While many women desire larger breasts on the other end of the spectrum some women’s cup runneth over, if you will. That is to say some women have very large breasts and would like to have smaller breasts. A breast reduction, or reduction mammoplasty, is a surgical procedure designed to reduce the volume and weight of the breasts. Breast reductions inherently entail some degree of lift, if not a significant lift, to the breast mound as well. Some women have very large breasts because of their genetic inheritance and some women have very large breasts because they are varying degrees of being overweight.
Regardless of the cause of macromastia (large breasts) the most common stated reasons for desiring a breast reduction are: back pain, neck pain, shoulder pain, breast pain, rashes under the breasts, inability to exercise, difficulty finding clothes that fits, feelings of self-consciousness, and unwanted social attention (looks, stares, comments). Additionally, many women report that they get frequent rashes beneath their breasts. These rashes can even progress into skin infections especially in the summer when the heat makes it difficult to keep these areas dry. Some women may even experience migraine headaches due to their large breasts. These are generally the type of migraine headaches that start at the back of the neck.
Breast reduction surgery also known as reduction mammoplasty is designed to reduce the size and thus the weight of the breasts. The reduction in the size of the breasts reduces the sense of self consciousness and the difficulty fitting in clothes that many large breasted women experience. The reduction in the weight helps reduce the other symptoms such as the neck, shoulder, and back pain. Breast reduction surgery is performed under general anesthesia. It can be performed as an outpatient procedure but many patients and surgeons prefer one night stay in the hospital for added comfort and added safety during the first hours of the recovery. Scars are usually contained on the lower part of the breast but also go around the nipple-areolar complex. Drains are often used. Liposuction of the lateral part of the breast and chest wall is often used to reduce bulk and folds in that area and is effective to varying degrees.
Breast reduction is a procedure that is sometimes covered by insurance and sometimes is not. Whether or not the surgery is covered by insurance depends on a number of facture related to the insurance policy, the size of the breasts, the amount of tissue predicted to be removed, and the nature of the symptoms experienced. The insurance criteria for coverage vary widely but in general a breast reduction is more likely to be covered the larger the breasts, the more the woman is willing to allow to be removed, and the greater the extent of symptoms. Some insurance carriers want to see the women have tried and failed conservative measures such as physical therapy, weight loss, and pain medications.
The fact that breast reduction is a procedure that is sometimes covered by insurance creates an artificial distinction between a “cosmetic” breast reduction and “medical” or “insurance” breast reduction. Breast reduction surgery inherently has “cosmetic” overtones. That is to say that women who are undergoing breast reduction surgery covered by insurance are still concerned about the appearance of the result and I am too as a surgeon. Women generally desire more compact breasts, with nipples/areolas in higher positions, and with an overall uplifted and more round appearance. Fortunately, the surgical maneuvers required to these “cosmetic” goals also coincide with what is required to make the breasts smaller, with less volume and less weight, which are the “medical/insurance-based” goals. So in many ways breast reduction surgery can be a win-win situation for patients. I should mention that it has been my experience that women who have undergone breast reduction are some of the happiest patients with whom I have interacted.
Breast reduction surgery is performed under general anesthesia. Drains are often but not always used. Many patients are discharged home on the day of surgery but a one night stay in the hospital is also common. Women are instructed to wear a surgical bra or a sports bra for three weeks following surgery. It is important not to wear a bra with an underwire during the first three weeks following surgery as the pressure from the underwire may irritate or injure the incision sites. Discomfort, bruising, and swelling are all variable depending on the patient. Some patients find the recovery easier than others. Depending on the type of work a woman is involved in she may return to her job activities anywhere from a week to three weeks from surgery. Strenuous activity, especially exercises that involve the upper body, should be avoided for three weeks. Most women experience a relief from their neck, shoulder, and back pain immediately. Many women go on to lose additional weight following surgery due to their increased ability to exercise norm.
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