Also
known as reduction mamoplasty, it is an operation intended
to reduce the size of a woman's breasts and improve their
shape and position. Frequently, the areola (dark skin around
the nipple) is also made smaller, Functional symptoms (medical
disorders) caused by excessive breast weight may be relieved
or improved by this operation.
Women
who have large, heavy breasts which may be the cause of
breathing difficulties, back, shoulder and neck pain, poor
posture, bra-strap indentations and chafing under the breasts
will benefit from reduction. Women
with excessive breast size, which may decrease a sense of
attractiveness and self-confidence are candidates.
Large
breasts that interfere with normal daily activities or with
exercise will be more comfortable when reduced.
INTENDED RESULT
More attractive contour and
smaller breast size.
Freedom from health problems
associated with excessively large breasts.
Improved self image.
PROCEDURE DESCRIPTION
Minimal
incision surgery using a "vertical" technique
is the most common method of breasts reduction used by our
doctors, This method has been used in Brazil and France
for many years but is performed by only a few Plastic Surgeons
in his country. The benefits include: fifty percent less
scar, a more narrow breast, better forward projection, longer
lasting improvement, shorter surgery time and less complications.
We have stopped using the "anchor" or inverted
"T" incisions as these provide inferior results.
The
procedure is done under general anesthesia on an out-patient
basis or in the hospital.
Generally,
two board certified plastic surgeons will perform the operation.
Physician assistant, nurses and medical students may act
as assistants. There will be a separate bill for the assistants
fee.
Liposuction
may be used to reduce the size of the breast in selected
patients. This method has the least number and size of scars
but has the greatest limitations in shaping and reducing
the breast.
Liposuction
may be combined with the vertical method.
There
are a variety of techniques for these operations. Occasionally
in patients with very large breasts, there is an incision
around the areola. Another between the areola and breast
crease, and the third within the crease under the breast.
This is an "anchor-shape" or inverted "T"
incision. When possible, these incisions may be modified
and more limited. Some operations may require only the
incision around the areola.
In
extraordinarily large or bulky breasts. For technical
reasons, we sometimes remove the nipples completely and
put them back as "free grafts". The sensory
nerves are all cut, and even though a certain amount
of sensation returns after healing, it will never be
normal and erotic sensation is lost completely. The milk
ducts are interrupted in this operation, so nursing would
be impossible. You will be amply informed in advance
if your breasts are in this category.
RECUPERATION AND
HEALING
The
incisions are covered with light dressings, and you will
be place in a bra, which you should bring to the surgery
center with you. The bra holds the breasts symmetrically
during the initial healing.
Initial
discomfort subsides daily and can be controlled with oral
medication.
Discomfort,
swelling and discoloration of the breasts are to be expected
for several weeks. Usually, our patients return to almost
normal activity within two weeks. The scars at the incision
lines typically become reddish. Raised and firm a few weeks
after surgery, but after many months they become pale and
soft. After 8-12 months, the scars are relatively inconspicuous.
The nipples and some areas of the skin may be numb or sensitive
after surgery. Sensation may return within a few weeks or
months, but may be diminished or overly sensitive.
Surgery
will probably reduce and possibly eliminate the ability
to breast feed.
Gravity
continues to have its effect, and there is a tendency for
the skin of the breasts to stretch over a long period of
time. Women very a great deal in this respect In general,
the smaller the breasts the less the tendency for sagging
to recur. If the breasts sag again, further excision of
the skin on an outpatient basis can be used to correct the
problem. If we try to lift heavy breasts without making
them smaller at the same time, sagging will return soon.
One key to satisfying result is realistic expectations.
OTHER OPTIONS
An additional procedure that
would enhance the result is Liposuction of the axillary
area to reduce excess fat deposits. Occasionally patients
respond to weight loss.
INSURANCE GUIDELINES
Large
breasts (macromastia) or breast hypertrophy can occur in
a variety of conditions (family trait, post pregnancy, excessive
adolescent growth). When the excessive causes functional
problems, insurance will generally pay for the operation.
These problems may include neck pain, back or shoulder pain,
hygiene difficulty, and breast pain. Other problems which
are less likely to be covered by insurance include skin
irritation, skeletal deformity, breathing problems, psychological/emotional
problems, and interference with normal daily activities.
Pre-authorization by the insurance company is required prior
to surgery, and the process takes approximately one month.
Each insurance policy has different guidelines and exclusions.
This
procedure is commonly covered by insurance though insurance
criteria are becoming more and more restrictive. Our staff
will assist you in obtaining pre-authorization.
NOTE
The
specific risks and suitability of this procedure for a given
individual can be determined only at the time of consultation.
All surgical procedures have some degree of risk. Minor
complications that do not affect the outcome occur occasionally.
Major complications are rare.
