Posts Tagged ‘breast reduction’
Thursday, February 2nd, 2012
Q: Dr. Eppley, I am interested in lipodissolve or laser liposuction of the lower abdomen. I am having a breast reduction done next month. My question is when is the best time for me to have the lipo procedures performed, before surgery or after surgery? I was informed that the best time would be during the same time as my breast reduction surgery. However, my insurance is covering the breast reduction and it does not cover the liposuction. I am also unsure if the doctor performing my surgery performs the lipo procedures I am interested in receiving. I was hoping for a lipo procedure that was less invasive such as lipodissolve or laser lipo.
A: Let me clarify some misconceptions that you have about various ‘lipo’ procedures. Lipodissolve injections are only useful for very small fat collections, no more than the size of one’s hand. I suspect your lower abdominal issue is bigger than that in size. Laser liposuction (aka Smartlipo) is simply an advanced form of liposuction and is just as invasive, it is not a minimally invasive procedure. In short, there is no non-surgical way to get rid of your abdominal fat concerns that would be as effective as liposuction. You could try Exilis radiofrequency treatments which does have some fat reduction effects.
In reality, there would be no better time than doing abdominal liposuction with your breast reduction and this is a common combination of cosmetic procedures. Otherwise you will have to have liposuction done separately where the out of pocket expenses will be higher.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominal liposuction, breast reduction, dr barry eppley, exilis, indianapolis
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Monday, January 2nd, 2012
Q: Dr. Eppley, I have a question regarding the potential complications of performing breast reduction surgery on a breast that has been previously radiated for cancer. I was irradiated for a localized ductal carcinoma five years ago. The irradiated breast has finally softened a bit and the skin appears pink and healthy after significant initial burning at the time of radiation. Six months ago, a plastic surgeon performed reduction surgery on the normal breast (from a size DDD to a size C) in an attempt to alleviate chronic back pain. He unfortunately removed so much tissue from the healthy breast that the radiated breast remains 2 cup sizes larger than the post-reduction normal breast. I am quite upset with the unsightly asymmetric results. The plastic surgeon did not want to attempt reduction surgery on the previously radiated breast due to the risk of poor healing etc. This seems to be good advice but doesn’t solve the current lop-sided result. The plastic surgeon suggested that I undergo a full mastectomy and flap reconstruction but that seems a bit much. Do you know of any reduction alternatives or surgical techniques that can overcome the complications of operating on irradiated tissue? Thank you for any information or advice you might have.
A: In today’s world of early breast cancer detection and treatments, it is no longer rare to see a patient for breast reduction that has had either a biopsy or lumpectomy and radiation. I have performed several cases of breast reduction previously without undue wound healing. This being said, it is important to realize that the effects of radiation on wound healing do not actually improve with time. The sclerosis of the microvascular of the skin actually worsens past the early post-irradiation period, so there is never a completely safe time to operate on an irradiated breast. The risk of wound healing problems is very real and the extensive devascularizing nature of a breast reduction procedure can unmask how compromised the circulation of the breast skin is.
There are two approaches to operating on the irradiated breast for a reduction. The first is to change or alter the surgical technique used. Using a standard breast reduction approach, the inferior pedicle is keep very wide (10 cms) and the raised skin flaps are kept thick. (2 to 3 cms) The amount of breast reduction that is internally removed may be less than that of the opposite breast so ideal symmetry in breast size will not be obtained. But maximal microcirculation is obtained. It is also extremely important to keep the skin excisional pattern conservative so no tension is placed at the intersection of the vertical and horizontal closure. The surgical technique can also be altered to be a free nipple grafting method where the breast resection is through the central mound and the circulation to the remaining skin flaps is completely unaltered. The second technique is the safest and may allow the reduction to be optimally matched to the opposite but the appearance of the nipple-areolar complex will be slightly different and nipple sensation and erection will be lost.
The second approach, and one that is reserved for the most severely radiation-damaged breast, is a two-stage technique. The breast is initially injected with a combination of stem cella and PRP (platelet-rich plasma) to improve the vascular quality of the breast mound. Three months later, the breast reduction is performed.
Which of these approaches is best would be based on how the breast looks and feels and the radiation dose and length of time from when it was done.
I would agree that immediate conversion to a mastectomy and flap reconstruction is overtreatment and should be reserved in case there is a major healing problem…and can always be done.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast reduction, dr barry eppley, indianapolis
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Saturday, April 16th, 2011
Q: Good Day! I am Miss Ameena Williams living in United Arab Emirates. I want to book for breast reduction surgery in your clinic. I and 6 of my colleagues will be spending our vacation in your country for three weeks in the month of May 2011 and I want to use this opportunity to have this breast reduction surgery done. I am 40 years old. Kindly confirm the best dates for you in the month of May and how many days it will take you to finish the surgery and also confirm if your firm will be able to handle this so that I can make my booking immediately.What is the total cost of the surgery in your clinic so that I can make the deposit payment. Payments is via credit card because of my location now in offshore and I hope your clinic do accept credit card.
Awaits your reply with the required info above. Kind Regards, Ameena Williams.
A: This is a classic example of an internet scam that is directly specifically at plastic surgeons. I have seen many examples of this in different versions but the story is always the same. Out of the blue without any prior interactions, a patient from another country (usually the United Kingdom or Saudi Arabia) sends an e-mail and requests surgery with a specific date in mind. Money is asked to change hands by credit card but the plastic surgeon will eventually be asked to front them money for travel. The plastic surgeon will initially be paid by their credit card. (stolen no doubt) In the end no patient will ever arrive and the plastic surgeon will be out the advanced travel monies.
As the old motto goes….beware those that come bearing gifts.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast reduction, dr barry eppley, indianapolis, plastic surgery internet scams
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Wednesday, March 16th, 2011
Q: I’m considering a breast reduction with the hope of going from a 36DD to a C cup. The surgeon is anticipating approx 300 cc reduction on each breast. Will that leave me with a C cup or less?
A: I would have to say that this is a question that your surgeon should answer for you since he/she has actually seen you and is in a better position to answer.
That being said, a 300cc reduction in breast volume for most women will not take a DD cup down to C, let alone less than a C cup. A 300cc reduction is quite small and would not qualify for an insurance-covered breast reduction because of the small amount of breast tissue being removed. Unless you are quite a small person, this will not cause a significant reduction in your breast size. I would go back and revisit this issue with your surgeon as there appears to be different levels of expectations in the end result. Breast reduction is a significant operation that is changing breast size at the expense of permanent scars. You want to make sure that in accepting this trade-off you are getting the breast size reduction that you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast reduction, dr barry eppley, indianapolis, plastic surgery of the breasts
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Friday, February 25th, 2011
Q: I would like to get a breast reduction on just my right breast. It is a couple of cup sizes bigger than the left and its very painful. I think people notice and I can’t find a bra that fits right and looks good without one of my breast falling out. Also, I can’t wear any cute shirts I like and I’m very self consious when my husband sees it. I know I would be so much happier in life if they were both the same size. How much would it cost to get tissue removed from one breast so that they are the same size and that is all? Also what do I need to do to to get started? Please help!
A: Breast reduction can equally be done on just one breast as it is on two. It just takes half the time and close to half the cost of a two-sided breast reduction. When reducing just one breast, you have the ‘advantage’ of the other breast as the cosmetic goal. While perfect size and symmetry cam never be absolutely achieved, they can be made very close. The trade-off you make is that for better size and symmetry, the reduced breast will have fine line scars that the other breast does not. The best way to get started is to visit a plastic surgeon and discuss the specifics of your breast goals. On average, the cost of one breast reduction done as an outpatinet procedure will run in the range of $ 3500 to $4500.
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast reduction, dr barry eppley, indianapolis, plastic surgery of the breasts
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Wednesday, October 6th, 2010
Q: I am interested in areola reduction surgery. I am fairly sure that I may have to lose more weight before I undergo any procedures. I was just wanting to know specifics about what I would need to do before I move forward.
A: There is usually a strong relationship between the size of the areola (diameter) and the size of one’s breasts. Although this isn’t 100% true, the larger the breast the larger the areola. Areolar reduction is a common part of almost every breast reduction and many types of breast lifts. But it can also be done as an isolated procedure if one is otherwise happy with the size and shape of their breast and just feel that their areolas are just too big.
Areolar reduction is done by a circumferential reduction, often called the donut procedure. A ring of the enlarged areola is removed and the surrounding skin sewn down around the smaller areola. This does result in a scar at the edge of the areola. How well that scar becomes in appearance in affected by how much the areola is downsized and how tight the surrounding skin of the breast mound is. For the best result in areolar reduction, the size and shape of the breast should be stable. Therefore, if you intend to lose more weight, it would be advised that you wait until you have achieved your maximal weight loss. By then the breast size will be stable and the resultant looseness of the breast skin will be an asset towards final areolar scar appearance.
Dr. Barry Eppley
Indianapolis Indiana
Tags: areolar reduction, breast reduction, dr barry eppley, indianapolis, plastic surgery
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Thursday, September 16th, 2010
Q: I am going to have breast reduction surgery and I was wanting to know if I have more children in the future will my breasts go back to the before size, or just bigger than the after size? My insurance will cover it now, not then, that is why I was curious.. Thanks for the help.
A: From a breast shape and size standpoint, the answer would be that one should wait until after having completed all the pregnancies that one desires then have a breast reduction. But life is rarely ideal and breast reduction followed by pregnancies are not rare. Teenagers and young women commonly have breast reduction followed by pregnancies. The back, neck and shoulder pain from large breasts make the appeal of such surgery very attractive to get relief now rather than years later. Also, if you have insurance now and may not later there is the obvious financial attraction to doing something while you have coverage.
That being said, breast reduction and secondary pregnancy are not mutually exclusive…provided one acknowledges that the breasts shape and size that is obtained from the surgery will be negatively affected by future pregnancies. Most likely they will get smaller, they will sag more (the bottom will fall out more) and they will become flatter in shape. Pregnancy stretches out the skin and shrinks away breast tissue causing a deflation effect. In rare cases, the reverse may actually happen where the breasts become bigger again.
There is nothing wrong with doing breast reduction before pregnancy as long as one realizes that the breasts will not stay the same size and shape afterwards.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast reduction, breast reduction before pregnancy, dr barry eppley, indianapolis, plastic surgery
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Saturday, August 21st, 2010
Q : When I was 20 and in the service I had a breast reduction. I went from a 44DD down to a C cup. I am now 50 and my breasts have slowly over the years grown back. I have been so uncomfortable physically and mentally from their size. I didn’t know breasts could grow back after they were reduced. Can I have another breast reduction at my age?
A: Breast reduction is a very successful operation at reducing one’s breast size as well as lifting it back up onto a better position on the chest wall. (where it once was) In most cases, once the breast is reduced it does not return to its original size. But breast regrowth has been reported and it does occasionally occur. This is almost always in the young female population when the operation is done during the teenage years. When done under the age of 18, exposure to continued bodily growth, weight gain and pregnancy can all be hormonal signals for breast tissue growth. But even in these circumstances it is still rare. Having it happen after one is developed is rare but not unheard of as you illustrate.
There is no age limit when breast reduction can not be performed. It is not an operation that is stressful to one’s bodily systems. It can be done using your existing breast scars as the operative pattern. It would be fair to say that there is no chance your breasts would regrow after being reduced at age 50.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast reduction, dr barry eppley, indianapolis, plastic surgery
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Saturday, July 3rd, 2010
Q: I am a 58 year old female who is looking for a highly qualified plastic surgeon to perform a breast reduction surgery. I need to be able to work with someone who can help me get my insurance plan to cover the cost as I feel this is medically necessary. I honestly don’t have a clue how the insurance works in a case such as mine . My health issues include fibromyalgia, arthritis, diabetes type 2, GERD, chronic depression, and anxiety disorder. I had a back surgery in 2008 for a lower back condition that required a L5S1 partial laminectomy, spinal fusion, surgical hardware, and a bone graft. I have arthritis in the rest of my spine as well. I have many issues with headaches, neck pain, shoulder and back pain. I also have problems with rashes under my breasts and bruising caused by wearing underwire bras for support. My bust size is a 44DD and, although I am not a small person, the size has become a hinderance to me as far as activities, heat intolerance, and the pain I live with daily. Please let me know if you think there is a chance we might be able to have a reduction covered under my insurance. I simply cannot afford to pay for any kind of health care or surgery on my own. Thank you for your time.
A: Breast reduction is often covered by one’s insurance if you qualify by their standard and well-known criteria. These include the following three items that your insurance will evaluate. First, you can not be obese or significantly overweight. One should not be more than 20% over their ideal body weight. If you are, you will be told by your insurance company that you have to lose weight to qualify. Secondly, you must have symptoms of back, shoulder and neck pain that has NOT responded to three months of conservative management such as physical therapy and/or chiropractic therapy. Such treatments must have documentation, not just saying that you have had them. Lastly, the amount of breast tissue that is going to be removed must be of a certain amount based on a calculated number known as your BSA. (body surface area) If the amount of breast tissue that can be removed does not meet the amount based on your BSA, you will be denied.
All of this information is put together in a letter, written by your plastic surgeon, and then sent in to the insurance company. This is known as a pre-determination. One then waits to get back written approval or denial before ever proceeding to breast reduction surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast reduction, dr barry eppley, indianapolis, insurance coverage for breast reduction, plastic surgery
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Thursday, June 24th, 2010
Q: How come with breast augmentation the work seems flawless with no scarring at all. But with a breast lift, there appear to be scarring and are not always even. Your augmentation is beautiful, the best i’ve seen so far. I dont think I need an implant because I am already a DD.
A: Breast augmentation is virtually scarless because the small incisions that are used to pass the implants through are placed in very unnoticeable areas. Whether it be in the lower breast crease, around the nipple, or in the armpit, they are undetectable except on the very closest of inspections. Breast implants do all the work of making the breast, including its new shape, and this makes it almost scarless.
Conversely, breast lifts must create their reshaping effect by removing skin. Because all aspects of the breast skin are in view in a well shaped breast mound, the scars are much more visible. In a typical breast lift, the scars will run around the nipple and vertically down to the lower breast crease. In more extensive breast lifts, the scar may also run along in the lower breast crease.
Unlike breast implants, which are symmetric in shape to start with and can be equal in volume, breast lifts are much more artistic in execution. They require a lot of judgment in how and where to cut the skin and, as a result, can not be expected to be as perfect in shape and symmetry as many breast augmentation results.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lift, breast reduction, dr barry eppley, indianapolis, plastic surgery
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