual results vary, often relief is felt immediately, in the recovery room, directly after surgery. An Inverted-T breast reduction can be used for any size breast, no matter how large. I advise all my breast reduction patients that breast feeding may not be possible after breast reduction surgery. The inverted-T technique preserves a wide inferior base, providing the greatest chance of preserving lactation for women who can't wait until after childbirth.

  • Vertical Breast Reduction

    A vertical breast reduction is similar to an inverted-T breast reduction. It lacks the horizontal inframammary fold (IMF) incision, so less reduction of the inferior breast skin is possible. For long pendulous breasts, an inverted-T approach may provide a more predictable cosmetic result.

  • Horizontal Breast Reduction

    A horizontal breast reduction is similar to an inverted-T breast reduction. It lacks the vertical incision, which runs from the lower pole of the areola to the IMF. It is best for the very ptotic (saggy) narrow breast. The nipple needs to be very low (before surgery) in order to eliminate the vertical scar.

  • Periareolar Breast Reduction

    For breast that are starting relatively smaller, with excellent skin tone, sometimes both the vertical and horizontal scars can be eliminated. A periareolar lift is limited in the amount of lift it can provide, but in carefully selected patients, it can provide adequate lift with minimal scars. Since the incision is periareolar, the amount of lifting is limited, similar to a periareolar breast lift.

  • Liposuction ("No Scar" Breast Reduction)

    The ultimate breast reduction would have no scars. For women with excellent skin tone and nipples near the optimal position, liposuction may be an option. Liposuction does not lift the breast so, liposuction for breast reduction works best with perky breasts. Liposuction can provide about one cup size reduction. The amount of reduction is limited by the amount of fat in the breast. Larger reductions can lead to a deflated appearing breast.

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Are My Nipples Removed?

The nipple and areola are not usually removed from the breast when Breast Reduction is performed. The exception to this is the free nipple graft. For extremely large reductions, when there are problems with areolar circulation, and in cases where limiting surgery time is important, sometimes a free nipple graft is utilized. It is much like a skin graft, so it allows for the widest possible range of nipple placement. The down side is loss of nipple sensation. I rarely recommend free nipple grafts for my female breast reduction patients.

Free nipple grafts are more frequently used for gynecomastia reduction of very large male breasts. Since no extra breast tissue needs to be preserved beneath the nipple graft, the result is a flatter, more masculine chest.

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Breast Reduction Insurance Coverage

Sometimes insurance will cover Breast Reduction Surgery that is done to relieve physical symptoms like shoulder rutting, neck and back pain, pain in the breasts, chronic rashes, or a history of recurrent infections under the breasts. Some health plans have completely stopped covering breast reduction surgery. Please check with your insurance company to see what is covered and what is necessary for approval. If you have an HMO plan, you will need to see an HMO doctor. Document your symptoms and what you are doing do treat them. A letter from other doctors you have seen about your symptoms, physical therapists, chiropractors, and a list of medications including the dose and frequency can help when seeking prior authorization for Reduction Mammoplasty.

Breast Reduction Recovery and Follow-up

Breast Reduction is an outpatient procedure. If you are healthy, you can go home the same day. If you have high blood pressure, or other medical problems, you may advised to stay overnight. Post-operative discomfort is most often described as pressure, and is usually well controlled with rest, ice and medications as needed. Follow-up visits are initially weekly, and decrease in frequency as you heal. Specific instruction will be provided tailored to your recovery, including scar reduction therapy.

Schedule Your Breast Reduction Consultation Today

If you are considering Reduction Mammoplasty, the best first step is an in-person consultation with an experienced, Board Certified Plastic Surgeon. Call our office today (925) 943-6353 to schedule your personal Breast Reduction Consultation today.

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