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Breast Reduction



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costs
good candidates
initial consultation
pre-op preparation
basic procedures/techniques
recovery
risks/complications
scars
satisfaction rate
breast reduction by liposuction
male breast reduction
before & after pictures

costs


BREAST REDUCTION (Mammoplasty)*
Cost Range: $5,000-$10,000

Average Total Cost : $5,200 Surgeons fee: $3,500
Anesthesiologist: $700
Facility fee: $1000


RELATED FEES**
Breast implant removal (Augmentation patients only) $2,086
Breast augmentation $3,043
Breast lift $3,503
Breast reduction in men $2,747

*Fees generally vary according to region of country and patient needs.
**These fees are averages only. Fees do not include anesthesia, operating room facilities, or other related expenses.
Source:
http://www.plasticsurgery.org/mediactr/average2001.cfm

good candidates


Good candidates for breast reduction surgery:
  • Women that have pendulous breasts (often signifies more glandular tissue than fat)
  • Women who are thin (thin women tend to have more glandular tissue than fat)
  • Women that have excessively large breasts (liposuction normally only provides a 30-50% reduction in size)
  • Women that have excessively dense breast tissue (often signifies more glandular tissue than fat)
  • Women before menopause (during menopause fat replaces glandular tissue)
You are also at increased risk for complications if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.

initial consultation


At the initial visit, your doctor will likely ask you to describe in detail what you would like improved. Be specific about what you would like done. If your surgeon fully understands your expectations, she'll be able to determine whether your goals are realistic. Your surgeon will examine your breasts. She talk to you about the what size you want your breasts to be and will show you where she intends to position the nipple and areola.

You are at increased risk for complications if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.

Because the size, shape, and amount of tissue in the breast will change after reduction, most women are advised to have a preoperative mammogram and a postoperative mammogram six months to a year after surgery for comparison.

pre-op preparation


[ ] Do not take aspirin or anti-inflammatory medications (your doctor can provide you with a list of OTC medications to avoid)
[ ] If you smoke, quit smoking for at least 2 weeks pre-op (and anticipate no smoking for the recovery, smoking greatly increases your risk of complications)
[ ] Obtain a copy of your doctor's protocol
[ ] Make arrangements to have someone drive you to and from the operation
[ ] Arrange for someone to care for you the first 24-72 hours after surgery
[ ] Fill prescriptions (especially pain medications and antibiotics) before surgery
[ ] Consider a pill case with time chart for taking medications
[ ] Set up home recovery area: lots of pillows, books, magazines, journal, stationery, T.V., remote control, videos, favorite CDs
[ ] Black out windows so you can rest during the day
[ ] Whistle, bell, walkie-talkies or intercom system for requesting help
[ ] Prepare and freeze meals for 2 weeks
Consider quick snacks: Protein shakes, soup, applesauce, jell-O, frozen dinners, yogurt, oatmeal, cottage cheese, juice (purchase flexible straws for easier drinking)
Be sure to have adequate protein - the body needs it for proper healing
Talk to your doctor about low-sodium foods to reduce swelling
[ ] Prepare Icepacks (can also use packs of frozen veggies or fruit, gel packs, etc/) to reduce post-op swelling
[ ] Moisturizers, scar reducing creams and petroleum jelly for incisions
[ ] Laxatives (pain medications are often binding)
[ ] Eye Drops (after any surgery, eyes can be dry)
[ ] Consider hand-held shower head and bathroom chair
[ ] Telephone with speaker phone near your bed (turn off the ringer so it doesn't disturb you while you sleep; have answering machine in another room)
[ ] On the day of surgery, wear loose clothing which will be easy to get off and on after operation (a shirt that buttons in front)
[ ] Follow your physician's directions carefully regarding medications, eating & drinking, etc.

Insurance Coverage
Insurance may cover mammoplasty if the size of your breasts are the cause of health problems. Check with your insurance company, and be sure to obtain proper pre-authorization for your surgery.

Questions to ask your insurance:
  • Does my policy cover the costs of the surgery, the anesthesia, and/or other related hospital costs?
  • Will there be an increase in my insurance premium?
  • Will future coverage be affected?
basic procedures/techniques


Anesthesia: General
Location: Hospital
Surgery time:3-4 hours

A mammoplasty is a surgical procedure that reduces, lifts and reshapes the breasts. It can also reduce the size of the areola (the dark skin surrounding the nipple). Many women seek breast reduction to alleviate painful discomfort and other conditions (back pain, shoulder pressure, rashes, skin tags, etc.) as well as to improve the appearance of their breasts.

The procedure is usually performed under general anesthesia. The operation takes about 3-4 hours, and you may require an overnight stay or be allowed to go home the day of surgery.

During mammoplasty, the surgeon makes an incision which is normally in a keyhole pattern: a circle around the aerola and two incisions down the breast which will be closed to form one line. Fat and extra tissue are removed. The surgeon then repositions the nipple and areola to a higher position and removes excess skin from beneath the breast.

In Figure 1 the outlined areas show where skin, breast tissue, and fat are typically removed and how the areola and nipple are repositioned. The arrows show how skin formerly above the nipple is brought down and sutured together to reshape the breast. After surgery, scars will appear around the areola and in the crease under the breast.

Figure 1


In some cases, the nipple and areola are transferred as a skin graft to their new position. This is only done when absolutely necessary, since nipple sensation is almost completely lost. Drains are then placed on the sides of the breasts to drain blood and excess fluid. The drains are not removed for 1-2 days. The incisions are then sutured closed and taped.

recovery


Pain Level: Moderate to severe discomfort. 1-2 weeks of pain medication
Sutures: Removed after 1 week
Drains: Removed after 1-2 days
Swelling and Bruising: 2-3 weeks
Numbness: 1-2 weeks.
Work: 2 weeks. If job is strenuous or requires lifting, wait longer.
Exercise: Wait 3-4 weeks
Final result: 6 months

On the day of surgery your chest will be painful, bruised and swollen and you may feel nauseated. Pain medication will be prescribed.

You will wear an elastic bandage or surgical bra over dressings for the first few days. The incisions will be taped to reduce scarring. You will wear an ace bandage or sports bra worn another 1-4 weeks. Do not wear an underwire bras during recovery.

According to the American Society of Plastic and Reconstructive Surgeons, the first menstruation following surgery may cause breasts to swell and hurt, and the woman may also experience shooting pains in her breasts for several months.

For faster recovery:
  • Keep ice packs applied to your chest on the day of your surgery.
  • Sleep in an upright position. Do not sleep on your stomach for the first two weeks after surgery.
  • Moisturize the breasts daily (do not apply lotion to any taped areas)
  • To avoid unnecessary swelling or bleeding, do not bend over, strain, exercise or do any other activities that could increase pressure in your chest during the first week.
  • Do not shower or bathe until the drains are removed
  • Wear loose clothing
  • Drink plenty of water and be sure to get adequate nutrition
  • Maintain a stable weight
risks/complications


List of possible risks & complications:
Anesthesia reaction
Asymmetry
Bleeding
Breastfeeding problems
Boxy or Flat Breast (normally occurs post-operatively as a temporary condition)
Change in nipple color
Dissatisfaction with breast size (too small or too large)
Fat Necrosis
Hematoma (pooling of clotted blood; risk is 3-4%)
Infection (signs of infection: warmth, redness, soreness, swelling)
Irregularities in position of nipples and areola
Keloid (heavy scar)
Nerve Damage
Nipple loss (1%)
Nipple numbness
Pain
Permanent numbness
Reactions to medications
Sensory change (4-7%)
Seroma (pooling of watery blood)
Skin irregularities
Skin necrosis
Slow healing
Swelling
Visible scar
Wound separation

Asymmetry
Small differences in shape or size of the breasts are not uncommon following breast reduction surgery.

Fat Necrosis
"Fat necrosis is more common in larger resections. A study by Strombeck reported a 16% incidence of fat necrosis in obese patients having resections of more than 1000 g. However, the incidence of fat necrosis has been reported as low as 0.8% in 371 patients undergoing an average resection of 870 g per breast."
Source: Daane SP, Rockwell B, Breast Reduction Techniques and Outcomes: A Meta-Analysis. Aesth Plast Surg 1999;19:293-303; Mandrekas AD, Zambacos GJ, Anastasopoulous A, Haspas DA. Reduction mammaplasty with the inferior pedicle technique: early and late complications in 371 patients. Br J Plast Surg 1996;49:442–6; 35. Strombeck JL. Reduction mammaplasty by Strombeck technique. In: Goldwyn RM, editor. Plastic and reconstructive surgery of the breast. Boston: Little, Brown & Co; 1976:195–209.


Nipple Sensation
Most patients will have some change in nipple sensation following mammoplasty. This is usually temporary but could take months to return.

Wound Separation
Sometimes the incisions will pull apart. This does not require additional surgery. It is treated with moist dressings. However, if this occurs, recovery time is much longer.

scars

The scars extend around the nipple, vertically down from the nipple and under the breast. The scars fade in time but tend to be wide scars and are still visible.

satisfaction rates


Patient satisfaction rates range from 80% to 95%, and symptom relief is reported from 70% to 100%.


BREAST REDUCTION SURGERY, MORE EFFECTIVE THAN MEDICATION, DIET, OR SUPPORT BRAS, TO RELIEVE SUFFERING OF OVERLY LARGE BREASTS

For Immediate Release
May 1, 2002

ARLINGTON HEIGHTS, Ill. - Women who suffer from painful physical symptoms of overly large breasts show greater improvement with breast reduction surgery over conservative treatments such as special bras, weight loss, physical therapy, or medication reports the April issue of Plastic and Reconstructive SurgeryŽ, the official medical journal of the American Society of Plastic Surgeons (ASPS). The study also confirms the benefits of breast reduction surgery are considerable and not dependent on body weight, bra cup size or amount of tissue removed.

"This study provides additional and even more convincing evidence that breast reduction effectively improves the overall health and wellness of large-breasted women with chronic pain related to their breast size," said E. Dale Collins, MD, a plastic surgeon at Dartmouth Hitchcock Medical Center in New Hampshire and first author of the study. "The findings also support the fact that more conservative methods of treatment -- often required by insurance companies -- have failed to deliver significant or lasting relief."

The study group included 363 women, 179 women with a median bra cup size of DD who underwent breast reduction surgery, and two sets of control groups that did not - 96 women with a bra cup size less than D and 88 women with a bra cup size of D or larger. Prior to surgery, 50 percent of the patients who had breast reduction surgery reported pain in the upper back, shoulders, neck, and lower back all or most of the time. While less than 10 percent experienced these conditions after surgery.

Prior to seeking surgical relief, the patients who had breast reduction surgery tried a number of conservative treatments including weight loss, supportive bras, medications and physical therapy. About 85 percent of these women previously tried weight loss to relieve their symptoms, but more than half found the effort completely ineffective and none of the women reported complete or permanent symptom relief. Additionally, 77 percent of them tried one or more medications to manage pain, including narcotic and non-narcotic analgesics, non-steroidal anti-inflammatory agents and muscle relaxants. After surgery, only 13 percent of these women required medication, just slightly more than the control group consisting of women with a bra cup size less than D (11 percent).

None of the conservative treatments provided full or permanent relief of symptoms. In contrast, both pain and overall health were markedly improved by breast reduction surgery, restoring patients to normal levels of function.

Plastic surgeons have long observed that reducing breast mass can effectively alleviate the symptoms associated with overly large breasts. However, insurance denials and policy exclusions for the procedure are becoming increasingly common. Insurers often request patients seeking surgery try conservative measures first. Additionally, some companies set arbitrary body weight restrictions. This study demonstrates that all women, regardless of weight, benefit from surgery and that conservative treatment weight loss was not effective in relieving related symptoms.

"I believe insurance companies drastically underestimate the severity of symptoms associated with having overly large breasts," said Dr. Collins. "Patients seeking surgery reported suffering from pain comparable to low back pain or arthritis. Breast reduction surgery is a safe and highly effective treatment option and should not be considered a last resort."

According to ASPS expanded statistics, 99,428 women had breast reduction surgery in 2001. Breast reduction surgery was the fifth most performed reconstructive plastic surgery procedure in 2001.

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or the Royal College of Physicians and Surgeons of Canada.
Source: http://www.plasticsurgery.org/mediactr/breast_reduction.cfm


breast reduction by liposuction


Liposuction reduces the breasts by removing excess fat. If there is enough elasticity in the skin, it will retract and produce a visible breast lift.

Advantages of breast reduction by liposuction over traditional methods
  • Less trauma to the breast
  • Faster recovery
  • Less visible scars
  • Fewer postoperative complications
The best candidates for breast reduction by liposuction have breasts that contain a large proportion of fat. If your breasts have more glandular tissue than fat, a mammoplasty may be more appropriate. The proportion of fat in the breast can be determined by a mammogram.

Candidates for liposuction
Types of women more likely to have more fat than glandular tissue in their breasts:
  • Women that do not have pendulous breasts (often signifies more glandular tissue than fat)
  • Women who are not thin (thin women tend to have more glandular tissue than fat)
  • Women that do not have excessively large breasts (liposuction normally provides a 30-50% reduction in size)
  • Women that do not have excessively dense breast tissue (often signifies more glandular tissue than fat)
  • Women after menopause (during menopause fat replaces glandular tissue)
Breast reduction by liposuction will produce a smaller version of the breasts that a woman had before liposuction. The breast's overall shape will be very similar to their shape before liposuction.

Liposuction removes fatty tissue from the breast, and mostly spares the glandular breast tissue that is responsible for milk production (breastfeeding is normally not affected). There is so little trauma to the breast tissue that mammograms usually appear normal after liposuction of the female breast. In contrast, after a mammoplasty, mammograms may show calcification and other changes in appearance.

After liposuction of the female breast, there is a gradual decrease in postoperative swelling over the subsequent 2-4 months. There may be temporary lumpiness for several weeks after surgery. This is not visible and is part of the healing processes.

Male Breast Reduction



Liposuction of the male breast is one of the four areas on men most commonly treated by liposuction. The other areas are the abdomen, flanks, and facial liposuction. Men with excessive fat in their breasts are good candidates for liposuction.

The normal male breast contains both fat tissue and glandular tissue. True breast tissue in males is typically a small localized lump located immediately under the nipple that is more firm than the surrounding fatty tissue. It is easy to remove fatty breast tissue by liposuction, but much more difficult to remove glandular tissue. A mammogram can help determine the amount of glandular tissue located within the surrounding fatty tissue.

Pseudo-gynecomastia
Pseudo-gynecomastia is an enlarged male breast caused by excessive fat tissue, but a normal amount of glandular breast tissue. Pseudo-gynecomastia occurs in many men as they become older and in younger men who are relatively obese.

Pseudo-gynecomastia can be effectively treated by liposuction.

Gynecomastia
Gynecomastia is an enlarged male breast caused by excessive glandular tissue. Excess breast tissue occurs in about 75% of young boys during puberty. This condition is normally temporary, and only lasts a few months. In 33% of puberal cases, the condition subsided within 1 year, and in 93% of cases, the condition subsided in 3 years.1
1Ersek RA, Schaeferele M, Beckham PH, Salisbury MA, Gynecomastia: A clinical review, Aesth Surg J 2000, 20:55-58

Gynecomastia can be treated by eliminating the cause or by surgical excision.

Causes of gynecomastia: (not an exhaustive list)
  • alcoholism
  • effect of medications
  • low levels of testosterone
  • renal failure
  • testicular canceradrenal tumors
  • cirrhosis of the liver
  • severe starvation
  • lung cancer
  • tuberculosis
  • hyperthyroidism
If a man has a single enlarged breast, it may be a breast tumor and a doctor may consider a mammogram.

Drugs
Drugs that can cause gynecomastia include:
  • Amiloride (Moduretic)
  • Amiodarone (Cordarone)
  • Amphetamines
  • Anabolic steroids
  • Antiandrogens (cyproterone)
  • Anticancer drugs (cytotoxic)
  • Androgens
  • Busulfan (Myleran)
  • Captopril (Capoten)
  • Cimetidine (Tagamet)
  • Clomiphene (Clomid)
  • Diazepam (Valium)
  • Diethylpropion (Tenuate)
  • Digitalis
  • Domperidone
  • Estrogens
  • Ketoconazole (Nizoral)
  • Marijuana
  • Methyldopa
  • Metoclopramide
  • Nifedipine (Procardia)
  • Nitrosourea
  • Penicillamine
  • Phenothiazines
  • Phenytoin (Dilantin)
  • Reserpine
  • Spironolactone (Aldactone)
  • Tricyclic antidepressants
  • Vincristine
You'll want to discuss any connection between your condition and any drugs you are taking with your physician.



Information provided is for general education about cosmetic surgery. This information is subject to change. BoardCertifiedDatabase.com does not guarantee that it is accurate or complete, and is not responsible for any actions resulting from the use of this information. General information provided in this fashion should not be construed as specific medical advice or recommendation, and is not a substitute for a consultation and physical examination by a physician. Only discussion of your individual needs with a qualified physician will determine the best method of treatment for you.
Copyright 2002. All rights reserved.