By Jeffrey Wisnicki, M.D., F.A.C.S.
Breast Reduction can literally be a weight off of one’s shoulders.
Among the most satisfied patients in plastic surgery practices are women who have experienced the relief of breast reduction after having lived years with the problems associated with oversized, heavy breasts. These women may initially suffer from neck, back, and shoulder pain. Rashes, upper extremity nerve symptoms and headaches are also not uncommon. This issue can be evident as early as the teenage years (a condition called virginal hypertrophy).
Initial conservative treatment may include physical therapy, weight modification, support bras, and supervised use of anti-inflammatory medication. These approaches may not alter the underlying problem. Surgical reduction of the breasts (also called reduction mammoplasty) does. Health insurance will often cover the procedure based on different criteria. A certain minimum amount of breast tissue removal must be anticipated as determined by the patient’s body surface area (calculated from height and weight). Signs and symptoms of breast heaviness must be documented as well as the failure over time of a nonsurgical approach to improve these.
Case 1 illustrates a smaller reduction with the removal of about one pound of breast tissue from each side. A little less tissue may be removed from the smaller side to improve breast symmetry. In addition to the weight reduction, the procedure allows for a reduction in areolar diameter when indicated and an uplifting with improvement in overall contouring. This is seen well on the side view. The scars resulting from the procedure do tend to fade over time, although scars do not disappear completely. These photos were taken about 7 months after surgery. The scars continue to “mature”, typically becoming lighter over the first couple of years. While we have patients use various scar reducing techniques, the ultimate appearance depends on the genetics of the individual.
Case 2 is a 54 year old woman with severe breast enlargement.
She wore a 36DDD bra prior to surgery and the some of the effects of her breast weight are seen in the grooving of her shoulders. She had a long history of back, neck, and shoulder pain and well as persistent rashes underneath her breasts. Support bras and anti-inflammatory medications only provided temporary relief and she wished to proceed with breast reduction.
She had almost three pounds of tissue removed from the larger right breast and less tissue removed from the smaller left breast, again to improve symmetry. Her nipple and areola were left attached on a mound of breast tissue and reduced in diameter and elevated up. Enough breast is left in place to preserve a good blood supply to the nipple and retain a satisfactory contour. Enough tissue is removed to make a significant difference in the weight the patient has to carry. This patient now has a marked improvement in overall mobility as well as alleviation of the problems her breasts caused.