Dr. Ernst N. Kaplan
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BREAST REDUCTION

Breast reduction, or reduction mammoplasty, is for a woman experiencing discomfort, health problems and/or extreme self-consciousness associated with very large, heavy breasts. The goal is to give the woman a more attractive contour with smaller, better-shaped breasts in proportion with the rest of her body. She will then benefit from freedom of health problems associated with large breasts and an improved self-image.

Medical problems associated with very large breasts caused by the excessive weight include back and neck pain, skin irritation, skeletal deformities and breathing problems. Bra straps may leave shoulder indentations. Large, heavy breasts also contribute to poor posture, and can interfere with normal daily activities such as exercise. Excessive breast size may also lead to a decreased sense of attractiveness and self-confidence. Breast reduction is commonly covered by insurance. Our staff will assist you in obtaining preauthorization.

The Procedure

Breast reduction is done under general anesthesia on an outpatient basis or in the hospital. The surgery removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The result may be further enhanced by liposuction of the side of the chest and near the armpit. There are numerous variations in technique for this procedure. The alternatives involve position of the incisions and subsequent scars, and how the nipple-areola is transferred to its new position.

Nipple transposition

Almost all breast reductions require preservation of the nipple and then transposition to a new (and in almost all cases) higher position. (The one exception is for women with extremely large breasts that are drooping below the umbilicus.) In order to move the nipple, the blood flow to the nipple must be preserved through a tissue connection (the pedicle). The preserved pedicle blood flow comes from one quadrant of the breast and the other quadrants are removed. Of these techniques, I now prefer the medial pedicle because it leaves the fullness in the top of the breast and removes the inferior portions. All of these methods have nearly equivalent potential to provide adequate nipple blood flow when properly performed. The difference is the direction of the blood flow and where the excess breast is removed:

  • Medial pedicle comes from the inside of the breast; the inferior, superior and lateral breast is removed.
  • Superior pedicle comes from the top of the breast; the inferior, medial and lateral breast is removed.
  • Inferior pedicle comes from the bottom of the breast; the superior, medial and lateral breast is removed
  • Lateral pedicle comes from the outerside of the breast; the inferior, medial and superior breast is removed.
  • Surgical variations

There are many variations of incision placement that determines the position of the final scar and the shape of the breast. With all variation a part of the incision is made as a circle around the nipple-areola in order to move the nipple to a higher position. The remainder of the incision is used to remove excess skin. The most common variation are the Vertical scar with a medial or lateral pedicle, the Wise pattern with an inferior pedicle and the Benelli technique with a periareolar scar. My personal preference is the vertical incision with a medial pedicle. However, in certain patients other techniques may be used.

Benelli (donut, periareolar)

The scar forms a circle around the areola, but there is a tendency for the scar around the nipple to widen

This technique can only be used for vary minimal reductions and is most commonly used for lifting the breast rather than reducing size

This technique tends to make the breast flatter, rounder and less projecting


Before & After

Wise pattern (anchor shape)

The incision goes around the nipple and then down to the breast crease and then horizontally medially and laterally in the crease.

This had been the most common technique for many decades until recently when the vertical scar technique was introduced.

The scars at the innermost and outermost edges may be heavy and noticeable.

This technique sometimes leads to breast “dropdown”. The breast becomes excessively full in the lower part of the breast and hollowed in the top part. If this occurs the nipple points upward.


Before & After

Vertical Scar (LeJour or Findlay-Hall)

With this technique the scar is around the nipple and then extends down to the breast crease (no scar is made horizontally in the crease)

With this technique the skin bunches at the inferior aspect creating bunching under the breast. However, most of this spontaneously shrinks over 6 months.

Occasionally a small office revision with local anesthesia is required to remove bunching skin that does not completely shrink

The vertical technique gives a more conical projecting breast then the other techniques.


Before & After

Recovery: What to Expect

  • When performed by a qualified plastic surgeon, breast reduction is a safe procedure. Nevertheless, as with any surgery, there is always a possibility of complications.
  • The breasts are placed in a surgical bra that will hold them symmetrically during the initial few weeks of healing.
  • Pain is minimal and subsides daily and can be controlled with oral medications.
  • Swelling and bruising disappears in the first few weeks following the surgery.
  • Breasts may initially appear slightly asymmetric during early healing. Their new shape is typically complete within 6 months. Most women have some natural asymmetry before surgery and some slight asymmetry may remain after surgery
  • Scars will fade in 6-12 months. Every effort is expended to make your scars as inconspicuous as possible. The scars will be red and lumpy in the months following the surgery, but the redness will fade and in time the scars will be less obvious. The good news is, your bra or bathing suit will cover whatever scars remain, and most likely, the scars will not prevent you from wearing low-cut tops.
  • Smokers are more likely to experience poor healing and wider scars.

Potential complications

  • The most serious potential complication is the loss of breast tissue and heavy scars or nipple damage due to inadequate blood flow. This problem is almost exclusively an occurrence in women who smoke, or have a vascular disease. Personally, I have not encountered this problem.
  • Some change in feeling of the nipple and skin is possible, but rarely is of significance.
  • Because the surgery removes many of the milk glands and ducts leading to the nipples, breast-feeding may no longer be an option. Surgery will likely reduce, but not eliminate the ability to breast-feed. Nonetheless, many women who have had breast reduction can nurse their baby. I recommend that you postpone breast reduction until after child-bearing and nursing.

The End Result

Breast reduction typically produces a high level of patient satisfaction. It ends the physical discomfort of overly large breasts; makes your body appear more evenly proportioned, and clothes fit better. As much as you desired the change, your new image will take some getting used to. Give yourself—and your family and friends—time to adjust to the new you and, like most women, you will enjoy the benefits.


Before & After