| Dr. Robin Yuan is a plastic surgeon certified by the American Board of Plastic Surgery. Here the Doctor has answered some of the common questions bizymoms visitors have about Breast Reduction Surgery.
Q. What is Breast Reduction Surgery?
A. Breast reduction surgery is a generic term to indicate removal of breast tissue and/or fat. There are two major components: weight reduction and aesthetic concerns. Most patients have a balance of both concerns but some might place a priority on one versus the other. Some patients have developmental hypertrophy or overgrowth of the breast. Changes of life events such as pregnancy or menopause can also cause enlargement of the breast.
There are dozens, if not hundreds, of techniques and categories of breast reduction surgery. The main considerations are methods to reduce volume, methods to maintain healthy circulation and sensation to the nipple-areolar complex, and patterns of skin reduction to achieve a pleasing shape. Each patient must be analyzed and a method chosen in a customized fashion using general principles or categories of techniques. As such, there is not a one-size fits all approach to breast reduction.
Most women undergoing breast reduction are seeking some relief of pain and discomfort in the posterior neck, upper back and shoulder area. Shoulder grooving is often seen and may be a factor that insurance companies look for to determine medical necessity. I will ask a patient to cradle her breasts in her arms for a while when she gets the discomfort to see if supporting the weight of the breast might relieve her symptoms. This mimics the effect of breast reduction. Pain associated with intrinsic disease of the cervical spine or shoulder would not be relieved. Dermatitis, chafing, intertrigo, or even skin ulcers can occur in the more extreme cases
Some breasts can be reduced completely, or in part, with liposuction techniques. Or liposuction can be used as an adjunct to surgical gland resection. While liposuction can possibly reduce the size and weight of the breast through small incisions, there is very little control over shape and the gland itself cannot be suctioned. Surgical resection is usually the predominant method and skin incisions are required in order to remove breast tissue and to shape the breast.
Older, more traditional, methods used the so-called Wise pattern, or inverted-T, or anchor incision that required scars around the nipple-areolar compplex, a vertical scar from the nipple to the inframmamary fold, and a rather long incision along the fold. The more incisions and the longer the incisions, the more shaping the surgeon could accomplish, just like the seams of a dress that needs tailoring. Because many of these breasts looked great initially but then sagged or bottomed-out over time, surgeons tried different methods to limit incisions. Shape is often temporary, but scars are permanent.
For over a decade, I have used limited scar techniques such that it is quite rare to need an inverted-T type scar. Most reductions can be accomplished with a lollipop scar (vertical scar reduction) or one with a short extension out to the side in the inframammary fold (short inframammary scar technique). I will use liposuction as much as possible to reduce the weight of the breast since this does not increase the amount of incisional scars. The actual techniques that I use is determined by the existing anatomy, the need to reduce pain and discomfort by reducing the weight of the breast, and the final size and shape that the patient desires.
Q. Who is a good candidate for a breast reduction?
A. Good candidates for breast reduction are as fit as they can be. I ask about diet and exercise activities since obesity is a relative contraindication and unhealthy patients may have more complications. They should be stable in their lifestyle and weight. An analysis of the pain and discomfort can determine if simple weight reduction of the breasts will be beneficial. Patients who are disproportional or top-heavy often seek out reduction surgery so they can be less conspicuous and fit into more traditionally-sized clothes. Good candidates also must have a clear picture of what they are looking for and also a reasonable expectation regarding limitations and risks of the surgery.
Q. What are the benefits of breast reduction surgery?
A. The obvious benefits to breast reduction is relief of pain and discomfort if the selection process has been followed and also an improved aesthetic appearance determined by patient desire. The procedure should fit the patient, not the other way around. In the end, the surgery to be planned to give the patient what she desires with the risks, side effects, and scars, she can accept.
Q. What are the risks involved of breast reduction surgery?
A. While there is some blood loss, this is minimal and never requires transfusions unless there is a clotting disorder. Small collections of blood or serum (i.e. hematoma or seroma) can occur, but are rare and usually reduced by placement of drains for 24-28 hours. Sensation to the remaining skin or nipple can be altered, although this is not predictable with some experiencing numbness and some noting hypersensitivity. Most patient's sensation return to near-normal. Poor blood flow to the nipple or skin can cause delayed healing, blistering, or even necrosis with loss of skin or nipple requiring debridement, prolonged healing, or subsequent revision. The use of hyperbaric oxygen therapy can help the tissues through periods of difficult healing. Scars are always present even though minimized. The quality is unpredictable with scars often showing skip areas of good scars alternating with thicker scars. Various forms of treatment may be instituted at various times of post-op healing although over-treating the scars is avoided. There are aesthetic complications such as asymmetry of the breasts, persistent deformity, an over- or under-reduction of the breast, and prolonged post-op pain. Despite all the potential complication, breast reduction surgery is one of the most satisfying procedures for patients with many of them regretting they never consider the surgery earlier in their life. Overall satisfaction with this surgery is close to 95% even with the extensive scars that may be needed.
Q. How much does a breast reduction cost?
A. The cost of breast reduction surgery depends on how the surgery is performed, how long the surgery takes, where the surgery is performed, and if insurance will cover some or all of the procedure. Out-of-pocket expenses can run roughly$10-20,000 when insurance does not cover it.
Q. Where do one find a doctor who performs breast reduction surgery?
Most plastic surgeons doing any breast surgery will offer breast reduction surgery. Surgeons who have extensive experience with breast reconstruction will do reduction surgery as part of the overall rehabilitation of the breast cancer patient.You can consult the American Society of Plastic Surgery or your state society for plastic surgery. Be sure the surgeon is board-certified or board-eligible by the American Board of Plastic Surgery. Often, gynecologists will be familiar with breast reduction surgeons in your area.
Q. What type of scarring should I expect?
A. Scarring is the price one pays for the benefits of surgery. The scars can be minimized in many ways but are always present. They are unpredictable.The best advice is to imagine a reasonable, not invisible, scar and see if that is worth the relief of discomfort and the improvement in appearance.
|
