ABOUT BREAST REDUCTION
The following information is regarding breast reduction which is important to review, understand and discuss with family and/or friends before choosing to proceed with surgery.
Goals of Breast Reduction: The purpose of breast reduction surgery is to reposition the nipple-areolar complex in a more normal location on the chest wall and to reduce excess skin and breast tissue, thereby producing a more naturally shaped breast. This tends to correct excessive sagging, as well as reduce breast size. As a side benefit to the physical changes of breast reduction, shoulder, neck, and back discomfort are usually relieved. In any given patient, these goals may be only partially met.
Limitations to the Procedure: Breast reduction surgery will not help back, neck, or shoulder pain due to other physical problems such as arthritis. Stretch marks in the skin will not be improved by this surgery. Absolute symmetry in the shape and size of the breast, as well as nipple position, is rarely achieved following this surgery. Subsequent breast sagging may occur as a result of aging, pregnancy, loss of skin elasticity, or the effects of gravity on the remaining breast tissue. Significant weight gain or loss may also change the shape of the breast. Redevelopment of breast tissue following reduction has been reported but has been extremely uncommon. There is no procedure available to reduce the size of the breast without surgical incisions so some degree of scarring is unavoidable following breast reduction surgery.
Alternatives to the Procedure: If no treatment for the condition of enlarged breasts is undertaken, one can expect further increases in back, neck, and shoulder discomfort with aging. Weight reduction and exercise in patients who are obese may lead to a small reduction in breast size, but breast tissue itself is not affected by weight loss. Without surgery, supportive garments can be worn which help to relieve some symptoms, but will not correct the underlying basic problem. Suction lipectomy, which is a form of fat removal, will help reduce that portion of the breast that is fatty tissue, but will not remove the glandular part of the breast enlargement.
Breast Cancer and Breast Reduction: There is no evidence that the incidence of breast cancer is increased or decreased after breast reduction surgery. Lifelong breast examination including physical examination and mammographic screening is still required following breast reduction surgery. Typically, there are mammographic changes noted after breast reduction surgery which are characteristics of this surgery and are generally easily recognized by radiographers. It is recommended that a new baseline mammogram be obtained 6-12 months following breast surgery. In patients over 35 years of age, a preoperative mammogram is obtained to screen for any suspicious areas in the breast tissue prior to surgery.
Surgical Techniques/ Anesthesia/ Recovery: The procedure takes place in the operating room and requires approximately 3 hours of operating time. The procedure is generally performed under general anesthesia. Blood transfusions are usually not required. If you desire, you may donate your own blood prior to surgery although I do not recommend this. Drains are utilized during the surgery and removed prior to your discharge. Immediately following surgery the chest area is wrapped in an ace bandage and I generally use the patient's old bra as an external supportive dressing at the time of discharge. Showers may be resumed 48 hours after surgery. There will be stitches around the nipple and underneath the breast which are removed 7-21 days after surgery. The breast area is generally quite black and blue following surgery which may take several weeks to resolve. It is not uncommon to see areas of drainage or small scab formation along the incision which may require special ointment or dressings for several weeks. It is necessary to refrain from heavy upper body physical exercise for 4-6 weeks following surgery. Lower body exercises can generally be resumed 2-3 weeks following surgery. I request that you refrain from driving for one week postoperatively. The average absence from work is 3-6 weeks.
Risks/Complications: The most common complication following surgery is a collection of blood or tissue fluid in the breast tissue. Drains are utilized to help alleviate this problem, but if a large collection of fluid develops, it is necessary to remove this in the operating room under light anesthesia. Infection is extremely rare and usually responds to antibiotic therapy. As mentioned above, it is common to see areas of scabbing or partial wound separation along the incision lines. This is treated with antibiotic ointments and special dressing when necessary. There may be temporarily increased or decreased nipple sensation which usually returns to normal in 3-6 months. In a small percentage of patients, there is a permanent change in nipple sensations or even loss of nipple tissue. Some degree of asymmetry in shape, size, or nipple position is usually noted. In some patients, excessive scarring can develop in which there are elevated, red, painful scars which generally improve with time, but may persist for several years following surgery. In rare instances, scar revision is required to alleviate symptoms. There may be a loss of pigmentation in the skin, particularly in the nipple-areolar area. Nipple retraction or change in contour may occur. Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation and/or of greatest concern. Any and all of the risks can result in additional surgery, time off work, hospitalization, and expense to you. Long-term changes in the breast may include the inability to breastfeed, as well as the development of breast lumps due to scarring or changes in breast fat. In some instances, a breast biopsy may be required to distinguish these normal postoperative changes from the development of breast pathology.
The practice of medicine and surgery is not an exact science. Although good results are expected, there can be NO guarantee nor warranty expressed or implied by anyone as to the results that may be obtained. Many factors beyond the control of the surgeon affect both short and long-term outcomes, scarring, and other health factors. On occasion, secondary surgeries may be indicated or desired to obtain the optimal result. If such procedures are performed, there may be additional charges incurred by you.
Comments: If you are a smoker, you must be off cigarettes for three weeks before surgery and for three weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss, and skin loss in smokers.
You must be off all products containing aspirin (Aspirin, Motrin, Advil, NSAIDS) for 2 weeks before surgery and 2 weeks after surgery. You must stop all herbal medications 2 weeks prior to surgery. ( check all medications with us)
Insurance/Payment: People having plastic surgery that is "covered" by insurance often have questions about why they are being charged by the office. Even if a surgery is deemed medically necessary, and not cosmetic in nature, then there may be charges that are either related to your deductible not being met or due to the actual benefits afforded by your plan. For instance, even if your deductible has been met for the year, you may have charges because your insurance only covers 80% of the allowable charge for the service (ie, the amount that insurance deems can be charged for surgery), leaving you to pay the remaining 20% until you meet a max out of pocket number which is dictated by details of your plan. We hope this helps to understand the very complicated insurance process.
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If there is any item that you do not understand, please call the office. An explanation or additional information will be provided.