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Who is a candidate for breast reduction?

Women with large, disproportionate breasts with pain, discomfort or embarrassment due to their breast size may be good candidates for breast reduction  (reduction mammaplasty). Ideal candidates for a breast reduction are women who are not pregnant or breastfeeding, are done having children, and are at a stable weight. Although breast reduction is generally recommended for mature women with fully developed breasts, surgery may be performed on younger women if their breasts are causing serious pain and physical discomfort.

When can patients return to work and resume normal daily activities?

After breast reduction surgery, it is often possible to return to work within one to two weeks, depending on the patient’s job.  Many patients resume most of their normal activities, including some form of mild exercise, within a few weeks. You may continue to experience some mild, periodic discomfort during this time, but these feelings are normal.

Because sexual arousal could cause incisions to swell and create the possibility of delayed healing, sexual activity should be avoided for at least two weeks after breast reduction surgery.

When can patients shower after breast reduction surgery?

Patients are often concerned that limited mobility after surgery will prevent them from showering for several days.  Dr. Jejurikar recommends that patients shower as soon as their drains are removed after surgery, generally about 48-72 hours postoperatively, to help them feel refreshed and to keep their breast skin clean.

Will health insurance cover the breast reduction procedure?

Breast reductions may be covered by medical insurance if the purpose of the breast reduction surgery is to alleviate physical discomfort and pain caused by oversized breasts. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed.

Insurance companies require specific documentation from plastic surgeons prior to approving reduction mammaplasty.  This usually includes photographs demonstrating large breasts and shoulder grooving from bra straps, as well as a letter describing patient’s symptoms, other treatment modalities attempted, and the estimated amount of tissue that will be removed.

Supporting documentation from other physicians and health care professionals can be very helpful in facilitating the approval process.  Letters from physical therapists and chiropractors documenting failed therapy for back pain and neck pain, as well as from primary care doctors demonstrating neck pain, shoulder pain and heat rashes despite appropriate use of a support bra, all help immensely.

How long will the results of breast reduction surgery last?

After breast reduction surgery, provided patients do not gain or lose a significant amount of weight or become pregnant, breast size should remain relatively constant in size. However, the effects of aging and gravity cause all tissues to sag over time; the breasts are no exception. If, after a period of years, the breasts become saggy or droopy, patients may choose to undergo a breast lift procedure to restore a more youthful contour.

Will there be scarring?

The various techniques for breast reductions require different incisions. Traditional breast reduction surgery uses anchor-like incisions that extend around the nipple, down the middle of the breast, and at the crease at the base of the breast. Vertical incision (lollipop) breast reduction surgery creates shorter scars that also circle the nipple and extend vertically down the breast, but avoid making an incision at the crease below the breast.   Dr. Jejurikar designs his incisions with the goal of minimizing scars while still creating an aesthetically pleasing breast. Scars from breast reductions tend to fade over time and can be hidden under bras, bathing suits, or a low cut top.

Can I breastfeed after a breast reduction?

There is a significant chance that breastfeeding is not be possible after breast reduction.   It is not possible to predict with certainty who will be able to breast feed after breast reduction surgery. Thus, if this is of paramount importance to a patient, she should delay surgery until a later time.

What are the risks and complications of breast reduction surgery?

Breast reduction surgery may have potential complications that are possible for all surgeries, including bleeding, infection, hematoma, adverse reactions to anesthesia, and poor scarring.  Potential risks that are specific to breast reduction surgery include asymmetrical breasts, altered or loss of nipple and areola sensitivity, and the inability to breastfeed.

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Breast augmentation is an intensely gratifying procedure for patients, as they see immediate results after the procedure.  Like any surgical procedure, though, patients need to allow some time for recovery.

Recovery is variable from patient to patient. Most patients feel tired and sore after breast augmentation surgery, but this usually passes in a day or two. Many patients return to work within the week.  After a week, most patients have mild fatigue and soreness, but no other significant symptoms.

Surgeons vary in the amount of time they restrict their patients from exercising postoperatively.  I ask my patients to refrain from all vigorous exercise for 2 weeks postoperatively and from all upper body exercises for 4 weeks.  Patients don’t always want to comply with this, as they feel relatively normal well before their postoperative restrictions are lifted.

Scars from breast augmentation incisions will begin to fade in a few weeks and will continue to fade for months or years.

Awake Liposuction

• Ask if the doctor is a member of the American Society of Plastic Surgeons (ASPS).  Membership in the ASPS ensures that the doctor is certified by the American Board of Plastic Surgery and meets requirements for ongoing continuing medical education.
• Confirm that the doctor is certified by the American Board of Plastic Surgery.  Merely hearing that a doctor is board certified does not indicate which board has certified that doctor.  There is only one board, the American Board of Plastic Surgery, that is recognized by the American Board of Medical Specialties to certify surgeons in the field of plastic surgery.
• Find out more about the surgeon’s specific hospital privileges.  Although some procedures are commonly performed in an office or ambulatory surgical center, it is important to learn whether the surgeon has the same privileges in an accredited hospital.  Hospital credentialing committees carefully evaluate a surgeon’s training and competency for specific procedures.  If a surgeon performs a procedure in an office or surgical center, but does not have privileges to perform the same procedure in a hospital, it may be because he was deemed unqualified to perform that procedure.

Taking these steps before scheduling a consultation with a cosmetic surgeon will ensure that you find a plastic surgeon with the highest qualifications.

Many patients who have had multiple pregnancies come into the office asking about mini tummy tucks.  If you think about, no one wants a long scar on the abdominal wall, making the concept of a mini tummy tuck very appealing.  These same patients say that they are bothered about sagging of their skin, stretch marks, the appearance of their belly button and bulging of their abdominal wall, none of which they can fix with diet or exercise.  Some of their problems are the result of irreversible skin injury that occurs with fluctuations in weight.  Other problems, particularly the bulging of their tummy, are the result of laxity (looseness) of the abdominal wall muscles.
The differences between a mini tummy tuck and a full tummy tuck extend beyond the differences in incision length.  A mini tummy tuck removes saggy skin between the belly button and pubic region; that’s pretty much it. Most of the bulging of the abdominal wall remains, as the problems with the abdominal wall muscles haven’t been addressed.  A full tummy tuck can remove more skin and more stretch marks, tighten loose muscles, thereby eliminating bulges of the upper and lower abdominal wall, and re-shape the belly button.  While it’s true that the incision is longer, in some cases, it doesn’t have to extend from hip to hip.  The length of the incision is primarily determined by extent of loose skin.
If a fully tummy tuck is needed, I am very sensitive to placing the incision in an area that can be camouflaged easily.  I ask my patients to wear a bathing suit bottom so that I can design the incision to fall within this area.  This way, even if the incision needs to be longer than a mini tummy tuck incision, it can still be hidden relatively easily.
The bottom line: body contouring surgery can do wonders for re-shaping and re-contouring the abdominal wall, and improving a patient’s self-confidence and physical appearance.   Both mini tummy tucks and full tummy tucks have their merits; it’s important that the educated plastic surgery patient understand the differences.

Many of my patients ask how I choose the optimal size for a breast implant. Some women are very concerned about choosing too large of an implant, as they know this can make their breasts look unnatural. Other women are afraid that they won’t choose a large enough implant to see a discernible difference. There are a variety of tools that I use to help my patients select the best breast implant size:

• Photos. Having patients bring photos of breasts they like and breasts they detest help me determine their goals. Some women desire subtle enhancement and others desire much more dramatic enlargement.
• Measurements. The chest wall diameter, breast width and height are all important factors in selecting an appropriate implant. The breast skin envelope is only so large; selecting an implant that is too large invariably means that implant will sit too high, too low, or too lateral.
• Trial sizing. Although it is inexact, having patients try different implants in a bra in the office is a useful exercise. It gives them a crude idea of breast size and shape in clothing and often helps them verbalize their goals.
• Conversation. Different implants have vastly different shapes and profiles. It’s important that patients understand how this differs in appearance from other types of implants, and that can only conveyed adequately in the preoperative consultation.
• Intraoperative sizing. I will often utilize intraoperative trial implants and always sit the patient up during surgery to ensure that the breasts have a pleasing appearance.  This is particularly the case for patients with breast asymmetry, to ensure that the final implants utilized provide the greatest possible symmetry.

In the past couple of weeks, I’ve had some patients engage me in conversations about breast implant profiles.  They had seen pictures on the Internet of patients with breast augmentation results they liked and wanted the same style implants as in the pictures.  These patients had a limited understanding as to what breast implant profile refers, prompting this blog entry.

The naming for implant profiles predominantly refers to smooth, round implants, which are the most common type of implants used for cosmetic breast augmentation.  The two major breast implant manufactures have different names for their implants.  Allergan refers to its saline implants as low, moderate, and high profile and its silicone implants as moderate, midrange and high profile.  Mentor has similar names, but also has a moderate profile plus implant, which is between its moderate and high profile implants.

The profile of an implant equates to the projection of that implant.  For a given volume, the higher the profile, the fatter and narrower an implant is.  As a result, higher profile implants tend to provide more fullness and a rounder appearance to the upper portions of the breast.  Higher profile implants tend to be really useful in women with relatively narrow breasts who want significant enlargement of the breasts; in these women, if a low or moderate profile implant were selected, to achieve the desired volume may entail the implant riding into the underarm region.  In contrast, a patient with a wider build or wider breasts may find that high profile implants may fail to adequately fill their entire breast; they often times benefit from implants with lesser projection.  Higher profile implants also tend to be useful in women who desire a small breast lift without the incisions associated with a formal lift.

Almost no patients choose low profile implants for aesthetic breast augmentation; the limited amount of projection provided with these implants does not coincide with their aesthetic goals.  Generally speaking, women looking to maximize their cleavage and perkiness often times opt for high profile implants.  Ultimately, though, the best implant profile for a patient can only be determined after a careful examination by a board certified plastic surgeon, taking into account the specifics of a patient’s breast anatomy, as well as their desired appearance.

Treatments with injectable fillers, such as Juvederm, Restylane, Radiesse, and Evolence, not to mention others, can restore a youthful appearance to the lips, nasolabial folds, marionette lines, midface, jowls and lower eyelids, with minimal to no downtime.  Many patients avoid these treatments, though, because they have heard horror stories from friends or colleagues about the pain associated with these treatments.  Suffice it to say, this needn’t be the case – there are steps your plastic surgeon can take to make these treatments more comfortable.

Recently, BioForm Medical, Inc., makers of Radiesse, received approval from the Food and Drug Administration to mix the filler with lidocaine, an injectable local anesthetic, prior to injection into the skin.  This approval was based on a large study of patients, in which 100% of patients reported feeling less pain when Radiesse was pre-mixed with lidocaine.  Many plastic surgeons, including me, have begun to pre-mix lidocaine with all fillers, including Juvederm, Restylane, and Evolence, not to mention Radiesse, prior to injecting into patients.  The results of treatment are still great, but patients are significantly more comfortable during treatment.

Others things your plastic surgeon can do to make your treatment with injectable fillers more comfortable include:
•    Using topical anesthetic gel for at least 30 minutes prior to commencing any injections.
•    Augmenting treatment with topical anesthetic gel with injections of local anesthetic into nerves above and below the lips.
•    Using small gauge needles and slow injection techniques

Combining all of these treatments can ensure that you’ll not only look fantastic after your treatment with injectable fillers, but you’ll feel pretty good during the treatment too!

This is taken directly from a press release from the American Society for Aesthetic Plastic Surgery

New York, NY and Arlington Heights, IL – What people find beautiful about themselves may be different than what they find appealing in another person. That’s just one finding from a recent consumer survey conducted on the BeautyforLife website (a joint venture of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.) Visitors were asked “What aspect of physical beauty do you find most appealing in another person?” In their 20s, 30s, and 40s, respondents look for a fit, well proportioned body; youthful skin ranked at the top for respondents in the 50s and 60s. When considering “Which part of your body are you most concerned about?” respondents ranked their abdomen/hips number one in their 30s. But surprisingly, respondents listed the face, not their body, as the most popular choice in the 20s, 40s, 50s and 60s.

“It is always important to understand what our patients are most concerned about at different stages of their lives. We want to be equipped to help our patients make the right decisions to maintain their beauty at every age—no matter which type of cosmetic medical procedure they are interested in.” said ASAPS President Renato Saltz, MD.

Additional results were revealed when answering “Which part of your body are you most concerned about?” While respondents primarily chose their face, significantly more respondents are concerned about their abdomen/hips than their breasts (chest)—with the disparity increasing throughout the decades:

1. 30s - 37% chose abdomen/hips as their top concern while only 18% chose breasts
2. 40s - 32% selected abdomen/hips and only 10% breast
3. 50s - 25% chose abdomen/hips compared to 7% breast
4. 60s - 23% indicated concern about their abdomen/hips, while only 7% selected breast

Community members were also asked to consider “The most important reason to maintain your physical appearance.” “To boost self-confidence” was the top choice across all decades, with “To attract potential partners” a close second for the 20s. In the 30s and 40s, the second-most popular choice shifted to “To increase professional opportunities,” which remained the number two choice in the 50s, but by a much smaller percentage. In the 60s, increasing professional opportunities fell to third behind “To help make friends.”

“The survey on the BeautyforLife website has provided interesting data about patients’ attitudes, motivation and perception. Our goal is to provide useful tools for prospective patients to help them first decide if a cosmetic medicine procedure is right for them and then to provide information on how to choose an appropriate provider,” said Dr. Richard D’Amico, past president of ASPS.

Another question asked members to contemplate “The most important factor in maintaining beauty.” While adherence to a healthy diet, regular exercise and skin care were popular choices, approximately one in five members felt that a cosmetic medical procedure was most important in the 50s and 60s.

This survey was conducted by The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, via their Beauty for Life program—a series of patient education tools.

About ASPS
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. For more information, please visit the ASPS website at www.plasticsurgery.org.