Dr. Andrew Barnett MD Cosmetic Plastic Surgeon

Breast Reduction

While a large drooping breast is unattractive, for most women it is the interference with physical activities, the pain and discomfort of carrying the weight, and the difficulty wearing fashions that are the motivating factors for breast reduction. This procedure is both functional and cosmetic. After the procedure, the most common question is "Why did I wait so long?"

-Andrew Barnett, MD

The woman with large breasts is forced to suffer with problems of shoulder, neck, and back pain, as well as the difficulty in dressing and wearing fashions which all seem designed for the slender, small figured woman. Breast reduction is a safe procedure designed to reduce and lift your breast with dramatically pleasing results.

How is breast reduction performed?

Breast reduction is designed to reduce the size of your breast while producing a more attractive shape. In women with large breasts there are generally three areas of excess: The breast gland (what's inside the skin), the skin surrounding the breast gland, and the areola (the dark area around your nipple). In addition, the nipple area is generally too low.

To perform breast reduction, I plan first to reduce the gland. The skin, which acts like a natural "bra", must then also be reduced to match the smaller gland. Finally, the areola is reduced and repositioned to a slightly higher location when the incisions are all closed.

Is the nipple-areola region removed from the breast and re-implanted?

No. The nipple-areola region is left attached and moved by repositioning the entire gland, with the nipple-areola attached. There are rare exceptions in patients with extremely large breasts, but this is quite unusual.

Where are the skin incisions located?

There are two main techniques that are used for breast reduction, the Vertical Technique, and the Inverted T Technique.

The older technique, the Inverted T Technique, which I still do on occasions, has a number of steps. To reduce your skin "bra", I basically take a dart in the area between the nipple and the fold under your breast. This fold is referred to as the inframammary fold. The incisions are located around the areola, and extend downward, in an up-side down V, to the inframammary fold. When the incisions are closed, the remaining stitch line forms an up-side down T, with the top part of the T (now the bottom part) in the inframammary fold, and the vertical part of the T extending to the areola. There is also an incision which goes around the areola.

The newer technique, which I do more than 90% of the time, is referred to as the Vertical Technique. This reduction limits the incision significantly by reducing or eliminating the horizontal portion of the inverted T so there is only an incision around the areola, and a vertical incision. Most women are eligible for this technique.

The advantage of the Vertical Technique is that the scarring is much less, and the breast shape is better. It is my preferred technique, and I use it when possible. At your consultation, we will discuss the differences between the two techniques.

Will there be much scarring?

During the first few months after surgery the incisions tend to become red and occasionally raised, but they tend to fade nicely with time. The final result, of course, depends on how you heal.

Is the procedure painful?

The surgery is performed with you asleep under anesthesia. Afterward, there is some discomfort, but it's quite minimal. Most patients tell me that they were surprised at how little pain they experience. You will certainly be offered pain medication after the procedure, but most patients require very little.

Hour long will I be off from work?

I recommend that you take a minimum of one week off from work. This allows you to recover from the affects of surgery. At the end of one week, you may resume non-strenuous activities, but you should limit lifting and stretching for an additional week.

Will I need a blood transfusion for this surgery?

If your breasts are very large, I may recommend that you donate blood before the surgery, although this is very uncommon. I never have had to give a blood transfusion to a breast reduction patient, although it is possible. Blood loss from this surgery is generally quite minimal.

Do I need any special tests prior to breast reduction surgery?

For women over 30, I strongly recommend a mammogram prior to surgery. This lets us see if there are any suspicious areas that should be biopsied at the time of the breast reduction. In addition, as for all surgery, routine laboratory tests are taken.

How small can you make my breasts?

The goal is to reduce the size of your breasts so that your discomfort is relieved and the breasts fit better with your general body size. At the time of your consultation, we can discuss this in detail.

Are there risks to breast reduction?

As with all surgery, there are risks. Bleeding, scarring and infection may occur. Differences in the size and shape of the breast, generally quite small, are occasionally seen. Loss of the nipple areola or loss of sensation to this area may happen, but this is very unusual. Inability to breast feed following surgery is a possibility. Continued droop of your breasts as you get older may also change the shape of your breasts. Adverse reactions to medications and anesthetics can also sometimes occur. These risks are explained not to frighten, but to inform you. Breast reduction has in fact proven to be a safe and predictable operation.

Will insurance cover the cost of surgery?

In the past, insurance companies were very lenient about providing coverage for breast reduction. Unfortunately, with Managed Care, the insurance companies have changed that policy. Coverage may be available in extreme cases, but the average breast reduction in my practice is no longer covered by insurance. We will be happy to submit the insurance forms and supporting documents, such as photographs and physical examination data, but the patient is responsible for the costs of the procedure. If there is some question, we can request pre-authorization from your insurance company.

Should I have it done?

That's a question only you can answer. At the time of your consultation, we can discuss your questions and concerns in detail. You don't have to decide on the first visit, and you may decide that you're not interested at all. What is important is that we work together to make the decision that's right for you.

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“I am a registered nurse… so after a lot of research and speaking to other physicians and fellow nurses… my decision was made. He is an artist and I believe the best in his field. Now my favorite thing to do is shop for bras. Thanks Dr. B, you are truly the best.”

-AN, RN, Napa, CA

“As a physician, I know about physician hype and marketing, the go to surgeon nonsense… Having lived and worked in the Bay area for many years, when it was my time I asked colleagues who performs consistently excellent facial work. Your name came up repeatedly… While I was impressed with your professionalism, it is the artistic, balanced, natural result that reminds me everyday that I made the right choice putting my face in your hands. Thank you.”

-LC, MD, Palm Springs, CA

“When I tell people that I have two adult children, they look at me and say, “You must have been a child bride.” Well I love the look on their faces when I tell them I’m 63. Sometimes I say “You know, Dr. Barnett is my secret weapon”, but most of the time I just say, “Oh, I guess I’m lucky. Good genes…” If they only knew! You are wonderful.”

-JG, San Francisco, CA

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Copyright 2014. All rights reserved. Andrew Barnett, M.D.