The typical patient with excessively large breasts presents complaining of shoulder grooving, shoulder pain, neck pain, and/or back pain. When breasts are large and in a low hanging position, the patient is forced to overly arch her lower back in an attempt to raise her breasts to a more anatomic position, altering the natural curvature of the spine. Additionally, intertrigo, irritation beneath the breasts due to moisture, is commonly found in the summer months. It also may be difficult to exercise despite wearing supportive bras.
An enlarged breast not only has an excess of breast tissue, but also an excess of skin. A Washington DC breast reduction removes both skin and breast tissue, creating a smaller breast which is also lifted to a more anatomic position. There are many techniques for breast reduction, but they all achieve the same goal of creating a smaller, lifted breast which is in better proportion to the patient’s body. In rare situations, limited to younger patients with excellent skin elasticity, a single cup size reduction may be achieved with liposuction alone, termed "lipo breast reduction.”
This is a procedure which may be covered by insurance depending on the specific policy as well as the amount of breast tissue to be removed. A letter of preauthorization must be sent to the insurance carrier in advance. The patient is also asked to get involved in obtaining insurance coverage for her procedure. Depending upon the patient’s age, a baseline mammogram may be obtained prior to surgery.
Breast Reduction Surgery
The procedure is typically performed on an outpatient basis with general anesthesia. The patient is first marked in an upright position prior to entering the operating room. The typical scar pattern extends around the nipple, vertically to the inframammary fold, and then horizontally in the fold. This is known as a “Wise pattern” or “keyhole pattern”. The skin and breast tissue to be excised is marked, and the nipple/areola complex is left attached to the remaining breast tissue. Breast feeding is a possibility in the future, but varies with each individual. Liposuction may be utilized on the sides to minimize the length of the incision. Occasionally, the procedure can be performed entirely with liposuction, and in some cases, an incision in the fold may not be required or minimal. At the end of the case, a temporary drain is placed on each side to prevent fluid accumulation in the breast. The patient is then placed in a dressing consisting of gauze padding and ace bandages placed circumferentially like a tube top.
Recovery from Breast Reduction Surgery
For the initial 24 hrs after your Washington DC breast reduction surgery, it is normal for there to be drainage staining the dressing out the outside. Depending on the type of drainage tubes used, the patient is seen in the next few days for dressing and drain removal. If non-dissolving sutures are used around the nipple/areola complex, these are removed at 4 and 8 days after surgery. All of the remaining sutures dissolve. The patient is asked to limit the use of her arms, keeping her elbows by her side for a period of 2 weeks from the day of the surgery. At that time, she will gradually start resuming her normal level of activity with the expectation that she will be back to normal at approximately 3-4 weeks. It is recommended that a mammogram not be performed until approximately 9-12 months after surgery to allow the scar tissue to settle and remodel.
Breast Reduction Risks and complications
Risks and complications are uncommon, but may occur. They include, but are not limited to: infection, bleeding, unfavorable scarring, delayed wound healing, sensory changes of the nipple and surrounding skin (increased, decreased, lost), loss of the actual nipple (very rare), persistent asymmetry, and need for revision in the future.
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