Your Questions
Your Questions
Q: Dr. Eppley, Does a breast reduction include them being lifted? Is there a way to make my areola smaller? Will my stretch marks go away if they are lifted? Is a reduction what you suggest or just a lift? I am only 19 and I feel like my breast look like Im 40 and have had kids already.
A: Thank you for your inquiry. I would agree that for a young women that is too much breast tissue with a lot of sag for you to carry around as well as from an aesthetic standpoint. You are an dial candidate for a breast reduction and your questions about such surgery are common. Let me clarify some basic concepts about breast reduction. Every breast reduction includes a full breast lift. While a breast lift can be done with a reduction, a breast reduction can not be done without doing a lift. In almost every breast reduction the diameter of the areola is reduced significantly, usually done to 40mm to 44mm diameter. Stretch marks that lie within the excised skin of the breast lift are removed. Any stretch marks that lie outside of that zone remain but often look better because of the lifting effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 370 lbs with 52N size breasts, with severe ptosis and painful sagging breast tissue, I have severe back pain from supporting such pendulous heavy breasts for years, will you reject me as a candidate for the surgery?
A: As you have surmised, at your current weight you are not a good candidate for breast reduction surgery. While there is no doubt you would benefit by such surgery, your current weight increases your surgical risks and poses several logistical issues which I will enumerate for you.
1) Any patient over 300 lbs has to be done in a hospital setting. This is not only because of the more comprehensive medical setting and your increased risk of medical problems, but you also need to be conserved overnight after a 3 to 4 hours surgery done under general anesthesia.
2) The other reason a hospital setting is essential is that they have the operative beds that can handle any weight over 300 lbs, most outpatient surgery centers do not.
3) Due to the cost of surgery in a hospital, it is only economically feasible if the cost of surgery is done through insurance.
4) No health insurance will approve a breast reduction with one’s weight being over 300lbs. One of their criteria for coverage is that one’s weight should not be more than 30% of their ideal body weight. At the least they expect to see that the patient has a documented history of substantial weight loss efforts. While we know that weight loss is not going to be the cure for the symptoms of your large breasts, it is an insurance criteria they use.
For all of these reasons, you are not a good candidate for breast reduction surgery at this time. What you need to do kids get your weight under 300lbs which would help lower your medical and surgical risks and give you a better chance to have your surgery approved by insurance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a breast reduction but my situation is a bit unusual. I currently have breast implants but gained weight after surgery with my third child. That was over ten years ago. I would like a breast reduction with my implants removed. I do not want to be bigger than B cup… I am currently a D/DD cup.
A: With breast implant removal and some significant breast tissue on top of them, a full breast lift may be likely needed. Due to concerns about blood supply to the nipples, the amount of breast reduction/lift that can be done may be more limited than going all the way down to a B cup may permit. Conversely, based on the size of your existing indwelling implants and their location (submuscular vs. subglandular), such a breast size reduction may be very possible. Larger breast implants that are in a submuscular position will safely permit more of a breast reduction/lift. I would need to see pictures of your breasts to help make that determination.
Removal of breast implants by itself causes an obvious breast reduction effect. But the now excess and potentially sagging overlying breast tissue must be managed to create a smaller and tighter breast mound.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a breast reduction question. Immediately after surgery when the dressings were taken off, my areola have a somewhat different size and shape. I know that my breasts will hange during the recovery period as the swelling goes down. I was wondering if my areolas would also change in shape and size as well? I knew there was a high possibility of them being different but I wasn’t sure if they just look a lot different in size now because they are still healing.
A: The areolas may change a bit but not a whole lot as the breast reduction heals. Areolas are usually a bit different after breast reduction surgery because they were not never really symmetric initially. While they are cut evenly using a ‘cookie cutter’ at 42mm in diameter during the first step in breast reduction surgery, the act of sewing them back to a new spot on the breast mound and the suturing rarely makes them as symmetric as the way they were initially cut out. I would wait six months and if the areolar size and shape is still an issue, adjustment of them can be done in the office under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 18 years old at height 5’4 and weigh 125lbs. I have breasts the size of 32DDD. I know I want to have a breast reduction sometime in life, and my question is if it’s worth having one before I have children?
A: When one undergoes breast reduction depends on how symptomatic one is from their large breasts. If they are heavy and painful and are interfering with your lifestyle then you do the procedure before children since you can get the benefits sooner rather than later. If they are large and not that uncomfortable then you wait and see what effect having children as on their sizes and the symptoms that are causing.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast reduction surgery. I am 24 years old, 5 feet tall and pregnant. I was a 32C before and am currently a 32G. You have high reviews on Real Self. I struggle with stretch marks on my breasts and have no faith in my breasts shrinking after because of them. I am interested in a combined breast reduction and lift.
A: While you may ultimately need some combination of a breast reduction/lift, it would be important that you wait a full six months after delivery before having the procedure. You want your breasts to fully shrink down and be a stable size with whatever sagging may ensue. In essence you want to have a ‘stable target’ to operate on so the breast reduction result does not change appreciably afterwards due to still evolving changes in your breasts.
You may also be surprised how much your breasts will shrink after delivery. What seems like a breast size that can never go down adequately can actually even end up too small later. The sagging will not improve with time and a breast lift may ultimately be needed but it is way too early to say that you need a breast reduction as of yet.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in some form of breast reshaping surgery I am torn as to whether a breast lift or a breast reduction is the right option for me. I have attached some pictures so you can help me decide between the two options.
A: Thank you for sending your pictures. In regards to your breasts it is important to remember that every breast reduction involves a breast lift and the associated breast lift is always a full anchor pattern lift. Thus the breast lift part does not change, the only variable in breast reduction surgery is in how much breast tissue should be removed (reduced) if at all.
Also every breast lift when done alone will reduce the size of the breast by almost one cup…and this is without taking out any breast tissue. (the removed skin is to lift and reshape the breast mound) In looking at your breasts I really see largely a breast lift with only enough breast tissue removed to ‘fit’ the remaining breast tissue into the lifted and reshaped overlying breast mound skin. Most likely you could get away with a full breast lift with no breast tissue removed at all.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I hate my breasts! I am just 20 years of age and my breast looks like they are 85yrs. They sag and my nipples are huge. Due the weight I have lower back pains and my shoulders hurt. I can’t where certain clothes. For once I would to be able to a strapless bra or even not have a wear a bra at all with my clothes. I need a breast lift!
A: Large hanging breasts, even in young women, can be both aesthetically unattractive and cause symptoms of back, neck and shoulder pain. A breast lift with areolar reduction, and a little breast tissue removal, can create a dramatic improvement in their shape and reduction or elimination of their associated musculoskeletal symptoms. The trade-offs for these dramatic breast changes are scars in the classic anchor or inverted T shape. One has to decide whether these changes are worth it but most young women would say so. It is also important to understand that breast shape is variable over one’s lifetime particularly when one is still very young. Pregnancies and weight gain/loss will negatively affect the result of any breast lift/reduction procedure with the most common changes being further breast tissue loss (involution) and skin sagging. (pseudoptosis)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a breast reduction. I would like that fat from my breast to be use for a buttock augmentation. I know this is a very large request but I hope it can be considered. I am a k cup. I’m only 5’3. The pain from my breast are unbearable. I’m only 17 years old. My breast have prevented me from so much and I have been turned down by so many doctors that I have lost count. My only wish is that I can have these procedures done before my senior year so I can finally experience my life as a normal teenager.
A: By your physical description and breast size, there is no question you would benefit physically and psuchologically with a breast reduction. However it is not possible or advised to take breast tissue and use it for buttock augmentation. Breast tissue is not pure fat but a mixture of fat and breast tissue. Within that breast tissue are tissue cells that may or may not in the future, become cancerous. Thus should not transfer any tissue for an elective aesthetic augmentation that has any potential for future malignancy. In addition, a breast reduction procedure does not remove tissue by a liposuction method but by an en bloc excisional method. This does not make it amenable to an injectable method even if it was appropriate fat tissue to use for buttock augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been waiting for my family physician to get me a referral to a plastic surgeon to consult me on a breast reduction. I have several health reasons for considering this type of procedure. I have a bulging disc along with deterioration of the tail bone and arthritis of the spine. I am about 50 pounds over weight, but have lost around 80 pounds in the last year or two. I have diabetes and kidney stone disease, so my losing weight was a must and I thought my pain would get better, but it has not, because I haven’t really lost any of my breasts. I would love to get a consultation with you, but I do not have the money to pay out of pocket and would like my insurance to pay for this procedure. That is why I wanted a referral so the insurance understands that it is not for cosmetics. What do you recommend for me to do in my situation. Thank you very much!
A: When using insurance you have to go through the proper channels (by the book) as this will ultimately effect the pre-determination process and decision for breast reduction surgery by your health insurance carrier. So you are going to have to get the referral from your family physician first before you can have a consultation. Most certainly they are never going to pay for a consultation without the referral.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast reduction surgery. Next month I am having barbaric surgery with a sleeve done. I have had a lot of female problems. I am having pain in my back and my chest from my large breasts. I do have Aetna Insurance so how does that process work to get a reduction on my breasts and having the insurance cover it?
A: Breast reduction is often covered by insurance and the process to determine if they will pay for it is known as predetermination. This requires photos to be sent as well as documentation that efforts at physical therapy are done (I don’t make the rules, we just have to follow them) for the insurance company to consider coverage. However, if you are going to lose weight, particularly through bariatric surgery, breast reduction surgery should only be considered after the weight loss has occurred. Significant weight loss has been shown to affect breast volume. You may find out that you only need a lift and not a reduction as extreme amounts of weight loss can cause a lot of breast volume to be lost. Wait to consider breast reshaping/reduction surgery until your breasts are in a stable period where your weight is where you want it or the best that it can be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have severe breast sagging/ptosis I believe. I would like a breast reduction or lift without implants if possible. I have udnergone a 150lb weight loss which has ruined my breasts! I’m 33 years old with 90 year old bags for breasts. They are heavy,ugly sagging breasts. I currently weigh 220lbs with a weight goal of 180lbs. I have read that some surgeons will not preform the surgery on someone with a certain weight or BMI, so I’m working on dropping further weight. I obviously need other areas worked on but right now my breasts bother me the most. Do I qualify for the Lollipop procedure or the one that follows after that? Have you worked on breast this large or severe? Can you help me?
A: There is no question that you have extreme breast sagging and near total breast involution. (loss of breast tissue) Breast sagging or ptosis is classified by where the nipple sits relative to the lower breast fold. When the nipple and the breast mound hangs way below the lower breast fold that is known as a Type 4 breast sagging. (on a scale of 1 to 4) Given how your breast sags I would have to classify yours as a Type 5 sagging which is off the scale!
I have seen breasts just like yours and successfully operated on them. The question that relates to your breast surgery is what type of reduction/lift is needed and the timing of the surgery as it relates to your weight. Understand that every breast reduction incorporates a breast lift. (although not every breast lift is a breast reduction) Your breast lift is way beyond that of the lollipop lift, rather you will end up with a anchor scar pattern due to extreme amount of lifting needed and the amount of breast skin removal. Another consideration would be a partial breast amputation and free nipple grafting technique. This will get you the greatest amount of lift and reduction although your young age and the desire to maintain some volume probably precludes against this more simplest approach. If you were a smoker thisn would have to be the technique of choice. As it relates to your weight, you should be within 25 lbs or less of your weight loss goal to have the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am currently 21 years old, and wear around a size 36 H. I am 5’1 and weight roughly around 210 pounds. The women in both sides of my family have large breasts. Both my aunt and my mother had breast reduction surgery. I do have discomfort while sitting which has caused me to have really bad posture. The bad posture has caused a pretty decent size hump on my lower neck/back. Would I be a good candidate for a breast reduction?
A: By your description I could not imagine a better candidate for breast reduction surgery. Your musculoskeletal symptoms and posture indicate that your breasts are too heavy and hung too low for your body frame to support it. You have already seen the benefits (and the scars) from breast reduction in your relatives so you are well aware of both the benefits and the trade-offs of the procedure. You age is not a limiting factor for having the surgery. While you are overweight for your height, that is also not an excluding factor in having successful breast reduction surgery. Weight loss will most likely make your breasts smaller but will not correct the sag which is often as much a culprit as their weight.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a breast reduction done but I would like to know if I can breast feed later on when I decide to have children. I am 25 years old, size 38DD, with a height of 4′ 11”. I have been having a lot of back pains,shoulders, and even neck pain as well. This is why I am interested in breast reduction.
A: Breast reduction is a commonly performed procedure that is frequently done in young women who have not yet had children. Even though it is a breast procedure that involves the glandular tissue, it does not interfere with the ability to breast feed. Many women have had breast reduction that have gone on to have children and were able to breast feed successfully. This is because the nipple-areolar complex and its attached ductal tissue remains intact to the central glandular breast mound which is not disrupted from its vascular attachments to the pectoralis fascia/muscle. Thus breast milk can be made and delivered through the uninterrupted and unscarred ducts out through the nipples. The incisions that one sees on the breast mound after a breast reduction have no connection to the breast lactation system.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a full breast reduction when I was a later teenager. I am now 36 years old) Now that I am older and with time my remaining breast tissue has fallen and is saggy. I would like to now have a breast lift to reshape them and give them more of a perky appearance. My original plastic surgeon has since retired and office records are no longer available. One plastic surgeon I consulted with said he said he would be worried about doing a second lift after the reduction. I have read from other plastic surgeons that a lift with a small implant is safe and will help. Is this a worrisome procedure after having a reduction? I would be open to a small implant but ideally would like to be the same size, just rounder. I’d love to be able to go bra less. Is this possible?
A: It is not rare to have a breast reduction done when someone is young that wants augmentation or a lift many years laters. It is perfectly safe to do a breast lift now using the same scars from the original breast reduction. The blood supply to the nipple through the central breast tissue pedicle will be undisturbed. It would be similarly safe to place an implant under the muscle which is beneath the overlying breast tissue mound. The role of the implant is to maintain upper pole fullness which a breast lift long-term will not do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 38 year old female. I had lap-banding in June 2012 and have since lost a lot of weight. I have gone from 339lbs to 268lbs. Currently, I am contacting you because I need help. I have always had large breasts. I have a 48E bra size at this time and despite my weight loss, have not decreased in bra size. My concern now, is that I have not been able to exercise properly because of the pain that my large breasts cause. In fact, in November of this last year I had an anterior cervical discectomy and fusion on an emergent basis due to a severely herniated c6-c7 disc- presumably caused by my large breasts. I have recently sought several consultations for a breast reduction due to this, but the consensus is that I need to have a lower BMI. I have very few comorbidities, so my surgical risk is minimal. Would it be reasonable to request a consultation from your office? I have Blue Cross Blue Shield and if deemed “medically necessary” breast reduction is a covered entity.
A: Thank you for your inquiry. While your weight may still be high by ‘ideal’ standards, the symptoms you experience with your breasts are not likely to be improve regardless of further weight loss. From that perspective, breast reduction at this point is not unreasonable. Sometimes the breast reduction just needs to be done regardless of the patient’s weight. This is more of getting the procedure approved through insurance at your weight than it is about the technical capability to do the procedure or in its ability to heal.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, Thank you for your prompt response and for clearing up the periareolar technique. I have heavy breasts so it sounds like the liposuction might not be enough for me. Do you perform the SPAIR technique? As you can see, I am trying not to have a lot of scarring. I know that it’s inevitable and I’m realistic just trying to avoid as much as I can. I have learned alot from your web site and appreciate it greatly.
A: What I was implying is that some scar must come off from around the areola to achieve a breast reduction/lift. However, no woman wants anymore breast scars that they have to have. There is where the SPAIR technique comes into play, a method which I am familiar and endorse. This is a combination of American and European breast reduction methods. The SPAIR acronym means a Short Scar Peri-areolar Inferior Pedicle Reduction technique. This methods reduces the breast scar load to about 50% of the traditional anchor method by eliminating the entire horizontal crease scar. While this is the least conspicuous of the three locations of the anchor breast reduction scar (peri-areolar, vertical and horizontal scars), any scar reduction is a benefit. As long as the amount of breast reduction stays in the range of about 500 to 1500 grams (where about 90% of all breast reduction weights are), I find that it works well.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, Hi, I’m interested in the periareolar breast reduction with lift and wondered if you perform this procedure? Also, I am interested in a tummy tuck at the same time if possible. Does you accept Tricare Prime insurance or Tricare and you a network or nonnetwork provider?
A: Thank you for your inquiry. For the sake of clarification, there is no such thing as a periareolar breast reduction procedure. Limiting the skin removed to the circumareolar area will not only not do any actual breast reduction but is a very poor method of breast lifting for most women with any degree of breast ptosis. (sagging) The only conceivable case in which a periareolar technique may be used successfully is where there is a very minimal amount of breast sagging and liposuction is be used for the removal of some breast tissue. Such a scenario would be most uncommon for most women who seek breast reduction surgery. I would have to see some picture of your breasts to see if this is a possibility for you. The reality about combined breast reduction/lifting is that it requires scars around the areola and downward to the lower breast fold and along the lower breast crease. (anchor scar pattern) This is the only method of breast reduction that actually really works.
It is certainly possible and very common to do any type of abdominal contouring in conjunction with any form of breast reshaping. When done together, these combined operations actually have a name….the Mommy Makeover.
Lastly, I am not a provider in the TriCare insurance program.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had large breasts as long as I can remember. While they were once more perky, they have fallen and are way out of proportion. They are just super saggy now and hang all the way down to my belly button. I think the reality is that I need a breast reduction although I am not super excited about the possibility of having scars. I am 32 years old and have never been married or had children. I am not sure whether I should wait to have surgery until I have had children or just do it now instead. I am also worried about having a breast reduction and ending up being too small. Being big-breasted is part of a body type that I am most comfortable with and it’s part of who I am and what I am known for. I want my breasts lifted but just don’t want to be flat-chested.
A: When one has breasts that are so big that they hang down to one’s belly button, they would be a good candidate for a breast reduction procedure. Breast reduction surgery combines a lift with breast tissue reduction to create smaller breasts that sit higher up on one’s chest wall. It is important to understand that there is a wide variability in the amount of breast tissue removal that can be done in any breast reduction. Thus you should not fear having a breast reduction because you think you will end up too small. That is a discussion you need to have with your plastic surgeon beforehand so there is an understanding as to how much smaller in breast size you find acceptable. Given your position, it is always better to end up with uplifted breasts that are still a little big rather than being too small. Whether you should have a breast reduction before or after having children depends on how much neck, back and shoulder pain you are in now. While pregnancy will ultimately affect the shape of your breasts, no matter if they had undergone surgical reshaping or not, the timing of the surgery should be based on musculoskeletal pain relief.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been researching your site. I am hoping to have breast reduction covered by insurance after the first of the year. I have a doctors appointmentt with my primary doctor next week to hopefully begin the process for this to covered by insurance. My question is that I would also like to have butt augmentation with fat transfer. Is it possible to have both surgeries at the same time?
A: It is possible to have both a breast reduction and buttock augmentation at the same time. From a recovery standpoint, it is really a combined breast reduction and abdominal and flank liposuction since the harvest for the buttock augmentation is from liposuctioned fat. I have done this exact combination of procedures a few times and patients have had no problems. As an aside, your primary care doctor can do little to help you get your breast reduction approved. Such as approval must emanate from a consultation with a plastic surgeon who will write a predetermination letter. Ultimately your insurance company will decide based on your weight, breast size and the amount of anticipated breast tissue removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been thinking about getting a breast procedure since I was 13. I have 34DD and I’m 5’1 ½. I’m very self conscious about them but my boyfriend thinks they are fine but I do not. They are too big and saggy (gross) I just hate them! If I got a breast reduction how much smaller would my breast’s be and would you recommend having implants put in?
A: Breast reduction surgery not only reduces the size of one’s breast but also incorporates a lift of the breasts as well. There would be no reason to place implants during a breast reduction, that would partially defeat the purpose of the procedure. The amount of breast reduction that can be achieved in the procedure is different for each patient. There is great variability in how much breast tissue would be removed and takes into account how much or little breast tissue one wants to remove. One could easily go from a saggy DD breasts to an uplifted and more perky full C cup. It is important to remember that the trade-off for that amount of breast shape improvement are permanent scars. You are trading off one breast problem for another, just be sure the scar issue is less of a concern than the way your breasts look now.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am entertaining the thought of a breast lift only. So I am researching a little bit. I am 50 yrs old and have always had nice naturally large breasts but with age they are hanging low but not flat yet. I’m a Size D now. My question is with a lift only does the procedure reduce the size when they are lifted? I’m sure some liposuction etc is needed so that seems to me it would take them down at least one size naturally. Is that correct? I’m thinking it would not be so bad as with age our backs take a toll carrying them around our whole lives, so smaller could be a good thing. Thank you for your time.
A: A breast lift, in its purest form, does not reduce the size of the breast. It lifts it, tightens the skin envelope and moves the nipple position into a more central position on the breast mound, but it removes no breast tissue. This is what separates it from a breast reduction procedure which also removes a significant amount of breast tissue. But variations can be done to a breast lift procedure to provide both a lift and a small amount of breast reduction. It is this procedure that you appear to be seeking by description. This combination breast lift-reduction procedure involves the removal of between 100 to 200 grams of breast tissue which will reduce the size of the breast by a ½ cup or so. Liposuction can also be done on the side of the breast into the back, an area which is outside the direct effect of any breast reshaping procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have severe breast asymmetry. Left is a D cup and right is an A cup. I also have very large areolas and my breasts are pendulous. Because they are so uneven I have had upper back soreness and other aches and pains. Would insurance cover me at all? It is just as disfiguring as other birth defects and even cancer. I am not at all exaggerating.
A: Whether your medical insurance would cover the reduction of your larger D cup breast is a determination of the insurance company. No physician can say with any certainty whether they will or won’t. This requires a written letter with photographs by a plastic surgeon to your insurance company. This is known as a pre-determination process. Once they have this information, they will then make either an approval or denial in a written response. They will definitely not cover any form of a breast lift such as may be needed on the smaller right breast and this would not even be submitted, lest it jeopardize any potential approval of the left breast reduction.
Dr. Barry Eppley
Indianapolis, Indiana
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
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
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
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
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
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
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