A breast reduction is an operation that removes unwanted breast tissue to make breasts smaller, lighter and more comfortable. It also usually lifts the breast as well. Patients often get relief from back and shoulder pain and are able to control the maceration of skin that can occur under the breasts from constant sweating and rubbing. More often than not it should be considered a reconstructive procedure to alleviate these symptoms, but insurance companies have created a maze of requirements and “guidelines” that make it immensely difficult, even in the most extreme cases, to have the operation paid for under their policies.
Dear Dr. Silberblatt, Though you did my breast a long time ago – I didn’t mean to wait this long to tell you how thankful I am with myself now and to you for a wonderful job. Each day is a blessing. I look forward to even wearing clothes that didn’t look right on me before. I really was in denial but thanks to you I accept myself now. -LC
There are many ways to do the operation and over the years I have tried inferior pedicle, central mound, superior pedicle and lateral pedicle techniques using circular, lollipop and inverted T incisions/scars. When breasts are so large that the nipples almost touch the belly button (or are below it), removal of all the breast tissue below the ribs with transfer of the nipple as a free graft is the only reasonable solution. When this more radical approach is not necessary, I have found that the inverted T incision yields the most consistently good results. Other approaches have unacceptably long down times or poorer scars in spite of the claims their proponents make.
The operation that I do starts with drawing a keyhole pattern on the breasts with my patient sitting up in the pre-anesthesia area. This pattern is centered on the new, higher location for the nipple. I also draw an elongated dome from the base of the breasts, around and over the nipple. During surgery I remove the skin on this dome, leaving a smaller nipple and areola attached on top. The skin and fatty tissue around this mound is now lifted off the breast tissue. Extra breast tissue on either side and above the inferiorly based mound is removed. This will be the substance and volume of the new breast. It is now lifted to be in a higher position on the chest and the skin flaps are brought around and under it to keep it in place. If necessary, liposuction of the sides is now done to reduce fullness in this area. All incisions are then closed. A bulky cotton dressing with ace wraps around the chest is used as a dressing. The dressing is changed after about five days but the breasts are supported in their new position for six weeks using special bras. Sutures are removed after about two weeks. In all but the most strenuous jobs, patients return to work in two to three weeks. If lifting and vigorous chest/arm activity is required, return to work might be delayed for as long as six weeks. The vast majority of patients find that breast reduction results in significant symptomatic relief and allows for a more active lifestyle. It is a procedure with one of the highest satisfaction rates.
Did you know that the garment industry has no set standard for what cup sizes mean? This is why two bras of the same stated cup size by different manufacturers vary widely in fit. In fact, the same bra may vary in size over time as a company shifts the manufacturing contracts to different factories around the world!