Enhancing your appearance with breast reduction surgery

Overly large breasts can cause some women to have both health and emotional
problems. In addition to self image issues, you may also experience physical pain
and discomfort.

The weight of excess breast tissue can impair your ability to lead an active life.
The emotional discomfort and self-consciousness often associated with having large
pendulous breasts is as important an issue to many women as the physical discomfort
and pain.

Also known as reduction mammaplasty, this procedure removes excess breast fat,
glandular tissue and skin to achieve a breast size in proportion with your body and
to alleviate the discomfort associated with overly large breasts.

Is it right for me?

Breast reduction is a highly individualized procedure and you should do it for yourself,
not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Breast reduction is a good option for you if:

What to expect during your consultation

The success and safety of your breast reduction procedure depends very much on your
complete candidness during your consultation. You’ll be asked a number of questions
about your health, desires and lifestyle.

Be prepared to discuss:

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine your breasts, and may take detailed measurements of their size and shape,
  skin quality, placement of your nipples and areolas
• Take photographs for your medical record
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of breast reduction and any risks or potential complications
• Discuss the use of anesthesia during your breast reduction

Preparing for surgery

Prior to surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Get a baseline mammogram before surgery and another one after surgery to help detect
  any future changes in your breast tissue
• Stop smoking well in advance of surgery
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can
  increase bleeding

Special instructions you receive will cover:

• What to do on the day of surgery
• Post-operative care and follow-up

Your plastic surgeon will also discuss where your procedure will be performed. Breast
reduction surgery may be performed in an accredited office-based surgical center,
outpatient/ambulatory surgical center, or a hospital.

You’ll need help

If your breast reduction procedure is performed on an outpatient basis, be sure to
arrange for someone to drive you to and from surgery and to stay with you for at
least the first night following surgery.

Procedural Steps:

What happens during breast reduction surgery?

Breast reduction is usually performed through incisions on your breasts with surgical
removal of the excess fat, glandular tissue and skin.

In some cases, excess fat may be removed through liposuction in conjunction with the
excision techniques described below. If breast size is largely due to fatty tissue and
excess skin is not a factor, liposuction alone may be used for breast reduction.

The technique used to reduce the size of your breasts will be determined by your
individual condition, breast composition, amount of reduction desired, your personal
preferences and the surgeon’s advice.

Step 1 - Anesthesia

Medications are administered for your comfort during the surgical procedure. The
choices include intravenous sedation and general anesthesia. Your doctor will
recommend the best choice for you.

Step 2 - The incision

Incision options include:

• A circular pattern around the areola

The incision lines that remain are visible and permanent scars, although usually
well concealed beneath a swimsuit or bra.

• A keyhole or racquet-shaped pattern with an incision around the areola and
  vertically down to the breast crease

• An inverted T or anchor-shaped incision pattern

Step 3 - Removing tissue and repositioning

After the incision is made, the nipple-which remains tethered to its original blood and
nerve supply-is then repositioned. The areola is reduced by excising skin at the
perimeter, if necessary.

Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely
large pendulous breasts, the nipple and areola may need to be removed and transplanted
to a higher position on the breast (free nipple graft).

Step 4 - Closing the incisions

The incisions are brought together to reshape the now smaller breast. Sutures are
layered deep within the breast tissue to create and support the newly shaped breasts;
sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent,
but in most cases will fade and significantly improve over time.

Step 5 - See the results

The results of your breast reduction surgery are immediately visible. Over time,
post-surgical swelling will resolve and incision lines will fade. Satisfaction with
your new image should continue to grow as you recover.

Important facts about the safety and risks of breast reduction

The decision to have breast reduction surgery is extremely personal and you’ll have
to decide if the benefits will achieve your goals and if the risks and potential
complications are acceptable.

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.
You will be asked to sign consent forms to ensure that you fully understand the procedure
you will undergo and any risks or potential complications.

The risks include:

• Unfavorable scarring
• Infection
• Changes in nipple or breast sensation, which may be temporary or permanent
• Anesthesia risks
• Bleeding (hematoma)
• Blood clots
• Poor wound healing
• Breast contour and shape irregularities
• Skin discoloration, permanent pigmentation changes, swelling and bruising
• Damage to deeper structures - such as nerves, blood vessels, muscles, and lungs -
  can occur and may be temporary or permanent
• Breast asymmetry
• Fluid accumulation
• Excessive firmness of the breast
• Potential inability to breastfeed
• Potential loss of skin/tissue of breast where incisions meet each other
• Potential partial or total loss of nipple and areola
• Deep vein thrombosis, cardiac and pulmonary complications
• Pain, which may persist
• Allergies to tape, suture materials and glues, blood products, topical preparations
  or injectable agents.
• Fatty tissue deep in the skin could die (fat necrosis)
• Possibility of revisional surgery

You should know that:

• Breast reduction surgery can interfere with certain diagnostic procedures
• Breast and nipple piercing can cause an infection
• Your ability to breastfeed following reduction mammaplasty may be limited;
  talk to your doctor if you are planning to nurse a baby
• The procedure can be performed at any age, but is best done when your breasts
  are fully developed
• Changes in the breasts during pregnancy can alter the outcomes of previous
  breast reduction surgery, as can significant weight fluctuations

Where will my surgery be performed?

Breast reduction may be performed in your plastic surgeon’s accredited office-based
surgical facility, an ambulatory surgical facility or a hospital. Your plastic surgeon and
the assisting staff will fully attend to your comfort and safety.

When you go home

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical
attention immediately. Should any of these complications occur, you may require
hospitalization and additional treatment.

The practice of medicine and surgery is not an exact science. Although good results
are expected, there is no guarantee. In some situations, it may not be possible to achieve
optimal results with a single surgical procedures and another surgery may be necessary.

Be careful

Following your physician’s instructions is key to the success of your surgery. It is important
that the surgical incisions are not subjected to excessive force, abrasion, or motion
during the time of healing. Your doctor will give you specific instructions on how to
care for yourself.

Be sure to ask questions: It’s very important to address all your questions directly with
your plastic surgeon. It is natural to feel some anxiety, whether excitement for the
anticipated outcome or preoperative stress. Discuss these feelings with your plastic
surgeon.

My recovery

When your procedure is complete, dressings or bandages will be applied to the incisions.
An elastic bandage or support bra may be worn to minimize swelling and support the
breasts as they heal.

A small, thin tube may be temporarily placed under the skin to drain any excess blood
or fluid that may collect.

You will be given specific instructions that may include: How to care for your surgical site(s)
following surgery, medications to apply or take orally to aid healing and reduce the risk
of infection, specific concerns to look for at the surgical site or in your general health,
and when to follow up with your plastic surgeon. Be sure to ask your plastic surgeon
specific questions about what you can expect during your individual recovery period.

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery? When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

The results will be long-lasting

The results of breast reduction surgery will be long-lasting. Your new breast size
should help relieve you from the pain and physical limitations experienced prior to
breast reduction.

Your better proportioned figure will likely enhance your self image and boost your
self-confidence.

However, over time your breasts can change due to aging, weight fluctuations,
hormonal factors and gravity.

How much will breast reduction surgery cost?

Cost is always a consideration in elective surgery. Prices for breast reduction can vary
widely. A surgeon’s cost for breast reduction may vary based on his or her experience
as well as geographic office location.

Many plastic surgeons offer patient financing plans, so be sure to ask.

Cost may include:

• Surgeon’s fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments, and
• Medical tests

Breast reduction surgery is generally considered a reconstructive procedure and may
be covered by health insurance when it is performed to relieve medical symptoms.

Many insurers define breast reduction surgery as reconstructive based on the amount
of tissue that will be removed.

However, pre-certification is required for reimbursement or coverage. Each insurance
policy varies greatly. Carefully review your policy to determine coverage.

Your satisfaction involves more than a fee

When choosing a plastic surgeon for breast reduction, remember that the surgeon’s
experience and your comfort with him or her are just as important as the final cost
of the surgery.

Words to know

• Areola: Pigmented skin surrounding the nipple.
• Breast reduction: Also known as reduction mammaplasty, the surgical removal of breast
  tissue to reduce the size of breasts.
• General anesthesia: Drugs and/or gases used during an operation to relieve pain and
  alter consciousness.
• Hematoma: Blood pooling beneath the skin.
• Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
• Liposuction: Also called lipoplasty or suction lipectomy, this procedure vacuums out fat
  from beneath the skin’s surface to reduce fullness.
• Local anesthesia: A drug injected directly to the site of an incision during an operation
  to relieve pain.
• Mammogram: An x-ray image of the breast.
• MRI: Magnetic Resonance Imaging; a painless test to view tissue similar to an x-ray.
• Reduction mammaplasty: The surgical removal of breast tissue to reduce the size
  of breasts.
• Sutures: Stitches used by surgeons to hold skin and tissue together.