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Picture of model, not actual patient.
According to the American Society of Plastic Surgeons, more
than 88,732 women had breast reduction surgery in 2008
Written by Dr. Tammy Wu, Modesto Breast Reduction Surgeon
Dr. Wu is a
Board
Certified Plastic Surgeon.
Breast reduction, or reduction mammoplasty, is a procedure designed to reduce the volume of the breasts in order to relieve upper back and neck pain and minimize shoulder grooves from the weight of the breasts.
Breast reduction is a surgery that is usually performed as an outpatient procedure, meaning that the patient will usually go home after surgery. The surgery usually takes approximately 2 to 3 hours or so to do. A lift is generally a part of the reduction procedure.
There are several different techniques to reduce the breasts. We will talk
about each one in more detail below. None of these techniques involve implant
placement. I often get questions from my patients who are considering breast
reduction, “Will you put an implant in my breast after the reduction?” My answer
is an emphatic “No”. The reason is that if you are seeking breast reduction for
functional reasons, ie, back pain, neck pain, and shoulder grooves, why would I
want to add more weight to your breasts after having just taken them away for
you? Each of the techniques below is designed to use your own breast tissue to
shape your breasts in the most aesthetically pleasing contour possible. No
implants are necessary to achieve that outcome in my opinion.
A. Inferior pedicle technique - The most popular technique in the United States currently is the anchor scar or inverted T inferior pedicle technique. This is a technique in which there is a vertical scar below the circumareolar scar (or the scar around the areola) with a horizontal scar at or near the inframammary fold (see diagram below). This technique removes breast tissue from the medial and lateral aspects or the sides of the breasts (inner and outer portions of the breasts) and also the superior portion (or the top part) of the breasts (diagram). The nipple/areola complex (NAC) is kept intact on breast tissue that is in the central and inferior portion of the breasts. Hence, the term of “inferior pedicle” technique – the NAC is based on tissues along the bottom part of the breasts.
As a result, this technique may produce breasts that are more bottom-heavy, and “bottoming out” is a “given”, ie, it happens in almost 100% of the time. However, measures are usually taken to minimize the distraction that the “bottoming out” will have on the breasts’ final aesthetics.
B. Free- Nipple Grafting – This technique takes the nipple/areola complex (NAC) off the breast tissue completely. The NAC is then replaced onto the breast tissue as a free composite graft (define composite graft) after completion of the volume or breast tissue reduction . This technique is usually reserved for patients who are considered to have “gigantomastia”, or excessively large breasts that often hang down to their umbilicus, or belly button, or even further. This technique is done as a “last resort” due to its complete disconnection from the breast tissue itself. When the NAC is disconnected from the breast tissue completely, the sensation and projection of the nipples may be completely lost. One also would not be able to breastfeed following reduction using this technique.
The scar on the outside using this technique is usually the same as the “inferior pedicle” technique, described in section A. But the breast shape may be modified accordingly to minimize the “bottoming out” effect that is usually seen with the inferior pedicle technique.
C. Vertical reduction – The vertical reduction, or lollipop technique, is one in which the scar is around the NAC with a vertical limb below it. There is no horizontal scar with this technique. The vertical breast reduction technique is inherently different from that of the above two techniques described. The NAC is based superiorly or surperior-medially, meaning that the blood supply to the NAC is on breast tissue that is coming from the inner and upper aspects of the breasts. Therefore, the tissue that is removed in this technique is the bottom portion, or inferior aspect, some laterally, and minimally superiorly (or on top). As a result, this technique naturally “lifts” the breasts on the chest, due to the location of the tissue that remains after the reduction, and this technique also tends to produce breasts that are rounder, and in my opinion, more aesthetically pleasing. The lift also lasts longer with less or no chance of “bottoming out”. Additionally, there are fewer visible external scars on the skin.
However, one downside to this technique is that there may be excess skin in the very bottom part of the vertical scar or incision that may not resolve on its own. This happens more often in people with a significant amount of excess skin. If the excess skin does not go away, it is removed approximately one year later after the body has ahd a chance to heal and contract.
The vertical reduction technique, or lollipop, is the reduction technique that I prefer for my patients, if they are candidates for this particular technique.
D. Liposuction – Liposuction has been described as a modality to reduce breasts. I believe that in the select few patients who have good skin elasticity, minimal excess skin, and minimal to small reduction, this may be a viable modality to reduce the breasts. This group of patients with the above characteristics tends to be younger, usually in their 20s and are nulliparous, meaning that they have never had children. The benefit of liposuction as a modality of breast reduction is that there is minimal external visible scar. However, the downsides to this technique are several. First, there is no skin removal; therefore, this modality relies on the skin to contract after the liposuction surgery. Good skin elasticity is important in achieving this outcome because elastin is the component in our skin that will be the major player in this process. Second, liposuction creates significant internal scarring, ie, the scars within the breasts, throughout the entire breast parenchyma (entire breast tissue complex). This may create some problems when screening for breast cancer on mammogram. Liposuction in general will create more internal scarring than the other techniques that are described in this section above and below. Therefore, I reserve this technique to the young patient with no family history of breast cancer, who has good skin elasticity, minimal excess skin, and who requires minimal to very small reductions.
E. Other techniques – There are many other modifications of the above three main techniques of breast reduction. Some of them may have the NAC based laterally (on the outside), or centrally (in the center of the breasts). The idea is the same. Unless one is planning on doing the free nipple/areola grafting technique, the NAC has to remain attached to a portion of the breast because it has to have its blood supply from somewhere on the breast. The blood supply can come from the top (superior), bottom (inferior), inner side (medial), and outer side (lateral), or it can be a combination of the four directions. The incisions on the outside with these other techniques, other than the lateral, is usually an inverted T, or anchor scar. The external scars can also be a modification of the vertical and the anchor, with a short L type of scar as well.
F. So, which one of these techniques is right for me?
This is a question that you would definitely want to discuss with your plastic surgeon who is going to be performing your procedure. For my patients, I will do a complete breast exam with measurements and find out from them the final volume that they desire after the reduction. I will also do a complete history and physical exam in order to assess the perioperative risks for my patients wishing to have this procedure. Then we will both decide on a technique that will give them the results that they are looking for in terms of the functional improvement as well as the cosmetic outcome.
Due to the potential functional impairment of heavy breasts, breast reduction may be considered a medically necessary procedure in which the insurance company may consider covering. You may check with your insurance carrier for your specific policy to make sure that breast reduction is not an excluded benefit. Many insurance companies will require that there is documentation of attempted non-operative therapy, such as physical therapy, chiropractic sessions, massages, pain medications, or a combination of the above treatment modalities, for at least 6 months from your primary care physician.
If you have a insurance policy that excludes breast reduction as a covered benefit, or if you have been denied by the insurance company, or if you do not have insurance and wish to pay out of pocket for the breast reduction procedure, the cost of this surgery varies from region to region.
In the Central Valley region of California, Modesto, the breast reduction surgery costs approximately $10,000 to $15,000 or so. This is the total cost including hospital, anesthesia, and surgeon’s fess.
Please call our office for more information. Our office is located in Modesto, California. Our office hours are Monday through Friday, 8am to 5pm. Our office staff will be happy to assist you.
Please feel free to contact our office at (209) 551-1888 if you would like more information.
Tammy Wu, MD
Modesto Plastic Surgery | Why Choose Dr. Wu | Cost of Surgery
Breast Augmentation | Tummy Tuck
Surgical Artistry webpage is for information
only, not medical advice.
www.surgerytoday.com homemade website
by Calvin Lee, MD and Tzuying Tammy Wu, MD, Modesto, CA
Date of edit:
06/17/2012