Breast Reduction

Patients may experience a variety of symptoms from large breast. These can include back pain, neck and shoulder pain, headaches, rashes and/or moisture under the breasts. Some patients need to wear multiple bras and may have trouble finding clothing that fits appropriately.  Bra straps may leave indentations in the shoulders due to the excess weight. Patients may also have difficulty exercising due to the breast weight.

THE BEST CANDIDATES FOR BREAST REDUCTION

In most cases, breast reduction is not performed until a woman’s breasts are fully developed (i.e. the breasts have stopped growing).  However, the surgery can be done earlier if patients have extremely large breasts or are very symptomatic.  In addition, because hormone levels can alter your breast shape, desire for future pregnancies should be discussed with your physician.  If you are lactating, you will need to wait at least six months after you are done breast feeding before undergoing a breast reduction.  Patients who plan on having children in the future should understand that the breast size may change after additional pregnancies and the ability to breast feed may be limited after a breast reduction.  Patients should be relatively healthy and have a BMI less than 35.

Some insurance companies have criteria that needs to be met before they will approve the surgery, including type of symptoms, care by other providers (such as physical therapists), BMI (related to the ratio between your weight and height), and the amount of tissue that needs to be removed.

PLANNING YOUR SURGERY

During the consultation Dr. Elswick with discuss your symptoms, previous treatments, current and desired breast size, and plans for future child-bearing and breast feeding should be discussed in great detail.

A thorough physical examination of your breasts will be performed, including measurements of the breast. If possible, a mammogram should be completed prior to your consultation for those patients who qualify based on age (at least 35 years old) and family history of cancer.  If any masses in the breast or armpit are found, these will need to be further evaluated prior to surgery.  Any major medical problems will be evaluated and should be optimized prior to surgery to minimize complications; patients with a BMI greater than 35 should lose weight prior to having surgery due to the significant increase in complications associated with being overweight.  Patients will have long term result from their breast reduction if their weight is stable and they are at their goal weight.  Patients who smoke or use other nicotine products need to stop doing so at least four weeks before and after surgery.

After the consultation, Dr. Elswick will send a letter to your insurance company to preauthorize coverage of the breast reduction.  This process generally takes 6-8 weeks.  You may wish to call your insurance company prior to your consultation to see what their criteria is to approve a breast reduction.

WHERE YOUR SURGERY WILL BE PERFORMED

If your breast reduction is covered by insurance, your surgery will be done at the hospital.  Dr. Elswick has privileges at William Beaumont Hospital of Royal Oak, William Beaumont Hospital of Troy, and McLaren Macomb Hospital.

If your breast reduction is not covered by insurance, you can choose to have the surgery at Columbia Surgery Center (our private surgical suite adjacent to our office) or at one of the above hospitals.

TYPES OF ANESTHESIA

Breast reduction is performed under general anesthesia.

THE SURGERY

The techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that goes around the areola (the pigmented portion around the nipple), extends vertically down the breast, and follows the natural crease beneath the breast. From there Dr. Elswick removes excess breast tissue, fat, and skin.  The nipple usually remains attached to the underlying breast tissue but is moved up to create a perkier breast.  The areola size is frequently decreased.  The breast is contoured to improve symmetry as much as possible.  Liposuction may be used to remove excess fat from the armpit or sides.

In most cases, the nipples remain attached to the blood vessels and nerves that are supplying them. However, if the breasts are very large or the blood supply to the nipple looks compromised, the nipples and areolas may have to be completely removed and placed as a skin graft; this will result in a loss of sensation in the nipple and areola and can lead to changes in color.

Occasionally, when the nipples are in the proper position and minimal tissue needs to be removed, liposuction alone can be used to reduce breast size.  This technique minimizes scars.

AFTER YOUR SURGERY

The incisions on the breast are usually closed with sutures under the skin which are absorbed by the patient’s body so there is no need for suture removal post-operatively.   Dressings typically consist of surgical glue and tape which remain in place until they begin to fall off in the first 2-4 weeks post-operatively.  Sometimes a large cotton pad is placed over the breasts to catch drainage and keep your garment clean, which can be removed 48 hours after surgery.  Sometimes a large foam pad is placed on the chest wall, under the armpits, to apply compression to this area, especially if you had liposuction done.  You will also be given a special surgical bra, which can be washed and re-used.  The surgical bra should be worn for at least two weeks post-operatively.  From there, you can switch to a sports bra that fastens in the front (we do not want you lifting anything over your head).  You should avoid an underwire bra for at least three months after surgery.

Typically, Dr. Elswick does not place drains after a breast reduction.  Your body will make some fluid after the surgery, which is absorbed in the weeks following your surgery.  Sometimes you may hear or feel fluid at the surgical site, which is normal.  If the body does not absorb the fluid, a drain can be placed by a radiologist afterwards, although this is rarely needed.

Mild to moderate discomfort and pain is to be expected after surgery, which will usually subside in the first few days to weeks after your surgery. You will likely to feel tired and sore for 1-2 weeks after a breast reduction.  Most of your discomfort can be controlled by medication prescribed by your doctor in addition to taking regular Tylenol.

Bruising and swelling is expected after surgery.  Generally the major bruising and swelling subsides 1-2 weeks after surgery.  However, the final result of your reduction will not be evident until 6 months after surgery.

You should not participate in any strenuous exercise, heavy lifting, or repetitive upper extremity activities for 4-6 weeks after surgery.  Strenuous exercise includes any activities where your heart rate exceeds 100 beats per minute.  We highly encourage our patients to remain active post-operatively, doing activities such as walking.  You should not lift anything heavier than 10 pounds (about a gallon of milk).  Activities with repetitive arm motions include vacuuming, dishes, laundry, etc.  It is ok to type and work at a computer.  You can slowly work back into your normal activities at 4 weeks post-operatively and should be back to your normal self at 6-8 weeks post-operatively.

When you can return to work depends on how you are healing post-operatively and what you do for work.  Patients with sedentary jobs can return to work as early as two weeks post-operatively, although generally at least four weeks off is recommended.  If you do a lot of lifting or repetitive arm motions, you will require six weeks off or modified duties at work.

YOUR NEW LOOK

The removal of the excess weight should bring relief from your symptoms and give you a chance to lead a more active lifestyle. This surgery may help your self-esteem and improve your confidence. The scars can usually be placed so that you can wear even low-cut tops.  With improvement in the proportion of your breasts, your clothes will fit better.  You should wait at least three months after surgery before purchasing new bras and clothing because this will give time for the swelling in your breasts to resolve.

RISKS ASSOCIATED WITH BREAST REDUCTION

Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them.  In addition, every procedure has limitations.  An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.

The most common complication after breast reduction is minor wound healing problems, which usually occurs at the fold at the bottom of the breast where the horizontal and vertical incisions come together.  This is typically treated with simple dressing changes but can lead to a widened scar in the area, which rarely requires surgical revision.  Other complications include bleeding, infection, seroma (fluid accumulation sometimes requiring drain placement), asymmetry, contour irregularities, and rarely loss of nipple sensation or nipple hypersensivity (the latter usually improves with time).  If the blood supply to your nipple is compromised, the nipple and areola will be removed and placed back on the breast as a skin graft.  If this occurs, you will not have any sensation in the grafted nipple and areola, you would be unable to breast feed, and you may have a change in color of the nipple and areola.  Breast reductions can also compromise your ability to breast feed in the future. Sometimes you may require additional surgeries to address these complications.

INTERESTED IN SETTING UP A CONSULTATION? 

Dr. Elswick is highly trained and skilled in Breast Reduction.  She personally meets with her patients at our office located in Troy, Michigan.  She will ensures that your questions are answered and that you are ready both physically and mentally for this surgery.

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