Breast Reduction Procedures

With a reduction, you always receive a lift, and many patients feel as if a weight has literally been taken off their shoulders after surgery. They find that they can breathe more easily, exercise harder, and even rest more comfortably after reduction surgery. Finally, you can just put on a regular bra in a real store and not have to shop at a specialty store for your support garments. It is one of those little surgical miracles. Breast reduction surgery has one of the highest patient satisfaction ratings of all surgical procedures according to the 2001 American Society of Plastic Surgeons Patient Review Study. This has been my experience as well. This operation really works. Your breasts will be smaller, higher, perkier than ever before. And although time and gravity may continue to work, most patients are really, really happy with their results.Many patients have suffered from large breasts for many years, and while a certain percentage of breast tissue is fatty tissue, oftentimes no matter how much weight you loose, your breasts still remain large. In fact, I have had many women feel like they have gained weight in order to remain in proportion to their breasts. Combined with the fact that larger breasts make it nearly impossible to exercise or loose weight, it becomes a vicious cycle.Rashes, especially in the summer, can be a bother. Women with asthma can feel like they are choking or unable to breathe when they lie on their back.Bra straps – even gel padded ones – can dig into your shoulders causing deep, permanent indentions. Sometimes pressure from the straps can even cause numbness and tingling in the finger tips and arms because the straps are pressing on the brachial plexus, an important nerve.In addition, back pain – especially between the shoulder blades – is a very common complaint. Sometimes women even develop a little dowager’s hump or hunch back, from leaning forward all the time. Tension develops in the neck muscles and can trigger migraines. Postural exercises can help. Physical therapy, or muscle massage, can sometimes relieve these problems, but it may help only temporarily. I have had some women gain relief with chiropractic adjustments of the spine. Acupuncture can address pressure points. Yoga and Pilates help loosen up the muscles. Ibuprofen, Advil and Aleve can be taken, but they are not a good long term solution.

While the many long-term benefits of breast reduction surgery have been amply documented in numerous medical journals, we still have to provide your insurance company with a reason they should pay for this procedure. This has become more time consuming than the actual surgery itself! How this helps hold down the high costs of medical care, I am not sure, but the debate is certainly contributing to lots of paperwork and gray hairs on our part. For your specific insurance company’s medical criteria, you can go to their web site and review their medical policy bulletins. For example, Aetna is at www.aetna.com. See United at uhc.com, Pacificare at pacificare.com, and Cigna at cigna.com/health. Halls.md will help you calculate your body mass index.

The standard surgery uses an upside-down T shaped or anchor scar. While the majority of people were pleased with the results, there were problems with the horizontal portion of the scar at the ends and where the vertical and horizontal scars meet. These areas were prone to enlarging from the tension on the sutures, leading to wider, thicker scars here. The vertical scar procedure or lollipop mastopexy was first described in 1964, but it was not until Madeline LeJour, from Belgium, combined this with liposuctioning of the breasts, in the 1980’s, that it received much attention. She and others have developed this into a fine art. I have been doing this for more than ten years now. The three key benefits over traditional methods of breast reduction are: LESS SCARRING, MORE SHAPELY BREASTS, GREATER LIFT.

I also do breast reduction with liposuctioning alone, as well as other types of reductions, but the vertical mastopexy has been wonderful. There was a good article at talksurgery.com, but you can do your own google search on vertical mastopexy, LeJour Mastopexy, etc.

Before and After Photos

Patient A

Front View

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This woman had huge breasts that interfered with her activities. Before surgery, see the dark spots between her breasts? This was from where her bra rubbed up against her causing a permanent discoloration of her skin. After surgery, look where the dark spot is – she really is much higher than she was before surgery.

Patient B

Front View

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Side View

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How difficult it was for this college student to feel comfortable in a swim suit. She was so large, it made it difficult to find clothes. She also suffered from back, neck, and shoulder pain. She underwent a reduction using just the lollipop incision, and is shown one year after surgery. Scars can take one or more years to fade.

Patient C

Front View

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Side View

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Other Side View

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This young woman developed breasts in 6th grade. She literally grew overnight! They were never up high, but were immediately droopy. Without surgery, her breasts would just continue to hang, lower and lower. Gravity always wins. She did not have a reduction per se, as no breast tissue was removed, only extra skin, and the breast tissue itself was folded or “coned” on itself to give it a more pyramidal shape – then the extra skin was removed This was done with just a “lollipop” shaped scar – so no scars in the bra line. She is shown here after a year, when the scars have faded.

Patient D

Front View

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Side View

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This 32 year old is only 5′ tall and 116 pounds. However, she had DD size breasts that were really heavy and out of proportion to her small frame. She also had back, neck, and shoulder pain. After her reduction, look how her breasts no longer spill out underneath her arm pits and down onto her ribs. She can wear a bra and not come out all over. She can walk and not have her arms rub against her breasts. You can actually see her rib cage! This woman is just so much more comfortable now.

Patient E

Front View

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Side View

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This young lady developed severe ptosis (breast droop) following childbirth. Her breasts became so engorged and large during pregnancy that it stretched her breasts out permanently. Ptosis can be measured in two ways – one method is to measure the distance between the sternal notch and the nipple. Usually that distance is between 8 and 9 inches (the notch is the boney holly between your two clavicles at the top of your sternum. If this distance is 10 inches or more, almost by definition you have droopy breasts. The second way to evaluate ptosis is to see if your breasts will hold a pencil or two. This patient was droopy by both measurements: she measured almost 9.5 inches, and could easily hold a pencil under her breast. She had a breast lift combined with fat transfers to her breasts, and this really helped lift up her chest. The fat transfers were added to the top of her breasts to help fill that out. No implant was used. How much of the fat will stay in place remains to be seen. This transferred fat is not as firm as an implant, and I can only add a little volume with it – like frosting on your cakes. I can’t make a whole cake out of fat transfers, but I can put a little frosting on top. One note, even with a breast lift, there will always be some slight droop. This is normal.

Patient F

Front View

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Side View

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A breast reduction also includes a breast lift! And it can literally take the weight off of your shoulders. This woman had over 1.5 pounds removed from each breast to achieve this result.

Patient G

Front View

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Side View

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This young lady felt her breasts were heavy and out of proportion to her body, especially as she got older. If you notice, she has a mole between her breasts and, after the reduction, the entire breast is ABOVE the mole! It really gives you an idea of how much lift you get with a “lollipop” reduction. She now has a torso and a waistline! Her breasts are not down to her elbows anymore. She feels so much more comfortable with her look. So much more fun to go shopping and have everything the same size.

Patient H

Front View

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Side View

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This woman’s large, heavy breasts made it difficult for her to exercise. After she had her reduction, she actually lost weight and gained muscle! I really have had a lot of women lose weight following a breast reduction, because it becomes so much easier to be active as you’re not lugging all that extra baggage around. Here she is 4 years after her reduction: her breasts are still proportionate to her figure and have stayed up! In addition, she had a tummy tuck just to show off her new look!