Your Questions
Your Questions
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
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
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
Q: My breasts are in terrible shape after having had 4 children and nursing them all. They are saggy and disgusting. I think they need a total breast overall. They look so bad I don’t even know if they can be helped. I have read about breast implants, breast lifts, and breast reductions and I think I need all three. Is it possible to have all three of the procedures I am asking for done at the same time?
A: The combination of a breast lift (skin reduction and tightening) with an implant is a very common procedure for the breast that is small in volume but has an excess amount of skin that sags over the lower breast crease. With the breast in this kind of shape, all three procedures are needed simultaneously to give a more pleasing and uplifted breast shape. This is the most difficult of all cosmetic breast procedures and is best thought of a breast reconstruction rather than a simple breast reshaping.
Unlike breast implants alone, this more extensive form of breast reshaping will result in scars on the breast. The scars will be similar to that of a breast reduction. Because of the difficulty of the procedure, secondary revisional surgery is not rare to get the best shape and symmetry between breasts that often start off not only badly shaped but different.
Dr. Barry Eppley
Indianapolis, Indiana
Q: My daughter had a breast reduction at the age of 14. She is now 19 and would like to have implants to bring some shape and fullness back to her breasts. Can you explain what happened? It seems like we are going in reverse. Once her breasts were too big, now they are too small.
A: While breast reduction reduces breast size by removing tissue volume and skin, the long-term results of the operation are not always stable. In fact, if you look at a woman’s breasts over a lifetime, they do change throughout her life for a variety of reasons. The younger a breast reduction is done, the more likely the breasts will eventually undergo shape and size changes.
The first explanation is that the initial breast reduction may have been overly done. While it may have initially looked good, once the breast swelling went away the amount of reduction may have been too much. Years later, the breasts will bottom out and look deflated and flat.
Breast reduction results are affected by a variety of bodily changes long after the surgery has healed. The two biggest are weight loss and pregnancy. Both cause breast involution or tissue shrinking, resulting in a decreased breast size and more loose breast skin.
Since her breast reduction was done early at age 14, she was barely through puberty. Often breasts can ‘regrow’ when done this early but I have never seen in my Indianapolis plastic surgery practice significant breast shrinkage after just five years by age 19. If she has become pregnant and delivered, this would explain what has happened. More likely, however, is that the initial breast reduction may have been too aggressive.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 42 years old. I have always had large breasts. I have permanent indentations on my shoulders from bra straps. I currently wear a 40F bra. I have had back and neck pain for as long as I can remember as well as rashes under my breasts which become unbearable in the summer. I had an MRI to rule out spine problems as a cause for my back pain and it was normal. I am extremely uncomfortable in a bathing suit (in fact, last summer I wore a bra under my suit) and I have a difficult time finding clothes that fit properly. I am unporportioned. I wear a size 18 pants, but a 3x top. I would love to be able to run. I currently weight 190lbs and am uncomfortable exercising but want desperately to lose weight. Please help me.
A: One of the real benefits to breast reduction surgery is how consistently it improves, or alleviates, the musculoskeletal pain from large breasts. While the size and weight of large breasts is often believed to be the sole reason for musculoskeletal pain, the sag of the breasts is just as important in contributing to the pain. Like a rope around the neck attached to several lbs of sugar in bags, this creates a downward pull on the neck and shoulders. Breast reduction surgery works because of weight reduction and resuspension of the remaining breast tissue back up on the chest wall. (thus eliminating that rope around the neck effect)
In a patient with these symptoms, breast reduction will reduce the back and shoulder pain, eliminate completely the rashes, and will enable her to exercise and run better. For many patients so afflicted, breast reduction surgery can be life-changing.
Dr. Barry Eppley
Q: I am a 23 year-old graduate student and former college athlete. My breasts are so large I am miserable all the time and can’t even run anymore. I wear a 36DDD bra and this puts too much strain on my body. My shoulders hurt all the time. I have been in physical therapy for my neck and back, have migraine headaches and asthma. I am 5’ 10 and weigh 190 lbs. Will insurance pay for my breast reduction?
A: Breast reduction surgery is commonly covered by insurance but not always. There are certain very specific qualifications that all health insurances require that a patient must meet to be eligible. These include being within 20% to 25% of their ideal body weight (not being too overweight), having a documented history of physical therapy or chiropractic treatments for three months that did not result in sustained pain relief (emphasis on being documented), failing other non-surgical therapies such as anti-inflammatory drugs and support bras (all patients meet these criteria), and having your plastic surgeon document the specific amount of grams that will be removed that meets the minimum amount based on your body surface area calculations. (estimated by your plastic surgeon) All of this information will be put in a letter by your consulting plastic surgeon and sent in with photographs of your breasts to your insurance carrier for their determination.
Generally, if all of these criteria are met a patient will be approved for breast reduction surgery. The most common reasons patients are rejected coverage is because they weight too much for their height, have not tried some form of physical therapy, or not enough grams of breast tissue are estimated to be removed. (in this patient based on height and weight, the BSA is 2.05 with a requirement of at least 1,000 grams removed per breast)
While any amount of breast reduction provides relief in all patients, and a patient’s weight or amount of breast tissue to be removed has not been proven to matter for pain symptom relief), these are the insurance criteria. Debating their merits with the insurance company is not a productive endeavor.
In patients where insurance coverage has been denied, breast reduction surgery can always be done on a fee-for-service basis. Your consulting plastic surgeon will be happy to provide you with a cost estimate.
Dr. Barry Eppley
Breast reduction is one of the most common plastic surgery procedures in the United States. Reduction of large breasts provides immediate and long-term improvement in back, shoulder, and neck pains that come from a woman having to carry around the equivalent of a rope around their neck with several pound bags hanging from them. Despite the common performance of the breast reduction operation, there are numerous misconceptions and misinformation that surround the procedure. Here are the top five breast reduction myths.
Breast reduction causes a lot of pain after surgery. Despite what many paients fear, breast reduction is not associated with much pain after surgery. There certainly is some soreness and discomfort, but acute and unbearable pain just does not occur. Since breast reduction is about the removal of skin and breast tissue, not muscle or bone, pain is far less than what many women fear.
My breasts will still sag after surgery even though they will weigh less. Breast reduction is a combination of a reduction AND a breast lift procedure. The surgical technique o f breast reduction involves an entire reshaping of the breast, upward nipple repositioning along with breast tissue removal. Beast lift procedures are essentially the same operation but without any breast tissue removal.
My nipples are removed during the operation and are put back in place at the end. In general, this is rarely done. In the most commonly performed method of breast reduction, known as the inferior pedicle technique, the nipples are left attached to a central mound of breast tissue. Breast tissue and skin is removed around it. Keeping the nipples attached keeps them alive and preserves feeling in them. In a less common breast reduction method, known as free nipple grafting, the nipples are in fact removed and put back later. But this method is only done in very large breasts in which the nipples are in danger of survival with the traditional inferior pedicle method of breast reduction.
I won’t be able to breast feed or feel my nipples after a breast reduction. In the inferior pedicle technique, the nipples (and their underlying glands and nerves) remain attached. Thus, the nerve supply to the nipple is maintained allowing for sensation, the ability of the nipple to get erect, and to be able to breast feed. There is always the risk that even with the nipples remaining attached, the nerve supply to the nipple will be injured from removing breast tissue from other areas, but this is not common. (although a possible risk)
My insurance won’t cover my breast reduction. No one, patient or plastic surgeon, can predict with any accuracy what any insurance company may do. This is why the submission of a pre-determination letter from the plastic surgeon in absolutely necessary in all cases. Your insurance company has very specific criteria for what qualifies someone for breast reduction (they all do) and the pre-determination letter must have all your information (breast size, symptoms, amount of breast tissue to be removed) to see if you qualify. My experience has been that over 80% of patients get approved on the first submission.
Dr. Barry Eppley
Breast cancer remains a threat to every women and the emphasis on early detection can not be overemphasized. As October and Breast Cancer Awareness Month has now passed, the upcoming holiday season may temporarily displace some of these concerns. Plastic surgery throughout the year, however, plays an inadvertent but beneficial role in the detection and management of this disease.
Breast reduction remains as a very popular and commonly performed plastic surgery procedure. It provides a dual reconstructive and cosmetic benefit by making the large breast better shaped and more uplifted and improving back, shoulder and neck pain by size reduction. As part of the reduction procedure, breast tissue removed is almost always sent to the Pathologist for examination. While I have yet to have positive cancer findings from submitted breast reduction tissues, reports exist that it is occasionally found.
The finding of breast cancer during a reduction procedure can occur in two circumstances. The first is during the course of the operation some suspicious tissue is found and sent to pathology for an immediate evaluation, known as a frozen section. The second is when the submitted tissues are examined by the pathologist and cancerous tissue is found. A recent study report has shown that the finding of breast cancer or precancerous tissue in pathology specimens existed in 12% of the patients studied in one treatment center.
This is a rather surprising finding given that prior published reports have not shown such high caner rates of cancer detection in breast reduction patients. However, given the relatively high incidence of breast cancer in women, it does seem logical that a significant number of yet symptomatic women have the disease.
This raises an interesting and obvious question. Does breast reduction surgery decrease the incidence of breast cancer? Will it decrease the risk of some women from eventually getting this disease? The answer to that is an emphatic yes….for some but not all women.
This question has been looked at and reported on in 2004. A study published in the pretigous journal of Plastic and Reconstructive Surgery reported a difference in risk of breast cancer after breast reduction surgery. This appears to be especially true in women who are over 40 years old at the time of surgery. Risk of cancer reduction in this age group was 28 to 50 percent. No reduction was seen in women having the surgery before the age of 40. Although the complete removal of a woman’s breasts (prophylactic mastectomy) can virtually eliminate the risk of breast cancer, most women find it extremely difficult to elect to remove all of their breast tissue. Women now have an additional preventative option to have their breasts partially reduced rather than removed. This represents a real alternative for someone who is a candidate for breast reduction, even though the amount of tissue removed may be small.
Given the occult incidence of breast cancer found in the pathology of asymptomatic women during routinue breast reduction surgery, this can be viewed as an additional benefit of the operation. However, I would emphasize that breast reduction is a risk reducer, not a preventative guarantee.
Dr. Barry Eppley