Medically known as reduction mammaplasty, a breast reduction lifts and reduces the size of the breasts. It is ideal for women whose breasts are too large. Common reasons include feeling self-conscious, back pain, neck pain, shoulder notching (where the bra straps cause an indent on your shoulder), breast sagging, difficulty with exercise, and difficulty finding bras and clothing. It is one of the highest patient satisfaction surgeries I perform.
Having completed a fellowship in breast surgery, and because many of my patients are interested in a female surgeon, this is an area of particular expertise in my practice. The goal is to give you smaller, lighter, firmer breasts with a nice shape. Frequently, the areola size is reduced. Many women notice following the procedure their posture is better, their neck and back pain subsides, and they feel more confident about their bodies. There is no typical patient. Your breasts should be fully developed. Occasionally when a young woman has serious physical discomfort, a breast reduction is done in the mid-teens, with the caveat a second reduction may be needed in the future.
Your breast enhancement consultation begins at my Palo Alto office, where I discuss the procedure in detail, review photos of typical results, and examine you to find differences between the size and shape of your breasts. At that visit we discuss types of reduction: vertical breast reduction, periareolar reduction, liposuction, and inferior pedicle/wise pattern reduction.
When she shared photos of breast reductions she performed I could see the passion she has in her work when she commented on the photos.
– K.M., San Francisco
The vertical breast reduction is a new technique and is my technique of choice. I like it because it allows me to fully reshape the breast tissue to get good form and projection. Many patients comment they have never been so round and perky. Those internal breast sutures help take tension off the skin, which helps my breast reductions maintain their shape and have better scars than other techniques. It also minimizes the scar, with a “lollipop” scar instead of the traditional anchor scar, so there is no scar under the breast. If your breast extends into your axilla (your armpit area), this portion is fat, and I remove it with liposuction at the time of your lift. I respectfully disagree with colleagues who say someone is “too big” or “too droopy” for using this technique. I have done this technique for over a decade, and I think the results are superior.
This is still a popular breast reduction technique and has been the workhorse of breast reduction surgery for thirty years. For extremely large reductions, I will still perform this procedure. I do not think it is as long lasting as the vertical lift, it relies on skin tone to do the lift, and the scar is substantially larger, with an “anchor” pattern.
This scar is just around the areola. It is good for a only for a small reduction/lift. It has issues with the permanent suture, areaola widening, and wrinkling of the skin. I tend to use it to do a small repositioning of the areola.
Is good to reduce the volume of the breast in fatty breasts. Most young women have dense breast tissue, so liposuction is more difficult. For older women who have softer, buttery fat, liposuction would work to decrease volume. Liposuction does not involve any skin excision, so for those with sagging skin, this procedure does not tighten and lift the breast. Be careful with this one. I had a patient who tried this under promises of “half your size” with “no downtime,” who now has rock hard breasts and constant pain.
I like to keep the nipple attached for sensation and ability to breast feed. This is used for extreme breast reductions. The nipple is cut off and used as a free graft. I have never needed to use this technique.
Breast reduction surgery is three hours under general anesthesia. Recovery time is two weeks. I perform these procedures at Stanford, the Menlo Park surgical hospital, and the private outpatient plastic surgery center in Palo Alto. If covered by insurance you may stay overnight. If it is cosmetic, then you will go home the same day.
Insurance will sometimes cover the surgery depending on your height, weight, and approximate volume to be removed. Every policy has different coverage. Many now require you to try “correcting” neck and back pain with physical therapy prior to surgery. If you take pain medication, have seen a doctor or chiropractor for neck and back pain, have been treated with antibiotics for rashes under your breast, please bring in letters from those doctors to support your claim. I will take photos and estimate the amount of breast tissue to be removed. The amount insurance requires removed varies with your BMI. The more you weigh, the more they require we remove. If you are not going down at least 2 cup sizes, about 300g, it is unlikely your surgery will be covered. The fat in your axilla (your armpit area) is not considered breast tissue. I do remove that with liposuction during the procedure.
Women who have not had children should note breast reduction may interfere with breast feeding ability.
If you are actively smoking, you need to stop at least one month before doing surgery.