When doing a breast reduction, what are questions other than the general questions (board certification, how to pick a surgeon, how many have you done? etc).
what technique do you use???
This is the biggest question for a breast reduction. I do the lollipop short scar technique. In 2020 70% of plastic surgeons do the anchor scar. I have no idea why. DO NOT DO THE ANCHOR. I have heard every “justification” of the anchor scar. “You are too big” “You are too droopy” “It won’t give you the result you want.” I disagree with all those excuses. I have done the lollipop technique for all my reductions for a decade now. In my experience, the vertical lollipop lift is better on almost all fronts: it lasts longer, it has internal shaping sutures, it has much less scar, and it doesn’t rely on skin tone to maintain the lift.
WHY DO OTHER DOCTORS STILL DO THE ANCHOR LIFT? You can ask them. I think many of them are fed patients because of their referral system (big places like Kaiser, Stanford, Palo Alto Clinic, etc), so they don’t feel the need to update their technique. I think many of them learned the anchor lift in training (as I did as well), and have not bothered to update their techniques. I think they may not understand the true issue of the scar in the inframammary fold. A recent consultation patient of mine saw three docs, and the other two had recommended the anchor. She was told “it is hidden under the breast,” implying it was not a big deal. I would reply, it is visible and it is a big deal- when you lie down, you will see that scar. You will feel that scar along your braline. It can get irritated by your bra. That big underneath scar in the anchor is the one that tends to form hypertrophic or keloid scars. So no. Just no.
Other questions:
- DO YOU DO LIPOSUCTION? For me the answer is yes. I do not “charge extra” for this. This is part of the reduction, and removes the axillary fat (the fat in the bra strap area) which helps narrow the breast and make the overall result better. You cannot liposuction the breast itself to do the reduction. Read my blog on it HERE.
- DO YOU USE DRAINS? For me, no. I used to use drains, and they would stay in for a day or two. I stopped using drains a few years ago now, and have not had issues.
- WILL INSURANCE COVER THIS? The answer is trickier than in the past. I did a breast fellowship after my plastic surgical training, and have done tons of breast reductions for 20 years now. When I started, most of my reductions were covered by insurance. Then the plans became tougher. Please see all my blogs on the subject HERE. We plastic surgeons do not determine if you are covered. We work with you to appeal to your insurance as to why your surgery is medically necessary. If you have seen physical therapists, chiropractors, acupuncturists, ask those practicioners to give a letter of support for your reduction. Most insurance companies really adhere to the Schnur scale. Again, read my blogs for additional detail. Of note: I am not contracted with insurance plans, so am considered “out of network.”
- DO I NEED AN IMPLANT? This one boggles my mind. Why would you ever put in an implant in a reduction patient? If they are coming to you to have a smaller breast, why would you ever ADD more volume? This is one where doctors justify it as improving the shape and upper pole (the cleavage area) fullness. Again, this is part of why I love the lollipop lift. Some of my patients have so much fullness people have asked them if we put in implants (we did not). In fairness, if you have poor skin tone, fatty breasts, wear poor support, or put your breasts through the wringer, you may not maintain the fullness in the upper pole over time. But in those patients, in a bra they look great. There are many negatives of putting an implant into a woman with a lot of natural tissue. You will for sure need to replace the implant at some point. Breast implants can get infected, migrate, turn hard, and leak. And you are at risk for the snoopy or waterfall deformity. BLOGS HERE. So say no to an implant.