1. What is the difference between a breast reduction and a breast lift?
In some respects, they are quite similar…from a skin standpoint. Every breast reduction incorporates a breast lift as part of the operation. But a breast lift does not incorporate a reduction of breast tisue.
The skin portion of the breast reduction operation is the lift. The nipple is moved upward and the skin is tightened and lifted around its new position. This creates the scars that one sees…around the nipple, down vertically to the lower crease, and then extending outward along the entire crease. (known as the anchor or inverted T scar pattern)
While breast lifts, in their fullest extent, may have a similar scar pattern, there is no internal breast mound removal as in a reduction.
2. Are most women happy with the results of their breast reduction surgeries?
Historically and even including the present, breast reduction remains as one of the most satisfying procedures according to patients in plastic surgery. Confoundingly, despite the scars, reduction of large breasts remains immensely satisfying.
This is psychologically understandable as the shape and appearance of the breast after is only a part of how patients judge the outcome. (unlike a breast lift) The significant reduction, and sometimes complete elimination, of back, shoulder, and neck pain from the breast reduction offers a tremendous physical relief. For many women this results in the ability to do more things, reduce the use of pain medications, and results in an overall liberating experience.
3. Are there different ways to perform a breast reduction?
There are different techniques for performing this procedure but they do not create the same result or amount of breast reduction. The most common alternative technique is to use liposuction with or without less skin removal. While this approach will reduce some breast volume, it will not move the nipple upward or tighten the breast skin. In essence, it deflates the breast but lacks the ability to lift it. For small breast size reduction, this may be useful. But most breast reduction patients do not usually benefit from such limited breast reductions.
The most common method of breast is the ‘inferior pedicle’ technique. There are numerous variations of it but it continues to be the workhorse of breast reduction because it simply works. It can achieve the most reduction of breast tissue while safely preserving the blood supply to the nipple.
4. How do you determine the size of the nipple/areola complex?
In most cases of large breast, the nipple-areolar complex (NAC) is also enlarged. While normal diameter of the NAC is around 38 to 44 mms, large breasts can have diameters up to 60 or 70mms. In breast reduction surgery, a circular nipple marker is used with differing diameters to mark the new NAC complex. This marks the cut which is initially made as the first part of the procedure.
In rare cases, the NAC is actually normal in diameter despite a large breast and cuts are made around its existing size.
5. Is the nipple removed during surgery?
This is a very frequent question that I hear from many potential breast reduction patients. There is a belief that the nipple is removed and put back at the end of the surgery. In most cases, this is not done. One of the primary goals of most breast reductions is to keep the nipple alive to maintain its shape, colors, and feeling. This is done by keeping it attached to the underlying breast mound pedicle from which its gets its blood supply. Removing it and replacing it as a skin graft works against these goals.
In some rare cases, the nipple is actually removed and put back. Known as a free nipple grafting breast reduction, this method may be used in older patients with very large breasts where the survival of the nipple may be in question. Many older patients are not as concerned about nipple feeling and are most interested in maximum breast mound reduction.
6. Do you use drains? If so, when will they be removed?
The use of drains varies amongst plastic surgeons. I use them in most every breast reduction case and remove them the very next day. They are not a nuisance in this early postoperative period and any blood and fluids removed is less that the body has to absorb later
7. Will my insurance cover the cost of breast reduction?
In many cases, yes. But most insurance companies have very strict criteria that a patient has to meet to be eligible. These include not being significantly overweight, the breasts have to be sufficiently large, and a sufficient amount of breast tissue must be removed. The goal of these criteria is to be certain that the patient is getting a medically necessary breast reduction, not a cosmetic breast lift. Eligibility requires that your plastic surgeon sends in a letter, with this information included, so they may make that determination prior to actually undergoing the surgery.
Dr. Barry Eppley
Indianapolis, Indiana