Over the past 100 or so years various procedures have been designed to reduce the size and weight of breasts. These procedures can be divided into those that remove the nipple areolar complex and replace it as a free graft much like a full or partial thickness skin graft. These are called free graft procedures.
The other procedures move the nipple areolar complex on a pedicle that continues to bring circulation to it. These are called pedicled procedures.
With a free graft you can have 100% take of a graft to a total loss of a free graft and anything in between. If the graft survives it may still lose part of its pigment.
There is a saying that if you have not had nipple necrosis after reducing a breast you have not done enough breast reductions. This happens rarely and its frequency of occurrence varies depending on which procedure is used.
Most ladies who have severe symptoms related to carrying heavy breasts are very grateful for the relief of symptoms following the breast reduction. These symptoms usually consist of frequent headaches, neck pain, shoulder pain, low back pain, not being able to sit on the floor without pain, unable to lay on their stomachs without pain, etc.
Most of the flap procedures have a significant incidence of losing their coned shape with time. This is due to two factors:
(1) The pedicle is buried under tissue flaps and the closure depends on tension in the flaps.
(2) The base circumference of the breast is not decreased.
There is a procedure that minimizes if not eliminates the nipple necrosis problem and gives long lasting excellent shape with preservation of nipple sensation. This procedure uses a pedicle which is a full thickness of breast down to the chest muscles that is rotated 90 degrees to reposition the nipple in a more superior position.
The breast tissue is removed primarily laterally and inferiorly about the medial pedicle and the base circumference of the breast is decreased by the width of this tissue crescent. The breast is shaped by repairing the breast and not by carrying the tension superficially in the skin pedicles. The skin simply moves as a result of the breast shaping, the skin is not shaping the breast.
The following are some questions commonly asked by patients:
Can I nurse my baby after I have my breast reduction?
There is a study that reported that only 60% of women made enough milk to satisfy their baby without other supplements. I would think you have a 50% chance of nursing your baby without supplements.
If I become pregnant what will happen to my shape?
If your breasts significantly increase in volume and you have postpartum breast involution you most like will develop some breast shape issues.
Do breasts sometime continue to grow even as an adult?
Rarely a lady’s breasts will continue to grow even as an adult. In the most extreme circumstance a mastectomy and breast implant may be the only way to obtain control of the problem.
Will my insurance pay to help me defray the cost of this procedure?
Generally if you do not have a rider stating that breast surgery is excluded, most insurance companies will want you to document your symptoms and other conditions that are made worse by your large breasts, such as bulging spinal discs, etc.
They will expect that a minimum weight of breast tissue will be removed. The amount of the minimal weight to be removed is usually calculated based on your height, weight and body surface area.