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When Too Much Is Too Much

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Breast reduction may be the solution you are looking for …

While many women elect to have the size of their breasts enhanced, there are just as many who feel that too much is too much. Breast reduction surgery, also known as reduction mamma­plasty, removes excess fat, glandular tissue and skin from the breasts. Women who have large breasts may choose this procedure to alleviate discomfort or to achieve a breast size in proportion with their body. Breast reduction surgery may also help improve self-image and self-confidence, as well as the ability to participate in physical activities.

According to the American Society of Plastic Surgeons, it is easy to see why breast reduction surgery has risen to become one of the top five plastic surgeries in the U.S. Women are tired of wearing unattractive industrial-strength bras; they are tired of being unable to sleep because they have to lift each breast simply to turn over at night; they are tired of the pain they are experiencing due to the weight of their breasts. They are also tired of people who discuss their chest size versus their personality or intellect.

Not surprisingly, there are also men who want to reduce the size of their breasts, especially if they live in a hot or southern climate. Breast reduction surgery for men has increased significantly in the last few years. Whatever the reason, both men and women can have better posture, less discomfort and be free from the restrictions large breasts have created in their lives.

Why choose breast reduction?
This procedure will change the size, weight, firmness and shape of the breasts. Breast reduction may be considered due to one or more of the following conditions: breasts that are too large in proportion to the body frame; heavy, pendulous breasts with nipples and areolas that point downward; one breast larger than the other; back, neck or shoulder pain caused by the weight of the breasts; skin irritation beneath the breasts; indentations in the shoulders from tight bra straps; restriction of physical activity due to the size and weight of the breasts; dissatisfaction or self-consciousness about the largeness of the breasts.

Breast reduction surgery can be done at any age, but it’s generally advisable to wait until at least age 20, by which time the breasts are likely to be fully developed. However, sometimes surgery is performed on teens who suffer significant emotional and psychological effects of having too-large breasts.

What is the procedure like?
Individual factors and personal preferences determine the specific technique selected to reduce the size of the breasts. The most common method, though, involves three incisions: One goes around the areola; another runs vertically from the bottom edge of the areola to the crease underneath the breast; the third follows the natural curve of the breast crease.

After the surgeon has removed excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.

Usually, the nipples and areolas remain attached to underlying mounds of tissue, allowing for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although there is no guarantee.

Rarely, if the breasts are extremely large, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In such a case, the decision will have to be made to sacrifice sensation and the possibility of breast-feeding in order to achieve the desired breast size.

How should one prepare for surgery?
Depending on age, or if there is a history of breast cancer in the family, the surgeon may recommend a mammogram before surgery and another some months after surgery, enabling detection of any future changes in the breast tissue. Following breast reduction, the patient will still be able to perform breast self-examination and the surgery will not increase cancer risk.

Smokers will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so avoid taking these medications for a period of time before surgery. The surgeon will provide additional preoperative instructions.

Breast reduction surgery may be performed on an inpatient or outpatient basis. Inpatients will typically only stay for one night. Either way, the patient will need someone to drive her home and to stay with her for the next day or two.

Are there significant risks involved?
Risks and potential complications are best discussed on a personal basis between the patient and the plastic surgeon, but some potential complications include bleeding, infection and reactions to anesthesia. Rarely, a patient may require a blood transfusion during surgery. This usually can be anticipated in advance, and the plastic surgeon may advise the patient to donate her own blood in preparation for surgery.

Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time. Permanent loss of sensation in the nipples or breasts may occur rarely. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

Following the advice and instructions of the surgeon, both before and after surgery, will most certainly lessen the risks involved.

How much does breast reduction surgery cost?
This surgery ranges in cost from $5,000 to $10,000, but on average the patient can expect to pay around $7,200 (surgeon’s fee: $5,500; anesthesiologist’s fee: $700; facility fee: $1,000). For men, the surgeon’s fee may be a little less (around $3,305).

Will insurance cover breast reduction surgery?
Since many patients elect to have reduction mammaplasty performed to alleviate pain and discomfort caused by overly large breasts, the procedure is often covered by medical insurance. In this case, patients will have to provide documentation showing the back, neck or shoulder pain suffered as a result of breast size and the likelihood of the procedure to relieve those symptoms.

While not all reduction mamma­plasty procedures are covered, it is worth checking with your health insurance provider to find out.

How long will the results last?
Unless the patient gains or loses a significant amount of weight or becomes pregnant, breast size should remain fairly constant. However, gravity and aging will eventually alter the size and shape of every woman’s breasts. If, over time, a woman becomes dissatisfied with the appearance of her breasts, she may choose a breast “lifting” procedure to restore a more youthful contour.

Results of Breast Reduction
Breast reduction surgery will make the breasts smaller and firmer. Without the excessive weight of large breasts, the patient may find greater enjoyment in physical activity.

The incisions from breast reduction surgery will heal and fade over time.

It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are easily con­cealed by clothing, even low-cut necklines.

Breast reduction often makes a dramatic change in the appearance. For this reason, it may take time to adjust to a new body image. Most women, however, become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure performed today.

By Elizabeth Anthony