Northern Virginia -Fairfax and Manassas, VA
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
Breast Reduction Indications
Breast reduction patients are amongst the happiest patients in our institute. Women who suffer from large breasts complain of pain due to the heaviness of the breasts affecting their neck, back, and shoulders. Some patients may also experience numbness in their hands. They are often dissatisfied with their body image and may be unable to wear the clothes that they desire because of their enlarged breasts. These factors may hinder a woman with large breasts from participating in sports, playing a more active social role, and simply enjoy life to the fullest. If the areola (the pigmented skin around the nipple) has enlarged with time and you would like it to be reduced, that can easily be done with a reduction. In addition to reducing the size and weight of the breasts, the procedure also provides a lift.
Breast Asymmetry or Unevenness
Very rarely are a woman’s breasts perfectly even, or symmetrical. Sometimes, the lack of symmetry can cause women significant distress. Many go to great lengths such as adding prosthetic implants in their bras to achieve symmetry. This is a common situation that women do not like to discuss. The solution is straight-forward. If a woman with uneven breasts seeks a breast reduction, it is simple to reduce one breast more than the other to make the breasts as symmetrical as possible. The treatment plan is agreed upon during the consultation.
The Initial Consultation
An initial consultation is set-up where we discuss the breast reduction procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Breast Reduction Procedure:
A breast reduction is also a lift. We perform it in a similar way to an “anchor” incision breast lift in severe cases or a lollipop incision breast lift in mild to moderate cases. In both procedures breast tissue and fat is removed as well as skin. Skin is removed from around the areola and a significant portion of the lower half of the breast leaving a scar that is shaped like a lollipop plus horizontal scars extending along the lower crease of the breast forming a scar that looks like an anchor. Alternatively, a reduction mammoplasty can be performed through a lollipop incision without the scars in certain situations. In a reduction, a large amount of breast tissue is removed, with an average of about 1-2 lbs removed from each breast. The breast reduction scar can cause women who seek this operation some anxiety, but having smaller breasts with the weight literally lifted off of their shoulders, offsets any dissatisfaction from the anchor incision scars.
We get asked a lot of questions about scars. Usually, scars will heal well. Scars can be revised in the future according to the patient’s wishes, but we have a revision rate of about 2% and the rest of the patients, with time, are happy. We also offer women a unique scar tape and cream system proven in a study on 800 patients to optimize scar healing. The vast majority of patients are very happy with their breast reductions.
Benefits of this Breast Reduction Technique:
There are different ways of performing a breast reduction. The two main techniques are either a vertical breast reduction with a scar around the areola and a lower vertical scar (“lollipop” incision) or a “Wise” pattern technique with an “anchor” incision. The rationale for performing a breast reduction with a “lollipop” incision is to spare a patient the horizontal scar at the bottom of the breast. The horizontal scar can heal unfavorably in some patients, so if it is unnecessary it can be eliminated. The advantage of a vertical breast reduction is less scar and a rounder shaped breast with more projection. The disadvantage of doing the “lollipop” incision (vertical breast reduction) is that it takes slightly longer for the breast to look natural. Additionally, a small amount of excess skin below the breast may need to be removed at a later time.
The advantage of the “Wise” pattern technique is that it is a simpler technique with few complications and consistent results. It also allows for more skin removal in cases of severe breast enlargement. The main disadvantage is the lower horizontal scar and some risk of bottoming out in the long term.
How We Minimize Complications of Breast Reductions:
At the Bitar Cosmetic Surgery Institute, our Northern Virginia breast reduction staff take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital, with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after a breast reduction is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. In our practice the rate of significant bleeding is less than 1%. Very rarely, we will put drainage tubes in the breasts during a procedure, if we feel there will be some bleeding after the surgery, so the blood will be drained into a plastic bulb that the patient can empty. Those drains are removed in the days after surgery.
The most important step in avoiding infections, in my opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after a breast reduction is extremely rare. It may occur at the superficial incision level where the tension is highest, and a small open wound may occur which will usually heal nicely with dressing changes and antibiotic ointment. The scar usually heals very well. Very rarely, we will do a scar revision to improve the appearance of that scar.
In a breast reduction, there is manipulation of a relatively large amount of breast tissue, resection of 1-2 lbs of skin, fat, and breast tissue, and the closure of skin under some mild tension. Because the incisions are under tension, as well as the weight of the breast causing pressure, there can be either loss of some skin or a small opening of the wound at the base of the breast. This is treated with dressing changes and cleaning of the wound in the office as needed. This can occur in about 2-4% of patients. Usually the wounds heal very well and nothing further needs to be done.
Ability to Breastfeed
Women are sometimes concerned that if they get a breast reduction that they will not be able to breastfeed afterwards. The likelihood of losing the ability to breastfeed after a breast reduction is about 4% in the literature. With the techniques that are described above, inability to breastfeed after breast lifts that we have performed has not occurred with any of our patients to our knowledge.
Loss of Nipple Sensation or nipple / Areolar skin
Similar to what has been said about ability to breastfeed, loss of nipple sensation is a potential complication that due to the technique with which we perform this procedure is a minimal complication, with less than 1% occurrence. However, there is theoretically a higher chance of losing the nipple in a breast reduction in either a lift or an augmentation procedure due to changes in blood supply to the nipple. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks. In one case, nipple sensation was regained after 6 months!
Smoking is an absolute contraindication in breast lift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, loss of nipple tissue, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.