Breast Reduction Washington DC
Breast reduction is a procedure to remove the weight and volume in large breasts that cause neck, back, and shoulder pain. Candidates may be women who have large breasts that cause significant pain and impairment in activities of daily living.
Heavy breasts can lead to physical discomfort, a variety of medical problems, shoulder indentations due to tight bra straps, and extreme self-consciousness.
Incisions outline the area of skin, breast tissue, and fat to be removed and the new position for the nipple.
Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast its new contour.
Scars around the areola, below it, and in the crease under the breast are permanent, but can be easily concealed by clothing.
The Best Candidate for a Breast Reduction
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.
In most cases, breast reduction is not performed until a woman’s breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.
Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight. Patients frequently complain of symptoms ranging from back/neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders, and unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.
Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.
If you are considering breast reduction, Dr. Baker’s web site will give you a basic understanding of the procedure: when it can help, how it is performed, and what results you can expect. It cannot answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask Dr. Baker if there is anything about the procedure you do not understand.
What Is a Breast Reduction?
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Dr. Baker removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)
Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast.
Preparing For Your Surgery
In your initial consultation, it is important to discuss your expectations frankly with Dr. Baker, and to listen to his opinion. Every patient has a different view of what is a desirable size and shape for breasts. It is important to note that if insurance approves the procedure, Dr. Baker will be required to remove the amount of tissue set forth by insurance guidelines in order for them to cover the cost of the procedure.
Dr. Baker will examine and measure your breasts, and will photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He will discuss the variables that may affect the procedure such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they will be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.
Dr. Baker will describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He will also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if they determine it is medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have Dr. Baker’s office write a predetermination letter if required.)
Dr. Baker may require you to have a mammogram (breast x-ray) before surgery. You will also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
Whether Dr. Baker performs your breast reduction at Georgetown University Hospital (Washington D.C.), Inova Fairfax Hospital (Falls Church, VA) or an ambulatory surgical facility (McLean, VA), you should arrange for someone to help you out for a day or two.
Breast reduction is nearly always performed under general anesthesia. You will be asleep through the entire operation. Breast reduction surgery may be performed in a hospital or an outpatient surgery center. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes two to four hours, but may take longer in some cases.
Risks and complications
Breast reduction is not a simple operation, but it is normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following Dr. Baker’s advice both before and after surgery.
The procedure does leave noticeable, permanent scars, although they will be covered by your bra or bathing suit (poor healing and wider scars are more common in smokers). The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience a permanent loss of feeling in their nipples or breasts.
After surgery, you will be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two. You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Dr. Baker will prescribe medication to lessen the pain.
The bandages will be removed a day or two after surgery, though you will continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.
If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.
Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.
Dr. Baker will give you detailed instructions for resuming your normal activities. Most women can return to work (if it’s not too strenuous) and social activities in about two weeks. But you will have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You will also need a good athletic bra for support.
You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks. A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don’t hesitate to call our office.
Your New Look
Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.
Dr. Baker will make every effort to make your scars as inconspicuous as possible. Still, it is important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut blouses.
Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You will be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.
However, as much as you may have desired these changes, you will need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you’ll be pleased with the results.