Baltimore, Maryland Breast Reduction

Breast Reduction

Of all the procedures performed in plastic surgery, the one that has the highest patient satisfaction is breast reduction. Approximately 95-98% of the women who have this procedure say they would do it again and that they would highly recommend it. The reasons for this is that there are many benefits from a breast reduction. Not only are the breasts made smaller, but they are also lifted and re-shaped so, cosmetically, the appearance of the breasts is significantly improved.

Back pain, shoulder pain, neck pain, grooving of the shoulders from bra straps and rashes that occur under the breasts generally are greatly reduced or disappear completely after a breast reduction procedure. It becomes easier for the woman to find clothing that properly fits them once the breasts are re-sized to a more proportionate shape and size and also makes it easier for them to exercise without the extra weight and volume of large breasts.

Overall, breast reduction is relatively straight forward and it is one of the most commonly performed procedures. Most plastic surgeons are very familiar with this surgery and are able to achieve excellent results. The recovery from a breast reduction is usually easy and uncomplicated as well. Most patients report that the reduction itself is not too painful and only causes soreness. Typically, patients are advised to take one week off from work.

The only difficult decision for women who desire breast reduction is deciding if they wish to accept the scarring. This is the main drawback of a breast reduction. When the breasts are large there is "ptosis", or sagging, of the breasts. This happens when the nipple and areola drop below the inframammary crease, or fold under the breast. When ptosis occurs, not only does the patient require reduction but they also will likely require a breast lift.

A breast lift is done by removing the excess skin that has stretched over time. This involves creating incisions on the breasts themselves. Incisions typically go around the nipple/areolar complex, vertically down the middle of the breast from the nipple/areolar complex to the inframammary fold and then, often, in the inframammary fold itself. It is a typical anchor-shaped incision. For some women, generally those requiring smaller breast reductions, it is possible to perform the surgery with a keyhole type scar. This is an incision around the nipple/areolar complex and vertically down the middle of the breast to the inframammary fold. These patients can sometimes avoid the incision and subsequent scarring of the inframammary fold. The incision is truly the major consideration for most women desiring a breast reduction.

When I discuss incisions/scars with patients, I generally tell them not to worry about the incision around the nipple/areolar complex. Everyone has two different shades of skin joining this incision and it is usually camouflaged beautifully. I also advise them not to focus on the incision under the breast, as it is in the crease and is not typically visible when the patient is looking in a mirror. My recommendation to my patients is to consider the vertical incision from the nipple/areolar complex to the bottom of the breast. This will be visible to them for at least the first year until the scarring fades. For most women, this is an acceptable trade-off. For some women, however, and especially for those who are younger and not married, the incisions may be something they are not willing to accept and they decide not to proceed with surgery.

Choosing the right size is also an important discussion to have with the patient. Most women who want a breast reduction have very large and very wide breasts. I explain to the patient that it may be possible to reduce them to a very small size, however this is generally not advised. For example, if a woman is a 38DDD I tell her everyone I have met who is her size has a very wide breast. While it may be possible to reduce this woman to an A or B cup, women who are naturally A or B cups tend to have fairly narrow narrow breasts that are proportionate to their smaller cup size. In other words, if you put an A or B cup size on a wide breast, the cosmetic results are generally poor and the breasts appear wide and flat. To achieve a natural, attractive end result, the cup size of the patient's breasts need to be in proportion to the width of their breasts at the onset.

Many women are symptomatic with back, shoulder and neck pain and are candidates for insurance coverage. For these patients, I explain to them that the first priority is to remove enough tissue to have insurance cover the procedure while at the same time removing enough tissue to treat their symptoms of discomfort. After this, I explain to them that the next priority is cosmetic. If someone has a goal of a C cup, I continue to remove tissue until either I achieve a C cup size or feel that if more tissue is removed the cosmetic surgery result will be compromised. I explain to people that I would much rather leave them a full C and look good and natural than artificially make them a C cup and leaving them appearing wide and flat. Patients generally understand this and would much prefer to maintain a good cosmetic shape as long as their symptoms are treated. Using this approach, I have had excellent cosmetic results and very satisfied patients. In summary, it is very important to discuss the final size with the surgeon pre-operatively to ensure that the patient will be satisfied with the final result.

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