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FAQ
Breast reduction surgery is a cosmetic operation performed to decrease breast size for patients who are dissatisfied with their natural breast size or shape. Many patients experience back, neck or shoulder pain from the extra weight of their breasts. Some women are uncomfortable exercising with large breasts. These patients may seek breast reduction at any age. A second large group of women experience some atrophy of their natural breast tissue following child birth, breast feeding, or massive weight loss. These patients often just wish to diminish the excess saggy tissue so breasts sit higher on the chest wall, providing a fuller, younger looking breast.
There is a third smaller group of women who have unevenly shaped breasts, so that one breast is much larger than the other breast, or one breast sags lower on the chest wall than the other breast. If their general health is satisfactory, any of these groups of patients can be evaluated for breast reduction.
Implants
In some cases, patients will also select breast augmentation to support the breast reduction surgery and to provide added fullness to the surgical outcome. All implants currently available have a silicone elastomer that forms the outer shell. Some are smooth and others have a textured surface. The outer shell may have a variety of shapes and can come in a number of different sizes. These outer shells are usually filled either with saline (salt water) or with silicone gel, though the latter is usually only available for breast reconstruction. Other substances are being studied experimentally but almost all implants used in breast augmentation in the United States today are filled with saline. As other substances pass the safety tests Dr. Cram and Dr. Aly will evaluate their use, but at this time we are using saline filled implants for all breast augmentation. The choice of outer surface, shape, and size is a matter for discussion in every case, and will be influenced by the patient’s needs, and the experience of the surgeons. As a general rule we favor smooth surface round implants for the majority of breast augmentation cases.
Anesthesia
Breast reduction can be done under local anesthesia with sedation, or can be done under general anesthesia. In either case the procedure is done on an outpatient basis. The choice of anesthetic technique will be discussed during your consultation. Patient safety and comfort are our primary concern, and the anesthetic choice will be chosen with these two parameters in mind.
Operation
Very few patients are perfectly symmetrical in their natural state, and breast reduction cannot correct all of the usually minor difference between the two sides, but in the majority of cases the symmetry will be as good as or better than the natural symmetry that existed before breast surgery.
Breast reduction surgery requires two vertical incisions underneath the nipple, removal of the nipple and a full incision following the full crease underneath the breast tissue. This procedure will help raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and nipples.
The surgical incisions are then closed in layers by internal absorbable sutures. At the skin level we normally use medical grade glue so there are usually no sutures to be removed. These wounds tend to be in areas that will not be seen in clothing, with the exception of the incisions in the arm pit which may be visible in tank tops and swim suits. In most cases they heal well enough that even if they were visible they would be missed by the average casual observer. The wounds may be dressed with bandages or left open with only the glue coverage. In some instances the patient is asked to wear an elastic bandage for a few days after surgery.
Recovery
On the day of surgery and for a few days thereafter there will be some discomfort due to the incisions. Most patients are back to work about 1 -2 weeks after surgery. Any pain or discomfort is usually well controlled by the use of a variety of narcotic and non-narcotic medications. Most often by the third to fourth post operative day the patient is able to provide adequate comfort with over the counter types of medication such as Tylenol. We encourage early general activities but restrict weight lifting and heavy upper body work outs. The surgeon will discuss activity levels at each visit.
Results
With any surgical procedure there are risks and potential complications. Bleeding and infection are two risks of any operation and could occur in breast reduction as well. Possible side effects include: temporary bruising, swelling, discomfort, numbness, dry breast skin or permanent scars. Possible risks: thick, wide scars; skin loss; infection; unevenly positioned nipples; permanent loss of feeling in nipples or breast. As surgeons, we are aware of all of these possible complications and will always do all that we can to prevent their occurrence. However, despite our best efforts there is always the possibility that one of these complications could occur. In that event, the patient and the surgeon must remain a team, and work together to obtain the best outcome possible under the circumstances.
Cost
The cost of the procedure will depend on the each patient’s individual needs as well as the cost of the operating room and the anesthesiologist fees. The patient is usually given the information on cost at the time of the first consultation. It is important to know what the price quote includes so that the total cost of surgery is determined.
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