Breast Reduction (Reduction Mammoplasty)
Overview:
Whereas many women seek to enlarge their breasts for aesthetic reasons, the opposite can also hold true. There are women who feel that the size of 
their breasts are too large and not in keeping with the proportions of the rest of their bodies.
There are also those women who suffer from chronic neck and back pain as a result of large, sagging breasts and the cosmetic benefits of breast reduction are secondary to the health benefits. Men can also seek breast reductions for the very same reasons. They wish to improve health and obtain cosmetic benefits than can directly relate to self esteem.
Candidates for Breast Reduction Surgery:
The first question that you may ask yourself is “Am I a good candidate for breast reduction?” There are several factors to be looked at, when considering breast reduction surgery.
The best candidates are:
Those who understand that the purpose of a breast reduction is mainly health related. For women, over-sized breasts can cause back and neck pain as well as issues with posture that can eventually lead to skeletal deformities. Normal and/or athletic activity may be limited, as well. There can be also be breathing difficulties and problems with sleep disruption leading to a loss of energy and vitality.
Finding clothing that fits properly can be frustrating. Over-sized breasts can also chafe against the underlying skin, causing irritation, rashes, and infections. However, beyond the medical considerations, over-sized breasts can also be a source of self-conscious issues – especially with teenage girls. Those women who possess any of these characteristics or symptoms may be good candidates for breast reduction surgery.
Initial Consultation:
It’s extremely important to have a detailed consultation with a qualified cosmetic surgeon prior to making a decision regarding breast reduction surgery. Medical concerns will be discussed as well as outcome expectations. Photos will also be taken in order to document the pre-existing condition and for comparison with post-surgical results.
A mammogram (breast X-Ray) may also be taken to check for abnormalities or cancer, prior to surgery. The costs of surgery and all miscellaneous charges should also be discussed as well as the specifics of the procedure, itself.
Procedure:
Prior to surgery, your surgeon will give you a list of instructions on how to prepare for surgery. This will include guidelines on eating, drinking, smoking, and taking or avoiding certain medications/vitamins. Some surgeons will also suggest that their patients diet before the operation.
The breast reduction procedure involves the removal of selected breast tissue consisting of fat, glandular tissue and skin. The procedure is performed under general anesthesia, so the patient will be asleep during surgery. The procedure may be performed in the surgeons own surgical suite, an outpatient medical facility or a hospital.
Prior to surgery, markings will be made on the breasts in order to determine the position of the breasts while the patient is in a sitting position. This will assist the surgeon in making the correct incisions while the patient is lying down. This will also assist with the determination of the new position of the nipples and areolae.
Once the patient is under anesthesia, the incisions are made along the markings and flaps are created along the sides of both breasts. This allows breast tissue to be removed and nipples to be moved to a higher position on the breasts. Usually, the nipples will remain connected to the nerves and blood vessels.
However, in cases that involve very large breasts, it may be necessary to completely move and graft the nipples to a new location – which will result in a loss of sensation to the nipples. The flaps are then refolded and sutured into place, thus shaping the breast into its’ proper proportion.
Recovery:
After surgery, sutures will remain around the areolae, in a vertical line beneath the nipple and sometimes horizontally beneath the breast (depending on breast size prior to surgery). Swelling, tenderness and bruising will be experienced and pain management can be assisted by prescription medication from your doctor.
Bandages are usually worn for 2 days after surgery and stitches will be removed in about 2 weeks. Drains may also be put into place during surgery and these will be removed within one week. There should be no heavy lifting or strenuous activity for 3-4 weeks and a soft surgical bra may be recommended by your doctor during the recovery period. It may take a few months before the breasts settle into their natural shape with up to a year before the final result is seen.
Risks and Complications:
As with all surgeries, there are standard risks involved that can include issues such as infection or reactions to anesthesia. Antibiotics can be used to treat infection and will be prescribed by your doctor. There are other side effects associated with breast reduction surgery such as the loss of nipple sensation and the inability to breast feed.
Additional effects include permanent scarring on the breasts and possible asymmetry (where the breasts are not the same shape and size). Improper positions of the areola and nipple can also occur. A qualified cosmetic or plastic surgeon can answer your questions regarding possible side effects and these questions should be covered in your consultation.
Cost of Breast Reduction Surgery:
There are three major costs when considering breast reduction surgery: the surgeon’s fee, anesthesia and the facility expenses. The surgeon’s fee is dependent on qualifications as well as the extent of the procedure, itself. The average cost for the entire procedure usually ranges from $5000-$7000.
More, if multiple procedures are done at the same time. Discuss the complete costs with your doctor if more than one procedure will be required. It’s also important to check with your medical insurance company to determine if the costs are covered under your health care plan. If not, surgeons usually offer multiple financing options that can make the procedure more affordable.
Choosing a Surgeon:
When choosing a surgeon, it’s important to choose a board-certified plastic surgeon. The surgeon chosen should have extensive experience in all types of breast surgery. Please note that the type of certification is important.
There are more than 150 self-designated boards, but only a handful that are designated by the American Board of Medical Specialties (ABMS), such as the American Board of Plastic Surgery. You should also request to see a sizable number of before and after photos as well as obtaining patient references.
Gynecomastia:
Gynecomastia is the enlargement of one or both male breasts and is experienced by roughly half of all men today. This condition can be caused by a number of factors to include steroids, blood-pressure medication, anti-depressants, an imbalance of sex hormones (estrogen and testosterone) or heredity conditions.
Surgery, liposuction or a combination of the two may be used to treat enlarged breasts. The reasons for surgery in men can be to reconstruct the contour of the chest for cosmetic reasons that may be related to self esteem. Another reason may be to determine if a suspicious lesion in the chest is cancerous. Enlargement typically occurs on both sides of the chest. If it is one-sided, firm and hard, you should see a doctor immediately to rule out male breast cancer.
Other Procedures:
Liposuction may sometimes be used as a breast reduction method for women in cases where a smaller amount of tissue (fat) removal is indicated. However, the skin must be extremely elastic in order to consider this procedural approach.