DO I NEED A BREAST REDUCTION?
Breast reductions are classically indicated for large breasts that cause a patient daily discomfort. This may include rashes and skin irritation under the breast fold, chronic back pain not caused by other deformities, and shoulder strap/bra strap grooving. Those with extremely large breasts may be candidates for insurance reimbursement, though this differs from plan to plan.
Breast Reduction can also be performed for lesser deformities to enable women ease with wardrobe options and well as quell unwanted attention. These lesser volume reductions are typically not covered under insurance. Incisions for large reductions resemble an “anchor” (around the nipple, vertical to chest wall and along the underside of the breast). Smaller reductions may be accomplished via vertical and nipple incisions only (“lollipop” or “keyhole”) or something in between the two.
Breast Reductions also are able to minimize size asymmetries by removing more on the larger side. All reduction surgery also incorporates a breast lift procedure to improve the breast position on the chest wall and place the nipple closer to the center of the breast mound.
WHAT HAPPENS TO THE NIPPLE?
The nipple is typically separated from the outer skin but left attached to its blood supply within the breast tissue in order to position it higher on the breast
In very, very large reductions with nipples set very far from the patient’s chest wall, removal and replacement of the nipple may be indicated. This is known as a “free nipple graft.”
What Do I Need to do to Prepare?
Ideal candidate for breast surgery include those with good breast health. Women over the age of 40 or with significant family history of breast cancer/disease would require a screening mammogram prior to any breast surgery. Women with abnormal breast complaints, such as irregular nipple discharge, skin dimpling or recent changes to the breast or any lumps or bumps should seek a work up to ensure no underlying breast pathology.
Those who have recently given birth should wait a minimum of 6 months after birth or after breast feeding to allow the breast to settle to its final state. If planning a future pregnancy, surgery may not be advisable until after. If future pregnancy is undecided, the risk of inability to breast feed following a breast surgery as well as changes to the breast during and after a pregnancy should be discussed and weighed.
All patients undergoing breast reductions should be NON-SMOKING for a minimum of 4-6 weeks prior to surgery and must refrain from smoking during the 6-8 weeks following to ensure proper recovery, avoid wound healing and scarring issues as well as minimize risks of infection.
Patients should also strive to eat healthy including a diet with adequate lean protein and vegetables. If nutrition is of concern, consider a multivitamin and/or supplementation with protein shakes.
What Can I Expect on the Day of Surgery?
Breast Reduction is a minor to moderate procedure that does not require a hospital stay though some patients may elect to stay overnight for a possible additional hospital fee. You will be asked to arrive to the hospital 1-2 hours before the start of your surgery, when the hospital staff will prepare any necessary documentation such as have you sign a consent form. You will meet and talk with the anesthesiologist team as this procedure would require general anesthesia during which time you are completely asleep and supported by a breathing machine. The nurses or anesthesiologist will place an IV and start fluids. Your surgeon will greet you just before surgery and place marks on your breast with a marking pen. You will then be taken to the operating room and placed on the operating table, where you will gently be put to sleep. You will awake in the recovery room with only minimal discomfort and will have dressing and a bra in place. Your family will be instructed on your care prior to leaving the recovery room.
It is advisable to rest that day and avoid foods that easily upset the stomach such as dairy and heavy proteins until you feel the anesthesia is waring off, which may take up to 72 hours.
Risks Associated with Breast Reduction?
- Poor wound healing. This most often manifests as a small shallow wound at the “T” zone of the breast incision (where the vertical incision meets the lower fold incision. Typically, it can be easily managed with basic cleanliness and wound care.
- Poor scarring, especially if you are prone to keloid or hypertrophic scar formation
- NO two breast are alike and although we strive to make them as similar as possible, it can never be perfect.
- Changes in nipple sensation
- Nipple loss in rare cases. Dr Downey will advise you if you have an increased risk of nipple loss and may recommend a free nipple graft in those cases
I’ve been wanting to do botox and get my skin looking great for some time now. I was a little nervous, Dr. Downey had a great staff, and she was super patient and fed me enough information to calm m…
– Stephanie O.
I had such a great experience with Dr. Downey. I was referred by a friend. This was my third attempt at getting surgery on some trouble spots after significant weight loss. I didn’t go in with h…
– Paul V.
It was very easy for me to make a consultation appointment. There was no pressure to sign up for surgery that day. Dr. Downey was very professional and friendly. She answered all my questions an…
– Brittany G.
I had breast augmentation on 12/2/14 and Dr. Downey and staff made the whole experience amazing. Since the surgery I have minimal scarring and I look and feel great! This was one of the best decis…
– Ashly T.
Dr. Cara Downey, thank you so much for the care you gave to me and the exceptional work you have done to my body! You are amazing. Because of you, dreams come true! You are the best! Thank you for ble…
– Andrea C.
I didn’t think I would ever feel this great again. Now I can wear strapless dresses. My shirts no longer have the peep holes near the buttons. I’m just so pleased with the work Dr. Downey has done. Bu…
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After Surgery: Precautions and Recovery
Some pain and discomfort is expected in the first few days, which will be eased with pain medication. Bruising and swelling may also be expected though extreme swelling and pain on one side only may indicate a problem and warrants a call to the doctor immediately. You will also be given a short course of antibiotics to prevent infection. The bra and dressings should be left in place for 48 hours, after which you can remove and begin showering regularly. Avoid baths or submerging in water for at least 4 weeks.
Athletic women, be patient. Most can resume work and social outings within days of having a breast reduction, but intense exercises should be put on hold until you get it cleared with Dr. Downey. For most this means avoiding anything in the first 2 weeks that can raise the heart rate and blood pressure. You will also not be allowed to lift more than 5-10 lbs for at least 4 weeks. At 6 weeks, you may be released to full normal unrestricted activity with a gradual ease into it. If your incision is in the fold of the breast, you will be told to avoid underwire for 6 weeks. Scars will be present, but those will greatly improve by about 6 months. You will most likely have drains, one in each breast that require minimal attention and are typically removed in 1-3 days. The recovery nurses will explain to you and your family how to handle them. Please refer to out handout on drain care in the patient document section.
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