Breast Reduction

At Buckhead Plastic Surgery in Atlanta

Large breasts are not just a fact of life for some women; they can negatively affect body image, self-esteem, health and overall quality of life. Breast reduction can ease the pain caused by trying to support large breasts. The procedure can also reshape the breasts for a more youthful appearance.

Deciding if Breast Reduction is Right For You

The key reasons for breast reduction are to:

  • Make the overall size of the breast smaller
  • Improve the shape to a more youthful lifted position.
  • Resolve headaches, neck pain, back pain, shoulder pain and chest discomfort

The trade-off with breast reduction is scars and incisions which usually heal very well. Occasionally the scars may be more noticeable (raised, red, wide and/or misshapen). Smoking, hereditary factors and weight gain can affect how the incisions heal.

If you are still in the childbearing years and you would like to have children or more children, possibly delaying breast reduction may be the right choice for you. Although breast-feeding is usually affected by a breast reduction surgery, a woman can usually produce enough breast milk to support most of the child's needs and give the child the benefits of breast-feeding. Supplements of formula may be required.

Breast reduction is not just for postpartum women. Many women have recognized the health and quality-of-life benefits of having a breast reduction surgery. Even pediatricians refer teenagers for reductions to alleviate the stress excessively large breasts place on the back, neck, shoulders and chests of young women.

How It's Done

The best technique for a woman's breast reduction addresses the shape of the breast, the location of the scars, the quality of the scars, the longevity of the reduction, preservation of sensation to the nipple and areola, and preservation of lactation. The degree of sagging or ptosis and the amount of excess skin play a major part in determining the best technique.

During your consultation and physical exam, Dr. Alan N. Larsen will review the specific techniques in breast reduction. Lesser degrees of reduction can usually be treated with smaller incisions. As the size of the breast increases, so does the incision required.

The technique that most often used for breast reductions or reduction mammoplasty is the SPAIR technique. With this technique, the incision goes around the nipple areolar complex (circumareolar) with an extension of the incision vertically from the nipple areolar complex to the inframammary crease. This technique affords the largest lift and the most tightening of the breast envelope for most patients.

Breast reduction is more than just removing excessive tissue and fat from the breast. The goal of a breast reduction surgery is to sculpt the breast into a smaller, perkier, more youthful shaped breast.

This procedure can only be performed by placing incisions on the breast. The goal of surgery is to have as few scars as possible placed in the most inconspicuous areas. Although minimal scar techniques are coming into vogue they may be inadequate for some patients. Incision placement includes these incisions:

  • Circum-areolar reduction mammoplasty: a concentric or donut-shaped incision around the areolas.
  • SPAIR reduction mammoplasty: a concentric or donut-shaped incision around the areolas with the addition of the vertical component down from the areolas to the breast crease. The technique Dr. Larsen uses most often.
  • Inverted T reduction mammoplasty: a concentric or donut-shaped incision around the areolas plus the vertical component from the areolas to the breast crease as well as a horizontally based incision along the breast crease.

Through one of these incisions, breast tissue and fat are removed. The nipple is repositioned and the entire breast is reshaped. Although the nipple is repositioned, it is not detached from its nerve or its blood supply.

Removing breast and fatty tissue will reduce the overall breast size and lift the nipple. The size of the areola, the dark skin surrounding the nipple, will likely be made smaller to match the shape position and proportion of the new breast. In some cases liposuction may be used as part of the breast reduction to remove fat from under the axilla or armpit.

The results of breast reduction are seen and felt immediately after surgery. These results may not the permanent. Significant weight gain or loss and pregnancy may affect breast size and the results of your surgery.

When planning for a breast reduction, several considerations should be kept in mind. Many women with large breasts experienced difficulties with breast-feeding. A breast reduction surgery can make it even more difficult.

Recovery

Immediately after surgery you will experience mild to moderate discomfort which is easily controlled with pain medication. Most patients are sent home after surgery. Follow-up will start the next morning when the dressings will be removed. Follow-up will continue every few days for the first week or two after which your visits will be staggered longer and longer apart as your healing progresses.

Most women return to work in 3-5 days and regular activities after two weeks if everything is healing nicely. The first few weeks after surgery, you will wear a loose-fitting bra. As healing continues and the discomfort resolves you can return to a regular supportive bra.

Postoperative recovery from a breast reduction or reduction mammoplasty is usually moderate. Breast reduction or reduction mammoplasty is almost always an outpatient procedure.

In Dr. Larsen's practice, patients who have no one to care for them the first day after surgery stay over. Patients who have had this surgery in combination with larger surgeries such as a mommy makeover will also stay over. The breasts are tender and swollen. The new shape and position of your breasts will be visible immediately. The final shape will take several weeks to several months as the breasts settle in.

In Dr. Larsen's practice, drains are not placed for this surgery.  After surgery you'll have padding placed across the breasts. The padding will be held gently into position with an ace bandage. You will be seen in follow-up the next day when the ace dressing will be removed and you will be placed into a loose-fitting sports bra or a shelf bra inside a camisole.

You should sleep sitting upright for the first four to seven days after surgery to help with swelling and discomfort. At about two weeks after surgery you are placed into a more supportive bra and you can return to a full exercise routine. Most women return to work within three to five days after surgery.

What to Expect

Different surgical techniques for the breast reduction or reduction mammoplasty will result in different postoperative expectations. The final outcome, however, is the same: smaller, lighter, perkier, more youthful breasts. The smaller incisions will heal faster have less swelling and less discomfort. The results will also be visualized very quickly.

The larger procedure with the incisions around the areolas and down the middle of the breasts will take a little longer to heal (see the final result), will often have more bruising and will result in more swelling and discomfort. With any surgery, the scars initially will look very nice. The scars will then turn pink followed by fading that can take a year or more to complete.

The results should last decades. Different factors such as weight gain and loss, a new pregnancy and/or breast feeding and your general tissue characteristics will influence the longevity. Not wearing a supportive bra may lead to secondary drooping or ptosis that may require a revision of the lift portion of the reduction surgery.

Is Breast Reduction Covered by Insurance?

In some cases, insurance may reimburse patients for breast reduction surgery. Coverage however can be arbitrary at best. Even after gaining approval for breast reduction surgery, the reimbursement can be rejected despite recognized standards for coverage relative to a woman's physical build and the amount of breast tissue reduced.

Schedule a Consultation for Breast Reduction

Are you interesed in finding out if breast reduction is right for you? Please contact the Atlanta office of double board certified plastic surgeon Dr. Alan N. Larsen. Our plastic surgery office is located in the Buckhead area of North Atlanta. Call (404) 367‐9005 to inquire about a personal consultation with the doctor.