Benefits of Breast Reduction

Breast reduction is the procedure used to reduce and resize disproportionately large, drooping breasts.  It not only improves the way the patient looks, but also relieves the weight bearing pain and discomfort of the neck, shoulder region and upper back.  This procedure also allows for more comfort during physical activity in addition to improving a more youthful appearance of the breast.
There are two principle ways that breast reductions are performed- with a “keyhole” type of incision and scar or with the “anchor” type of incision and scar.

Keyhole incision

breast augmentation with silicone implantsAlso called the vertical breast reduction, this procedure utilizes an operation similar to a vertical breast lift, with more breast tissue removal than the purely cosmetic lift.  The vertical breast reduction allows for removal of a small to moderate amount of tissue, and creates a breast that is higher and smaller than the pre-operative mound.  This operation is termed a “vertical reduction” because most of the breast tissue resection occurs through the vertical incision that lies underneath the areola.  In all breast reduction operations, there is an incision around the areola as well which allows repositioning of the nipple to the proper location.  The advantage of this vertical approach is that it does not use an incision underneath the breast, and therefore there is no resulting scar across the inframammary fold.  The disadvantage to the vertical breast reduction is that there is a limited amount of breast tissue that can be resected because of the limitation on access to the breast tissue through the smaller incision.  Other shaping of the breast that is sometimes required utilizes the addition of liposuction, particularly on the side of the breast and chest wall.

Anchor incision

This breast reduction operation goes by many different names… Weiss pattern, Wise pattern, and anchor pattern breast reductions all mean the same thing.  In this operation, the scars are similar to the vertical reduction with the addition of the incision and subsequent scar along the underside of the breast in the infra mammy fold.

While many patients are un-nerved by this scar, it is in fact the least apparent one as the remainder of the breast tissue tends to cover this scar when the patient is upright.  While the addition of the scar under the breast may seem like a disadvantage, this incision allows more access to more breast tissue, and therefore this operation is more able to shape a drooping breast or remove more tissue from a very large pre-operative breast.  Many patients complain about breast tissue around the side of their chest and sometime toward their underarm.  This anchor breast reduction allows for direct removal of this extra tissue which is often a major plus for women with larger breasts.
Far and away, the most common complaint that Dr. Lowenstein hears following breast reduction surgery is “I wish I would have done this sooner!”  This is not made up nor supposed to be a joke… patients truly say this more often than not following their operation.

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FAQs: Breast Reduction

  • How are breast reductions performed?

    Breast reduction can be thought of as breast lifting with resection of more tissue in order to significantly reduce the breast volume. Details regarding the operations are very similar to those discussed with breast lift. Primary incisions for breast reduction are either the vertical breast reduction which leaves a lollipop scar, or a Weiss pattern breast reduction which leaves an anchor type of scar. The latter operation is usually used for large reductions.

  • How much tissue is removed?

    Breast reductions are tailored to your body in order to maximize your breast shape. No two patients are the same and evaluating your breast size relative to your body size will allow Dr. Lowenstein to discuss the amount of tissue removed from each breast to result in an attractive and comfortable breast size.

  • What can I expect after surgery?

    Breast reduction patients are some of the most satisfied patients undergoing plastic surgery. Recovery often involves minimal pain and breast reduction patients are often very surprised that they are so comfortable so soon after their plastic surgery. As Dr. Lowenstein does not use drains in his breast reduction surgery, there is little postoperative maintenance needed. You will see Dr. Lowenstein the day after your surgery, and then in the following weeks. Showering is permitted the first postoperative day. Most patients return to school or work in about a week, though vigorous exercise is avoided for a 3 week period.

  • What is a pedicle?

    When we discuss breast reductions, we often use the term “pedicle “ when referring to how the operation is to be performed. The pedicle refers to the tissue that lies between the chest wall and the nipple, and this tissue carries the blood supply to the areola and nipple complex.

  • What the difference between a superior and inferior pedicle?

    When tissue is removed below the nipple and the nipple gets it’s blood supply from it’s connection to the breast above it, the term we use is a “superior pedicle”. An older way to do these breast reduction operation utilizes an “inferior pedicle.” In these cases, the nipple is left attached to a column of breast tissue that is attached at the base to the lower, or inferior aspect of the breast. Operations using the inferior pedicle are known over time to “bottom out” which means that while the nipple stays in the same place, the breast tissue tends to droop and result in a breast where there is a long droopy breast but the nipple seems to be too high. It is this reason that Dr. Lowenstein most often uses a superior pedicle operation in which the nipple remains attached to the upper breast. This approach tends to provide a long term aesthetic outcome while allowing for excellent tissue removal.

  • What is the nipple amputation technique?

    While rarely used, the nipple amputation technique is used when the breast is too large to provide adequate blood supply to the nipple once the breast is made smaller. This operation requires the removal of the areola and nipple from the breast, and re-application of the nipple and areola to the smaller breast mound in the correct location once the breast mound is reduced and properly shaped. This operation re-applies the nipple and areola as a skin graft, and therefore the nipple will completely lose it’s feeling and ability to produce milk. This operation is only used in the most extreme cases of macromastia, or large breasts.

  • Will I have feeling in my nipple after a breast reduction?

    The answer to this question varies with the shape and size of the patient’s breasts. The nerves to the nipple come from the side of the chest wall, and the more tissue that needs to be removed in this region increases the risk that these nerves will be cut. In smaller reductions, the likelihood that nipple sensation remains intact is increased.

  • How long does a breast reduction take?

    The length of time a breast reduction takes depends on the amount of tissue removed and the experience of the surgeon. The longer the incisions, the more sutures that need to be used and the longer the time for the operation. On average, Dr. Lowenstein’s breast reductions take him about two to three hours.

  • Can breast reduction be combined with other operations?

    Yes, a breast reduction can often be combined with other operations as long as the combination of operations can be done in a reasonable amount of time and the patient is healthy. Often a breast reduction is combined with an abdominoplasty during the same operation to provide the patient with a completely new figure.

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