Breast Reduction

Making Breasts Smaller and Higher Through Surgery
Macromastia (macro=large, mastia=breast)
Large breasts can cause a multitude of problems, including neck, back, and shoulder pain, headaches, shoulder-grooving (where the bra-straps dig in), postural problems (which contribute to upper extremity nerve problems), interference with activities and exercise, rashes under the breasts, inability to find clothing that fits properly, and problems with self-image. As a result, women with large breasts are often in chronic pain, have little energy, may be overweight because they are unable to exercise, and have self-image problems, all of which interfere with quality of life.

Possible Solutions to the Problem of Large Breasts

Weight loss and exercise are usually suggested (if not required) by insurance companies prior to approval for surgery, but often futile. Weight loss, even if successful, usually does not alleviate the symptoms of macromastia. Many women are unable to exercise because of the large breasts themselves – hence, a catch-22. Aspirin, Tylenol, Ibuprofen, and other medication may benefit some, but usually their effect is limited. Powders may reduce your chance of developing a rash in hot weather. Chiropractic care is rarely of help. Invariably, surgery is the most effective, most efficient, and most successful way to treat the problem of macromastia.

Breast Reduction Surgery

Breast reduction is an operative procedure in which breast tissue and excess breast skin are removed. The removal of breast tissue results in a smaller breast. Removal of excess skin results in a breast that is higher on the chest wall and more aesthetic. This is an important component of this operation, because it allows the breast to be restored to a youthful appearance and shape. If excess skin were not removed, the breast would actually look worse following breast reduction than before surgery.

During the operation, your nipples will be moved to a higher position on your breasts. This is usually accomplished WITHOUT removing your nipples and putting them back on. The technique plastic surgeons use to accomplish this is called transposition, in which the nipple stays fully attached to the breast – only the surrounding skin is moved. Because the nipple preserves its attachment, most women retain (or improve) nipple sensation, the ability to attain an erect nipple, and the ability to breast feed.

Getting Your insurance Company to Cover the Cost

Of course, getting your insurance company to cover anything these days can be quite a challenge. Your best bet is to find a plastic surgeon who has a good track record with getting approval from insurance companies. If your plastic surgeon estimates that he or she can remove at least 500 grams (one half pound) from each breast, AND your plastic surgeon can show that you have disabling symptoms directly attributable to your large breasts (see first paragraph on this page), AND your plastic surgeon can show that you have tried everything under your power to resolve these symptoms yourself (see second paragraph), AND your plastic surgeon can provide photos documenting the need for this operation, then there is a chance that surgery will be pre-authorized by your insurance company. Recently, however, meeting ALL of the above criteria has STILL not been enough. Most insurance companies now also require that the woman requesting this operation be at or near her ideal body weight. Unfortunately, this is where the catch-22 appears again: Women with macromastia are often unable to exercise because their large breasts are too cumbersome to allow it. So, they are unable to lose the weight necessary to satisfy the insurance company’s requisites for pre-authorization. Dr. Shay Dean has found that when she includes in her letter to the insurance company the patient’s prior history of macromastia during times of near ideal weight (if applicable), that this information verifies that IF the patient were able to lose weight, that she would still have macromastia and still be in need of the operation. You should ask your surgeon about including this information in your letter or pre-authorization (if applicable in your case). Of course, even though it may seem unfair that you and your surgeon are made to jump through such hoops, it is critical that both you and your surgeon include only honest information in your letter to the insurance company. Also, remember that even if your insurance company pays for the procedure and even if you use an in-network physician, you may still be responsible for a portion of the cost (check your policy to find out).

FYI – Many of you have inquired about whether Dr. Dean still performs breast reductions. He does so, and this continues to be one of his most common procedures. He accepts nearly all insurances.

Breast Reduction: During and After Surgery

Anesthesia: General Location of operation: Surgery Center or hospital. Length of surgery: 2-4 hours Length of stay: Overnight Discomfort: Moderate. Anticipate 3-7 days of prescription pain medication. Swelling and Bruising: Improve in 2-4 weeks. Bandages: Will be removed in 1-7 days. Stitches: Will be removed in 5-7 days or will be absorbable. Support: You will wear a sports bra or ace wrap for 1-4 weeks. Avoid an under wire bra until your surgeon approves it. Back to work: 1-3 weeks. Exercise: May be resumed in 2-4 weeks. Final result: Will be seen after the scars have matured, which will be about 1-3 years.

Risks of Breast Reduction Surgery

Scars: The only drawback to removing excess skin is that it necessarily causes scars. Fortunately, the scars can be limited to areas that are hidden when you are wearing a bra – they are located around the nipple, below the nipple, and along the crease beneath the breast. The scars fade after surgery, but it can take years for them to do so. There are some techniques of breast reduction which may eliminate the scar along the crease, but most of these techniques are in the development stage at this time. Usually the scars are acceptable, especially when considering the benefits gained in quality of life following breast reduction, but no one can guarantee that you will be pleased with your scars. If you are going to have this operation, you simply must accept the fact that you are exchanging the problem of macromastia for scars.

Nipple or breast numbness or sensory change: Numbness is uncommon. It is more likely that your nipple sensation will improve because the nerve to your nipple will no longer be stretched due to the weight of your breasts.

Nipple Loss: This is a tragic problem, because, in it, one or both nipples lose their circulation and die. There would also be an open wound, requiring care. Eventually, the wound would close, or surgery would be necessary to close it. The nipple would then be recreated artificially by using your own skin or tattooing a nipple. Nipple loss is most likely to occur in smokers, but may occur in anyone. If you smoke, you should quit at least 2-4 weeks prior to surgery to reduce your risk of this problem.

Infection, bleeding, fluid collections (seromas), asymmetry (unevenness between sides), and healing problems may occur following any surgery. If you are young and healthy and follow your doctor’s instructions, you may reduce your likelihood of these events.

Final Size: No one can guarantee your final cup size, because cup size is not standardized. Have a detailed discussion with your plastic surgeon prior to surgery to communicate your desired size. Explaining you preference in comparison to your current size is sometimes very helpful. For example, you might want to be somewhere between one third and one half of your current size.

Tips and Traps of Breast Reduction

Realize that this operation involves scars. If you are unwilling to accept scars, you should not have this operation, as no surgeon can predict how the scars will heal on you.
Quit smoking for at least two weeks before surgery.


Dean Plastic Surgery