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Breasts are the first object of attention of all newborn beings. Additionally, surgery on the breasts has been the focus of plastic surgeons since the advent of the specialty. The number of articles published on breast surgery far exceeds all other areas of cosmetic and plastic surgery. Indeed, there are numerous techniques that have evolved in breast reduction surgery since the late 1800’s when breast reductions were initially performed. Plastic surgeons are ever in pursuit of the perfect technique for reducing large breasts. However, the ultimate scarless technique has yet to be perfected.
Heavy, large and pendulous breasts can cause substantial problems for women who are so endowed. Specifically, breast traction on the shoulders and spine can result in neck strain, headaches, back pain, poor posture and skin inflammation underneath the breast mound. Also, numbness has been caused by the abnormal pressure of large breasts on the nerves that exit the arms. Patients endowed with large breasts are frequently overweight and are overweight in many cases to overcompensate for the abnormal proportions of their breasts. Many patients with very large breasts have lowered self esteem and choose to wear baggy clothing to hide their overly endowed attributes. Many women, young and old alike, curtail activity in athletic activities to avoid the embarrassment of tight fitting clothes and the additional strain and pain that large breasts cause during vigorous work outs. Because of this, a vicious cycle is created: No exercise results in increasing weight gain, which results in increasing breast size.
It is hence not surprising that many women seek relief from the symptoms related to their large breasts with the hopes of obtaining breasts with aesthetically pleasant size, symmetry and sensation. During the course of the early to mid 1900’s, there has been substantial improvements in the techniques used for breast reduction. Fortunately, most insurance carriers view breast reduction surgery not as cosmetic surgery, but rather as surgery of a functional nature. Because of this, many women are able to undergo breast reductions with little or no out of pocket expense.
There are many misconceptions with regard to breast reduction surgery. Many people believe that breast reduction is a painful operation. This is far from the truth. Most women are startled to find how little pain they have after breast reduction surgery. It is not uncommon to hear women claim that they only took one or two pain pills in their entire post operative course. In fact, breast augmentation surgery is typically substantially more painful than breast reduction due to manipulation of the underlying pectoralis major muscle. Breast reduction surgery, is performed predominantly on the breast mound, which produces very little discomfort.
Another common misconception about breast reduction surgery is that all breast reductions will result in loss of sensation in the nipple and areolar area. While it is true that some women will lose sensation in the nipple, using some of the newer techniques of breast reduction, many women actually state that they have improved sensation in this area. The reason for this is breast reduction diminishes traction on the sensory nerves to the nipple complex. Once the breast is made smaller, there is much less pull on the nerve that gives feeling to the nipple and the feeling improves in many patients. While it is certainly technique dependant, it is not uncommon to have unaltered or even improved nipple sensation after surgery.
A common question that is asked is, “Can one breast feed after breast reduction surgery?” The answer to this question depends upon the technique used by the individual surgeons. However, unless the breasts are extremely large, requiring free nipple transfer (defined as necessity to remove the nipple off of the breast and replace it as a graft), 50% of breast reduction patients can go on to breast feed.
The recovery period for breast reduction surgery is rather short. Most women are requested to wear a bra for a minimum of one week after surgery. This is to help diminish the risk of collection of blood or serum underneath the breasts by the comprehensive forces of the bra. Most patients are able to get back to vigorous activity within three weeks. It is quite common to lose substantial weight after surgery, as patients are jump started onto a substantial weight loss program as they are able to increase their athletic activity. It is certainly advisable to approach one’s ideal weight prior to undergoing breast reduction surgery since further weight loss will reduce one’s breasts even further. While most plastic surgeons realize that it is difficult to attain ideal weight with very large pendulous breasts in many cases, compensation is made for some further weight loss when undertaking breast reductions.
One of the most interesting techniques that has evolved in breast reduction surgery is the use of liposuction alone to reduce breasts of only moderate size. This can be done with a small puncture wound incision underneath the breast mound. This eliminates the need for the substantial breast reduction scars that are typically required for larger breast reductions. This allows women who have been in that “grey zone” for breast reduction who felt that surgery would improve their symptoms, but did not warrant the scars. Other techniques in breast reduction now involve a vertical scar only in reducing the breasts.
With regard to the indications for surgery. Any women who have breast size out of proportion to her body habitues, may have profound effects on her muscle and skeletal systems. Any woman who complains of neck, back and shoulder pain as well as headaches and persistent rashes on the chest wall with numbness in the little finger side of the hand will frequently be improved by breast reductions. Additionally, women who show poor posture with notching from her bra straps and stretch marks on the upper aspects of the breasts, will in fact frequently improve with breast reduction surgery.
The goals of surgery in all breast reductions are to decrease the volume of the breasts while maintaining the sensitivity and blood supple to the nipple complex. Additionally, one hopes to create an esthetically pleasing breast contour with as minimal scarring as is possible.
After breast reduction surgery, many women enjoy a completely new outlook on life and pursue activities that were previously unattainable. Clearly, breast reduction surgery is one operation that can significantly improve the quality of life in many women with very minimal emotional, physical and financial costs. In short, a woman’s breast size will frequently effect her career choices and professional and personal lives. It is for this reason that breast reduction patients rank among the happiest patients in any plastic surgeon’s office.
Procedures are performed by Dr. Barry Cohen, Board Certified Plastic and Reconstructive Surgeon with great interest in cosmetic surgery. Procedures conducted in Rockville MD, and McLean, VA.