San Francisco Breast Reduction
BREAST REDUCTION OR REDUCTION MAMMOPLASTY
Breast Reduction, is a surgical procedure that reduces the size and shape of the breasts by removing excess skin and underlying breast tissue. It also reduces the size of the nipple-areolar complex, which frequently becomes enlarged as a result of breast development. The surgery creates breasts that are lifted, smaller and shapelier.
With large breasts, a variety of medical conditions can result:
- “Shoulder grooving” due to excessive weight on bra straps
- Back and neck pain
- Difficulty fitting into clothes
- Slumped shoulders and other postural changes
- Difficulty with physical activities
- Irritation to the skin in the crease underneath the breasts
- Feelings of self-consciousness
For these reasons, most insurance plans provide coverage for Reduction Mammoplasty procedures. However, it can be purely a cosmetic procedure for women who are self-conscious about their breast size and do not meet the requirements of the insurance company.
Dr. Delgado has extensive experience with Breast Reduction surgery as well as working with insurance companies who cover this type of surgery.
WHO IS A CANDIDATE?
Women with disproportionately large breasts are good candidates for surgery. This is done for both cosmetic improvement and symptomatic relief. In general, women with size DD or greater are the most frequent candidates. However, even size C or D can be too large for a petite woman. While women from any age can benefit from the procedure, it is usually performed after the breasts are fully developed.
Insurance companies are making the approval process more and more difficult. There are numerous insurance companies, all with varying plans and coverage. Dr. Delgado’s surgery coordinator is experienced in securing authorization from insurance companies who offer such coverage. If supplied with the patient’s insurance card and her date of birth, the patient coordinator can submit a request for authorization from the patient’s insurance company. The application process can take three to six weeks and sometimes up to eight weeks or longer, before coverage can be successfully confirmed or denied.
These are some of the basic criteria that some insurance companies may require:
- DD in size or larger
- A total of 500 grams of tissue removed for each breast
- Symptoms not due to other medical conditions
- Failure of physical therapy or medications such as anti-inflammatories to alleviate symptoms
- The patient is not grossly overweight
It is very helpful if issues of this kind have been documented by your family care or other physician and we often include such documentation in requesting authorization from an insurance company.
Before Breast Reduction
For patients considering a breast reduction, they first want to have a personal consultation with Dr. Delgado. This can be scheduled at either the Marin County or San Francisco office.
During the consultation, Dr. Delgado will want to know how having large breasts has a negative effect on the patient’s life and what her concerns are about her appearance. During the consultation, Dr. Delgado will also conduct a routine breast exam.
The following issues will be discussed:
- Explanation of the different types of reduction:
- Short scar or lollipop reduction
- Inverted-T or anchor reduction
- Free nipple graft
- Revised nipple-areolar position
- Incision locations
- The patient’s desired new size
- Whether the patient is likely to qualify for insurance coverage and the steps involved in securing such coverage
The patient will be receiving a booklet that supplies detailed information on instructions for before and after surgery, including instructions on medications. Anti-inflammatory products, including aspirin must be discontinued for 2 weeks prior and 2 weeks after surgery as they interfere with the ability of the blood to clot. The instruction booklet will contain a complete list of medications that the patient must avoid, but any medications that the patient takes should be brought to Dr. Delgado’s attention. Tylenol, or acetaminophen, is safe to take, but, the patient must not take more than 1 gram over 4 hours or 4 grams per day as this may cause liver damage. Homeopathic preparations and a list of vitamins will be included in the booklet which the patient can use to promote healing and limit bruising, both before and after surgery.
Breast Reduction Surgery
DAY OF SURGERY
Breast reduction surgery is generally performed at a hospital or an ambulatory surgery center. The patient may be kept overnight to keep her comfortable.
Marin Cosmetic Surgery Center (MCSC), which is a fully accredited outpatient surgery center, is where Dr. Delgado performs reduction mammoplasty surgery. MCSC which is Dr. Delgado’s private surgery center is situated at his office in Marin County at the campus of Sutter Marin County Community Hospital. Being situated next to the hospital allows Dr. Delgado’s private patients to have the utmost in medical care at his surgery center with an extra measure of safety.
A surgical marking pen is used to draw a detailed map on the breasts and chest before anesthesia is given. The doctor needs an architectural plan to enable him to make adjustments that will accommodate the changes of the body as it moves from a prone position to an upright position. Whatever technique is used, the skin will need to be tightened as the nipple-areolar complex is moved up. Excess tissue will be removed and remaining tissue will be contoured and reshaped. Liposuction is used in many cases for removal of excess fat that may be on the sides of the chest.
The short-scar or lollipop technique was developed in Europe and now shares great popularity in the United States. This procedure limits the incisions and reconstructs the internal breast tissue to a more conical shape, giving the breasts a youthful appearance that is long lasting. The inverted-T technique is a time-tested gold standard. This procedure can be used for all size breast lifts and reductions. The skin incision is made like the lollipop incision, but an additional horizontal incision is made along the crease. This can tighten the skin to a great extent, but at the expense of a slightly larger incision. The shape of the breasts relies largely on the skin-tightening component.
The free-nipple graft technique is used for very large-breasted women, in which the anchor type of procedure is not safe. The free-nipple technique excises the nipple off of the underlining blood supply. The skin and breast is reconstructed much like the inverted-T technique, the nipple is replaced and sewn intact as a full-thickness skin graft. This technique works extremely well in large-breasted women. The scars are similar to an inverted-T. The nipple-areolar area usually loses sensation. Dr. Delgado has observed some women gain significant sensation after a free nipple graft.
Once the incisions are made and the breast tissue is reduced, the skin is meticulously closed in several layers. Steri-Strips™ are placed over the sutured incision lines, gauze pads are placed over each breast and a soft compression bra with front hook closure is put on the patient.
The surgery is done under general anesthesia. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers anesthesia. (See credentials for Randy Gaynor, MD on this website.) The anesthesiologist calls the patient the evening before surgery to review his/her medical history, confirm last minute instructions and answer any questions he/she may have regarding the anesthesia.
After surgery, the patient will be kept in the recovery room for a few hours. The patient will be allowed to go home with the help of a family member or friend once she is fully awake. Dr. Delgado may determine that a patient should be kept overnight to keep her comfortable in early post-operative period. Keeping the head and back elevated while sleeping is very important to control swelling.
In 3 to 5 days the dressings will be replaced, and if drains are used, they will be removed. In 24 hours after the drains have been removed, the tiny incisions will close, making them waterproof and then it is safe for the patient to shower. Until the drains are removed the patient may only take sponge baths, as the incision sites are vulnerable to infection and therefore must be kept dry. The surgery booklet has detailed instructions for wound care. Generally the sutures will be removed in 10 days. Suture and drain removal can be scheduled at either of Dr. Delgado’s offices, Marin or San Francisco.
For the first couple of days after surgery, the pain should not be too severe, but the breasts will be uncomfortable, therefore pain medication is prescribed to keep the patient more comfortable and aid in sleeping. Except for women with a low pain threshold, most are able to discontinue the pain medication by the third day.
After the first week, most of the swelling and bruising will be resolved, but women should allow themselves two full weeks for recovery. The patient is able to return to normal activities after the bruising and tenderness have resolved. Driving a car, returning to work and resuming social activities is possible after the first week. The woman should wait a week after surgery before resuming sexual activity as it could cause swelling and discomfort. The patient needs to wait six weeks after surgery before attempting strenuous exercise or swelling may recur.
RISKS AND COMPLICATIONS
Risks of complications are minimized at Marin Cosmetic Surgery Center due to their highly trained team, but all surgeries carry the risk of infection, bleeding and anesthesia complications. Reduction mammoplasty will leave scars from the incision around the nipple-areolar complex continuing to the base of the breast and along the breast fold when using the inverted-T technique. It is possible that there might be a reduction in sensation of the nipple and breast area. It may take up to 6 months for the feeling to return. Breastfeeding usually remains an option for women that have had breast reductions, but there may be a small minority that will lose the ability to nurse. In rare instances, one breast may be slightly a different size. There may be some slight differences with the nipple-areolar complex.
Women are able to enjoy immediate results of their breast reduction, but need to plan on at least a couple of months for their breasts to settle into their new position and shape. Right away women will notice that their balance is better. Shopping and trying on clothes will be a great experience. Improved posture, and reduction in back and neck pain will be realized as the body enjoys a lighter gravitational pull. Even though there are scars that result from this surgery, Breast Reduction patients are some of the happiest plastic surgery patients stating that the changes that the surgery has made are life changing.
FREQUENTLY ASKED QUESTIONS
About Breast Reduction Surgery
1. Will health insurance cover the cost of breast reduction surgery?
The surgery is often considered to be a reconstructive procedure, rather than elective plastic surgery. As a result, the chance of your insurance covering all of the surgery is more likely. A number of factors determine whether or not your procedure will be covered. These include the unique terms of your insurance policy, the amount of breast tissue that will be removed and the potential health risks you could face if you do not have surgery. To learn more about this, consult our guide, “Will Insurance Cover My Breast Reduction?”
2. Is reduction mammoplasty permanent?
Yes. Your breasts will always be smaller than they would have been without surgery. However, the remaining fat cells will swell and enlarge if you gain weight or become pregnant.
3. How is the surgery performed?
It is performed by surgical removal of skin and breast tissue. The nipple-areolar complex is also repositioned, in a higher, more youthful position.
4. Where are the incisions made?
The size of the breasts determines the technique used and the amount of tissue to be removed. The incisions could be the short scar (lollipop) technique or inverted T incision.
The incision circles the border of the areola, where the pigmented skin of the areola meets the lighter skin of the breast. There is also an incision from the inferior edge of the areola down to the breast crease. If the incision is an inverted T, there is also an incision that runs under the breast, hidden in the crease of where the breast meets the chest.
5. Is there bruising after surgery?
? The moderate swelling and bruising from breast reduction surgery resolves in seven to ten days.
6. How long will I be out of work?
Most patients are able to return to work within seven to ten days. Some patients will return to work in as little as five days. The exact amount of time will depend on the extent of your surgery, your pain tolerance and the physical demands of your work.
7. When will I be able to see the results?
After surgery, you will immediately notice the decrease in the volume and weight of your breasts. If you have reduction mammoplasty surgery to alleviate back pain, relief will be evident right away. The final aesthetic results take longer. The breasts will settle into place and the incisions will smooth out and eventually fade. This takes almost a year to complete the maturation process.
8. Who is a good candidate for breast reduction?
The ideal candidate is a patient who is at least 18 years old and is someone with realistic expectations. If you are self-conscious about the size of your breasts, or if you suffer from neck, back, or shoulder pain due to excessive breast size, you may be a good candidate.
9. What is the cost of a reduction mammoplasty?
The cost of breast reduction surgery varies with the surgical time needed, which is dependent on the techniques used and the complexity of the case. In general, approximately $9000-12,000 will cover Dr. Delgado’s fees, the board-certified anesthesiologist’s fee, the surgery center and all postoperative care. If your surgery is covered by insurance, there may still be a deductible or co-pay.
10. To whom should I talk about breast reduction?
If you are considering surgery or would like to learn more about reduction mammoplasty, contact us to schedule a consultation. Dr. Delgado, an experienced breast reduction surgeon, will discuss your goals with you and explain how we can help.