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BREAST REDUCTION WHO IS A CANDIDATE? 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. |