Breast Reduction

Who is a candidate?

Breasts are a focal part of a women’s femininity and sexuality, and changes in breast size or shape can often affect a women’s self-esteem and confidence.

Common reasons for having breast reduction surgery (or reduction mammoplasty) include:

  • Upper back and/or neck pain
  • Shoulder grooving
  • Rashes or open wounds below breasts
  • Asymmetry between the breasts
  • Changes following pregnancy, weight gain or loss, and aging

Will insurance cover breast reductions?

Insurance may pay for breast reduction surgery if you meet specific criteria laid out by your specific insurance plan.

You can often find the exact criteria online for your insurance carrier.

Common criteria include having the presence of upper back or neck pain, shoulder grooving, recurrent rashes or open wounds below the breasts, and having failed a trial of conservative therapy such as the use of powders and creams for the rashes, garment or bra changes, and possibly even physical therapy.

If you meet the criteria of your insurance plan, our office will submit for pre-authorization of the procedure on your behalf. This requires a consultation and photographs (that may be requested by the insurance company).

If the insurance company approves the pre-authorization, it is still no guarantee they will pay.

Each insurance provider also has their own criteria of how much breast tissue must be removed from each breast before they will pay for the surgery.

In some cases it may not be possible to remove that amount and still leave behind an aesthetically pleasing breast, and it is always possible they can later deny the claim.

Dr. Patel can estimate if this is a possibility in your case, and advise you accordingly.

Types of breast reduction?

When it comes to breast reduction surgery, there are different incision types and different “pedicles” of blood supply.

The classic incision is the Wise pattern incision, otherwise known as an anchor type incision.

Another option is the vertical incision, which is the same as the anchor minus the horizontal portion that lies in the fold. 

With either type of incision, the breast tissue that is left behind must have good blood supply to survive. Two common techniques include inferior pedicle reduction and superior-medial pedicle reduction.

In her experience, Dr. Patel prefers the superior-medial pedicle technique, due to the improved long-term appearance of the breast with better cleavage and less bottoming out of the breast.

Risks of breast reduction surgery

The standard surgical risks include pain; bleeding; infection; breast reduction scars; painful or hypertrophic scarring; injury to vessels, nerves, surrounding structures; change in nipple sensation; change in breastfeeding ability; asymmetry; poor cosmetic result; prolonged edema, numbness, parasthesias; fat necrosis; loss of all or part of nipple areola complex; need for further procedure and out of pocket costs; and risks of anesthesia.

Mammograms after breast reduction

If you are age 40 or greater, have a family history of breast cancer, or have a lump, you should obtain a baseline mammogram prior to breast reduction surgery.

If you already get routine mammograms, it is recommended to wait 6 months after surgery to get your next mammogram in order to allow time for healing, and then resume your normal screening schedule.

Can I have a breast augmentation at the same time as the reduction?

While it may seem counterintuitive, some women opt for implants at the time of their reduction.

The breast reduction accomplishes removing excess skin and breast tissue from various portions of the breast, and reposition the remaining tissue into a higher position.

What you cannot get from a breast reduction is fullness at the upper pole of the breast, and for that reason some women choose to have implants to fill that upper part of the breast.

Some surgeons prefer to do the reduction and implant surgery at separate times.

It is possible, however, to combine the procedures, understanding that you may have to come back for a revision if needed later.

In massive weight loss patients, there is also a greater tendency for the skin and tissues to stretch after the reduction, making the chance of revision higher.  

The second surgery is not always required, however one must always plan for the possibility, and understand this occurs at additional out-of-pocket costs. Please see the breast augmentation procedure for information on that portion of the procedure.

Postoperative follow-up visits

Visits following surgery typically occur the day after surgery (for dressing change and making sure there was no bleeding, fluid collection, or blood supply issues overnight), the week after surgery (for removal of drains if present), 2 weeks after that, and then spread out less frequently thereafter.

The schedule is adjusted based on doctor/patient preferences and needs.

Recovery time

Walking the day of surgery is recommended. You may shower 24 hours after the drains have been removed.

No baths, soaking in tubs, hot tubs, or swimming pools until incisions are fully healed. Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incision is okay.

Scar gel may be used starting 2 weeks after surgery or once incisions have no open areas, crusting, or scabs.

A soft, supportive (snug but not too tight), non-underwire bra that zips or fastens in the front is recommended for the first 6 weeks following surgery.

In general, Dr. Patel recommends avoiding exercise for 6 weeks following surgery, at which time you can ease back into your workouts.

Light activity that does not involve the upper body may be okay around 3 weeks after surgery.

You may return to work 2 weeks after surgery, depending on your pain level, stamina, and activities required in your occupation.

You may drive once you are no longer taking pain medications or muscle relaxers, and allow a 24 hour minimum window between your last pain medication or muscle relaxant dose and driving.

All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient.