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Breast Reduction - Questions & Answers

How would you be evaluated for Reduction Mammoplasty?

Your cosmetic surgeon will evaluate a number of factors at your first appointment. These include your measurements, the size and shape of your breasts, and the placement of the nipples and areolas. He or she will also take photographs so an accurate record of your progress can be kept. Your plastic surgeon will also give you an estimate of how much breast weight that can be removed.

Can I Have Breast Reduction Surgery if I Have Medical Conditions Besides Those Caused by Large Breasts?
Yes. However, your cosmetic surgeon will first require that your medical conditions, such as diabetes or hypertension, be optimized prior to your surgery. Uncontrolled diabetes, thyroid, and immune disease can complicate your healing after surgery.

Can I Have Breast Surgery if I Plan to Lose Much Weight After the Surgery?
You should postpone Breast Reduction surgery until you have lost weight and your breasts size and weight have stabilized. Excessive weight loss after reduction mammoplasty can cause dramatic sagging of your breasts, requiring further surgery.

How Soon After Childbirth Can I Have a Breast Reduction?
You cannot undergo general anesthesia, or take any medications, while you are breast feeding. Also, it takes about six weeks for your breasts to reach their stable size and weight after you stop breast feeding. After this, you may undergo Breast Reduction. However, make sure that you are not planning further pregnancies in the near future.

Are There Options Besides Surgery for Breast Reduction?
Obese women who have large breasts may consider losing weight before embarking upon Breast Reduction. This initial weight loss will first reduce their risk for surgical complications; second it will make their recuperation easier, and third will bring their breasts to their stable weight and size before proceeding with reduction Mammoplasty. Also, women who have back and neck pain along with large breasts should first try physical therapy and weight loss before considering surgery.

Will Insurance Cover the Cost of Breast Reduction Surgery?
Because disproportionately large breasts lead to a number of chronic medical conditions, such as severe back pain, many health plans will cover the cost of Breast Reduction surgery. Insurance companies will consider factors such as the amount of breast tissue to be removed, what kind of coverage you have and how severe the medical complications from your breast size are. In other words, their focus is upon medical, rather than cosmetic, necessity. The companies may require that a certain number of "grams" be removed from the breasts for the surgery to be considered medically necessary.

In general, most insurance companies require that you have had at least six months of documented evaluations and treatments by your primary care physician in order to rule out spinal disorder as the primary cause of your neck and back pain. You must have undergone six months of physical therapy and other conservative treatments of your back and neck pain and have recommendations from both your primary doctor and your physical therapist, spine surgeon, or chiropractor that you will benefit from reduction mammoplasty.

Some insurance companies do require photographic documentation of your breast size as well as a complete letter delineating all your symptoms that have risen from this disease. Finally they require that a large portion of breast tissue (minimum 500grams, 1.2 lbs) be removed from each breast in order for this surgery to be considered medically necessary and not just as a mean of getting a Breast Lift.

The following is an example from The Regency Blue Cross Group's listed Policy and Criteria for determining a Breast Reduction as Medically Necessary.
Policy/Criteria

Reduction mammoplasty may be considered medically necessary when two or more of the following clinical indications and physical findings are present, which have failed to respond to appropriate conservative therapy:

  1. Documented pain in the upper back, neck, shoulders, and/or arms, which must be of long-standing duration and increasing intensity
  2. Ulceration of the skin of the shoulder or shoulder grooving
  3. Intertrigo between the pendulous breasts and the chest wall
  4. Lordotic posture
  5. Ulnar paresthesia

In addition to the above clinical indications, the following criteria must also be met:

  1. The patient must be old enough that the breasts are fully grown; and
  2. The amount of breast tissue removed from each breast must be either:
    1. A minimum of 600 grams or
    2. If less than 600 grams is to be removed, then the tissue removed must be equal to or greater than the 22nd percentile cutoff weight for body surface area* (see below for body surface area/breast weight table).
    3. In cases of significant asymmetry (i.e., one breast meets criteria A or B above but the other breast does not), the total amount of tissue removed for both breasts must be equal to or greater than two times the minimum as determined in A or B above. For example, if the criteria require removal of 500 grams per breast, a total of 1,000 grams must be removed. 400 grams may be removed from one breast as long as 600 or more grams are removed from the second breast.

Is There A Minimum Age for Breast Reduction?
It is recommended that you don’t have breast surgery until you have reached adulthood and until after your breasts have stopped growing. Exceptions may be made for girls who have a rare and extreme kind of breast overgrowth known as "virginal hypertrophy." These girls develop gigantic breasts during adolescence that become a physical and psychological predicament for them. After having undergone reduction mammoplasty during adolescence, these girls often have further Breast Reduction surgery at a later age when their breast size stabilizes.

Is there an age limit for having Breast Reduction?
Breast Reduction is not restricted to young women – elderly women may also be candidates for the procedure. Women from their teens to their eighties may undergo the procedure. Many women do wait until after age 50 to undergo the procedure – later lamenting that they didn't do so sooner after a lifetime of the pain, rashes, back and posture problems.

Women undergo the procedure at different ages for different reasons. For example, some girls in their late teens realize they will not be able to endure a lifetime of the side effects of having large, pendulous breasts. Others may choose to wait until they have completed childbearing and breastfeeding before they seek the relief of Breast Reduction. Still others don't act until referred by their general physicians to address neck and back pain.

Does Breast Reduction Increase The Risk of Breast Cancer?
Absolutely not! In fact Breast Reduction reduces a woman's chance for developing breast cancer. By reducing the total size of the breast, it reduces the area in which breast cancer can potentially develop. It also makes breast self-examination and mammography easier.

Does Breast Reduction Surgery Affect the Ability to Breastfeed?
As a rule, Breast Reduction will reduce your ability to breast feed. However, this can depend on the type of Breast Reduction that is performed. This will definitely be the case where the areola and nipple have been detached, and grafted back onto the breast.
With the "nipple pedicle" technique, the nipple-areolar complex is kept attached to its roots, therefore lessening the chance of damage to the milk ducts. But even with this technique you can lose your ability to breast feed because a considerable amount of glandular breast tissue has been removed.

How Will My New Breast Size Be Determined?
Your cosmetic surgeon will take your measurements, and discuss your options for a breast size that is both to your liking, and proportionate to your body frame. Many women feel like they want to go as small as possible, just to finally be rid of the large breasts that have hindered them for so many years. In the end, however, your cosmetic surgeon will discuss what size is realistic for you, to achieve the relief that you seek, while achieving the figure that is right for you.

Will My Cosmetic Surgeon Show Me Pictures of How My New Breasts Will Look?
Although no plastic surgeon can guarantee an exact bra size or breast shape, he or she can give you some indication of the range. They can also show you before-and-after pictures of women similar to you who have had reduction mammoplasty. You should also know that your chest frame places constraints on your surgeon with respect to the ultimate size and shape of your breasts.

Will I Need a Mammogram Prior to Breast Reduction?
Yes. Your cosmetic surgeon may recommend a "screening" mammogram prior to your surgery, depending upon your age, or family history of breast cancer. This will help detect questionable breast areas that can possibly be evaluated or biopsied at the time of your Breast Reduction surgery.

You will also be asked to have another mammogram several months following your surgery as a "baseline" for future mammograms. Additionally, breast exams and mammography may be easier to perform following Breast Reduction. Smaller lumps may be harder to detect in women with very small lesions, but will appear more readily once the breast size has been reduced.

Can Males Undergo Breast Reduction?

Yes. Men like women can also develop disproportionately large breasts. This condition is called Gynecomastia –from the Greek words for "women-like breasts."

Development of breast tissue in men is actually quite common.

Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one or both breasts. Although certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases. In fact, one out of every three adolescent males develops significant breast tissue. Of these, one third will continue to keep their breasts into adulthood.

For men who feel self-conscious about their appearance, Male Breast Reduction Surgery can help. The procedure removes fat and or glandular tissue from breasts and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.

At your consultation Dr. Younai will answer your questions and explain to you your treatment options for Breast Reduction, including pros and cons of each procedure, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. There are also many before-and-after pictures and high resolution images of Reduction Mammoplasty available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.
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