Breast Reduction Surgery
Patients with large breasts are often plagued by neck pain, back pain, or shoulder pain. There are patients who do not wish to have large breasts and make a personal choice that smaller breasts will enhance their body contour. Patients often experience limitations in their activity and lifestyle secondary to the size of their breasts. Patients with uneven breasts will often benefit from a breast reduction to create a more symmetric appearance. Dr. Spence has successfully performed many breast reductions at his Orlando, Florida plastic surgery practice. Breast Reductions are performed at his onsite fully accredited state of the art surgical suite. Schedule your consultation today at 407-999-2585 with Dr. Kenrick Spence at Hillcrest Plastic Surgery. Also feel free to browse through our Breast Reduction Before & After Photos.
Evaluation for Breast Reduction
- Overall good state of health
- Evaluation of the breast and chest to detect any asymmetry which needs to be corrected
- Evaluation of the body proportion to detect the breast size to enhance body contour
- Breast measurements are taken, e.g. chest bone to the nipple, the nipple to the fold of the breast.
- Determination of the amount of ptosis (droop) of the breast; this is measured as grade I, II, or III. Grade III is the worst, resulting when both the nipple and the breast tissue lay way below the fold of the breast.
- Examination for shoulder grooving (bra straps cutting into the shoulders) and inframammary intertrigo (a rash beneath the fold of the breast).
- Determination of:
- Asymmetry (unequal breasts)
- Sensitivity of the nipples
- Extent of stretch marks
Preparation for Breast Reduction
- Mammogram prior to surgery, as needed
- Must stop smoking at least 6 weeks prior to surgery
- Must stop all blood thinning agents, such as Aspirin or Vitamin E, prior to surgery
Procedure: Breast Reduction
There are several different types of breast reduction. The general principle is the removal of breast tissue and skin, moving the nipple to a higher position on the chest wall, and reshaping the breast to a more youthful appearance. Dr. Spence believes in performing breast reductions with the shortest scars possible. The most popular breast reduction in his practice involves the lollipop, or vertical, scar. Other kinds of scars include the anchor scar with an incision around the crease of the breast. A periareolar, or donut, scar in a circular fashion around the nipple is sometimes used. Liposuction is useful to bring the breast down a cup size in a breast with good skin elasticity.
In cases of extremely large breasts, the nipple may be removed completely and reattached as a graft; this is termed a free nipple graft.
All breast reductions procedures are not the same. The technique of breast reduction will be chosen based on the distance the nipple is to be moved up on the chest wall, the size of the breast, the extent of the reduction, and the shape of the breast to be created.
Some breast reductions produce a flatter, broader breast while others produce a more projecting breast. Dr. Spence uses 5 different types of pedicle techniques depending on the shape of breast he wishes to create:
- Superior pedicle
- Medical pedicle
- Inferior pedicle
- Central pedicle
- Bipedicle (a combination of pedicles)
The pedicle is the method by which the nipple is kept attached and moved up on the chest wall. A special suture technique is used to control the size of the areola to prevent widening after surgery.
Risks of Breast Reduction Surgery:
- Loss of nipple sensation - may be temporary or permanent
- Poor scarring: breast reduction scars will take several months to reach their final appearance
- Poor wound healing (more common among smokers)
- Regrowth of enlarged breast, particularly common in very young patients with large breasts (Juvenile Hypertrophy)
This is a short list of risks. During your consultation Dr. Spence will discuss additional risks of breast reduction surgery and preventative measures one can take to minimize these risks.
In Dr. Spence's practice the most frequently combined procedures with breast reduction surgery include liposuction and abdominoplasty or tummy tucks. These procedures both provide a dramatic effect on body contour and are safely performed in a fully accredited facility.
Breast reduction patients are some of the happiest patients in plastic surgery because of the relief of symptoms gained from the procedure coupled with the cosmetic benefits that lead to dramatic enhancements in body contour. To schedule a breast reduction consultation with Dr. Spence at the Hillcrest Plastic Surgery, call 407-999-2585 or request a breast reduction consultation online.
Plastic Surgery Frequently Asked Questions (FAQ)
Please note that insurance companies have tables of weight and height requirements along with symptoms and the amount of breast tissue removed to justify whether they should pay for your breast reduction. Many studies have shown that these requirements are outdated and that there are times when removal of smaller than 500grams of breast tissue will relieve the patient symptoms, as well as their mental well-being. For patients with PPO insurance Hillcrest Plastic Surgery is able to work with your insurance company thru providing documentation from your surgery. A study showed that the Galveston scale was the most predictable showing relief of symptoms in patients with breast reduction surgery.
This may happen when your surgeon is compelled to remove a certain amount of breast tissue to get your insurance company to pay for it. There are generally 2 options.
1. A modest size breast implant to enhance your appearance without return of symptoms.
2. The use of fat grafting to modestly enhance the size of the breast.
This is probably not a good idea. Removing all your breast tissue is essentially a Mastectomy. Breast Implants in mastectomy patients have a much higher incidence of complications.
Working with your surgeon based on your height, chest width, and body proportions. You may decide the best breast size for you. When working with your insurance company you may not have that choice.
This can sometimes be a condition called Poland syndrome. The right breast requires reconstruction or enlargement. This can be done with an implant or your own fat. A breast reduction is performed on the left breast to obtain symmetric breast.
A study published in Eplasty by Dr. Bui in 2019 showed that breast reduction patients experienced relief of symptoms as long as 15 years after surgery.
A study published in International surgery in 2014 by Dr. Yavuz showed that enlarged breast with increased weight on the chest can cause a relative restriction in chest wall compliance and impair pulmonary function, reduction in breast weight may improve lung function.
Keloids after a breast reduction is a thick raised scar resembling a cauliflower, which grows outside the boundaries of the breast reduction surgery. The best treatment for this is superficial radiation therapy and precision surgery.
It is the excessive and rapid growth of one or both breast around the time of puberty.
This is infrequent but there have been reported cases of enlargement of the female breast after the use of prednisone, a steroid and spiromlactone a medication sometimes used to treat acne.
It depends on the extent of the reduction and whether a free nipple graft is performed, as this can affect the ability to breast feed.
Yes, liposuction alone can be used for a breast reduction. Typically it is used in patients who have very tight skin with good elasticity and the ability to snap back. Liposuction can be used to take the breast down as much as a cup size.
Yes, the breast can grow again in response to hormonal changes, pregnancy, and weight gain.
Dr. Spence's preference is not to operate on the breasts while they are still growing. At age 16 their may still be some hormonal changes and enlargement of the breast. A 16-year-old patient will be followed to determine that breast growth has stabilized. Once this is found to be so, it is safe to proceed with surgery.
It typically takes 6 to 8 weeks for the majority of the swelling to go out of the breast; we have most patients wear a support bra until then.
It is Dr. Spence's preference to have you lose as much of the weight as you possibly can; also, remember that breast size can sometimes change with weight gain or loss and it is best to have the surgery when your weight is most stable.
Yes, breast reduction scars do fade over time; however, much of your healing is dependent on your skin type. Some patients have the tendency to form hypertrophic or keloid scars no matter what surgical technique is used.
Yes, different amounts of tissue may be removed from each breast to create improved symmetry.
Yes, the size of your nipples can be reduced without reducing the size of the breast. The procedure can be performed under local or general anesthesia.
Yes, the size of your areolas (darkened area around the nipples) can be dramatically reduced with a breast reduction.
Liposuction can be used to address this to produce an excellent result with virtually no scarring.
Yes, the grooves on your shoulders are due to the weight of your bra straps. When the weight is removed this should improved
Remember that nipple rings can become infected. These must only be replaced after all incisions are healed and your surgeon gives you the go ahead. This should be done with a sterile technique to prevent infection.
Some plastic surgeons will accept insurance coverage for your breast reduction. Usually you must prove that it is medically necessary by documenting back, neck, or shoulder pain. This sometimes requires supportive letters from your physician. Please note that Dr. Spence does not participate in any insurance plans. If you are interested in having your insurance company cover this, contact them and have them provide you with a list of plastic surgeons on your plan. Dr. Spence's practice does offer financing options for your breast reduction.
It is very important to understand the nature of potential scarring from a breast reduction. There are typically 3 types of scarring that can be unfavorable:
- Hypertrophic scar – These scars are red, thick, raised, and may be itchy and painful. These types of scars are usually confined to the boundaries of the incision.
- Atrophic scar – These scars are sometimes paler than the surrounding skin and the skin is typically thin and widened.
- Keloid scars – These are rope like scars that are raised with irregular borders and sometimes grow outside the boundaries of your incision.
All surgeons would like to have fine line scars from their surgeries; however, there are times, despite the most meticulous surgical techniques, unsightly scars can occur. This depends on how your skin heals and the predominant kind of collagen its produces.
Not always, as skin in different areas of the body can react differently. Since there is no guarantee, what is important is that a clear discussion of the risks of scarring takes place prior to your surgery. If unfavorable scarring does occur, a plan should be in place to manage this.
Some possible treatments are:
- Scar revisions – This involves surgically removing the area of unsightly scarring and resuturing the skin. This is usually performed after the scar has matured, which could occur several months to 1 year after surgery.
- Dilute steroid injections – These are usually performed at the first sign of appearance of hypertrophic and keloid scars. It is important to notify your surgeon when these initial signs occur.
- Laser treatments of scars – Different types of lasers are available to treat scars. The timing and frequency of laser interventions depend upon the kind of scar that is being treated.
- Silicone sheeting (or topical creams) – This is applied early in the course of care (sometimes as early as 2 weeks after surgery). This is thought to work by temperature, compression, and humidity of the scar.
It is important to sort out the origin of pain before undergoing a breast reduction. It would be unwise to undergo surgery and still find yourself with these symptoms. Enlarged breasts can contribute to these symptoms. Many patients see orthopedic surgeons or neurologists to determine the source of pain before visiting their plastic surgeon. This work up may involve a CAT scan and an MRI.
This is called inframammory intertrigo. Most often a breast reduction will help, but if changes in the pigmentation persist it will often respond to topical bleaching creams.
Free nipple grafts are usually performed in extremely large breast reductions where there is inadequate blood flow to keep the nipple alive if it is kept attached. This can occur in very large breasts (Gigantomastia) or when the nipple must be moved very large distances up the chest wall. The downside of a free nipple graft is that the nipple will often lack sensitivity and may loose some of its pigment. Pigment can often be restored by dermal tattoos.
Patients who have extremely large breasts that cause back, neck, and shoulder pains or limit their ability to exercise are often more motivated to exercise and lose weight after their breast reduction.
The responses to Frequently Asked Questions listed here are not intended to be medical advice, but are the practice of Dr. Spence and will vary from surgeon to surgeon and patient to patient.
Schedule a Breast Reduction Consult Today
To schedule a breast reduction consultation with Dr. Spence at Hillcrest Plastic Surgery, call 407-999-2585 or click here to send us an Appointment Request Form online. Our practice serves Orlando and the surrounding areas of Florida, and we look forward to helping you achieve your goals!