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Health

All About Breast Reductions

| 08/17/2022

Illustration by Sophi Gullbrants

Breasts can be a source of pleasure, but for many people, they’re also a source of pain, discomfort, or annoyance. 

At the day-to-day annoyance level, having large breasts can make it pretty tough to find clothes that fit properly. At the medical level, large breasts can cause back, shoulder, and neck pain, headaches, skin rashes or infections, and can even inhibit your ability to do daily activities. 

In short, having big boobs can cause big problems. So, it’s no wonder that breast reduction surgery is the 8th most common plastic surgery in the world, making up 4.2% of surgical procedures performed by cosmetic surgeons in 2020

Not only is breast reduction a common procedure, it also has extremely high patient satisfaction ratings. One 2012 study found that more than 95% of breast reduction patients were satisfied and would do the procedure again. 

Before we dive into some of the things you should know, remember: Every person’s health needs are unique. If you’re considering a breast reduction, connect with a board-certified plastic surgeon in your area. The information here is just educational, and the only person who can help you make the best medical decision is your own surgeon. 

Types of Breast Reduction Surgery 

There are a few different types of breast reduction procedures, and the type that you get will depend on your surgeon’s preference and what your desired outcome is. In the United States, breast reductions are most commonly done using either the vertical incision technique or the inverted-T incision technique. 

Vertical Incision (aka the “Lollipop” Incision) 

The “lollipop” incision got its nickname because, well, it kind of looks like a lollipop. It is sometimes also called a keyhole procedure. Using this technique, your surgeon would make an incision around the areola and then vertically down the center of the lower half of your breast. 

This type of incision typically results in less scarring than anchor-type incisions simply because there are fewer incisions made, and it’s becoming more popular over time. Still, this type of procedure is only recommended for folks who have minimal to moderate amounts of breast tissue to remove. It can lead to some puckering of the skin at the base of your breast — often this reduces over time, but if it doesn’t, you might want a scar revision procedure. 

Inverted-T Incision (aka the Wise Pattern Incision) 

This type of incision is also called the anchor incision, and it’s the most common type of incision used in breast reduction surgeries. This type of incision uses the same basic pattern as the vertical incision, then adds an additional horizontal line at the bottom fold of the breast. 

Dr. Alexis Parcells, a board-certified plastic surgeon who prefers inverted-T procedures in her practice, shares that “The best way to think about a reduction is to understand that your breast is a sphere.” 

The inverted-T method is popular because it gives your surgeon the most control over the final shape and position of your breasts, and as Dr. Parcells notes, most people who want a reduction don’t just want a size decrease — they also want to change the position of their breasts, too. “In order to reduce [a patient’s] symptoms, we need to not only remove volume (reduce), but lift at the same time, and this requires the removal of skin, which requires scars.” 

If you’re seeking a reduction because your breasts are proportionately much bigger than your body, and if you have a lot of sagging, then your surgeon will likely opt for the inverted-T method. 

Liposuction

Yes, you can technically use liposuction to reduce the size of your breasts. This is sometimes called “scarless breast reduction” because you only have a small incision rather than an open surgery. It also has a faster recovery time than other types of reductions. 

Liposuction only removes a small amount of fat, so if you’re looking for a big change, lipo isn’t going to do it. A liposuction procedure doesn’t involve a lift or skin removal, so if sagging is something you’re worried about, then liposuction likely isn’t the best procedure option for you. 

Another thing to note is that your surgeon has no way of knowing how much of your breast volume is made up of glandular tissue and how much is made up of fat before they begin the procedure. Liposuction only removes glandular tissue, not fat, so it’s possible that they might start the procedure, then see that most of the breast tissue is glandular, and only be able to remove a very small amount of fat, resulting in minimal reduction. 

Round Block Technique (the Benelli Technique) 

This technique uses only one incision — a circle around the areola — and was designed to result in very little scarring

This type of procedure is less common in the United States and is only recommended for people seeking a small amount of tissue removal. It isn’t recommended for people with extensive sagging, either.

What Happens to Nipples During a Breast Reduction

During many breast reduction surgeries, the nipples stay attached to the breast’s blood and nerve supply and are then repositioned on the breast at the end of the surgery. Sometimes, extra skin might be removed from the outer edge of the areola.  

Not having to remove the nipples means that you’re less likely to experience changes in nipple and areola sensation after surgery, but it doesn’t completely eliminate that risk, since most reduction surgeries involve incisions around the areola. 

If you have very large breasts and are seeking a significant reduction, your surgeon will likely entirely remove and resize your areolas and nipples, then reattach them at the end of the procedure — this is called a free nipple graft. 

If a free nipple graft is done, you may have a complete loss of nipple sensation, at least for some time. That being said, one study found that most patients eventually regained some amount of sensation after a free nipple graft. 

Breastfeeding After Breast Reduction

If you’re planning on becoming pregnant, you may wonder if you’d be able to breastfeed if you get a breast reduction. In short, yes — most people who undergo breast reduction surgery should be able to successfully breastfeed later on, but it depends on the type of procedure done. That’s because breastfeeding relies not only on the presence and function of the mammary gland but also on nerve responsiveness and function (not to mention the psychological components). 

A 2017 review of 51 papers on breast reductions and breastfeeding found that only 4% of patients who had experienced free nipple grafts were still able to breastfeed. So, if breastfeeding is important to them, patients who are seeking breast reductions might opt to wait until after they are done having children to undergo a reduction, especially if they are seeking a significant size change. 

No matter what, if you’re considering having children and breastfeeding in the future, talk with your surgeon about your hopes and expectations. They can talk you through all of the options and together, you can decide what the best option is for you. 

How Much Breast Reduction Surgery Costs 

When we think of surgery in the United States, we think of hefty price tags and stacks of bills. Figuring out how much a breast reduction surgery will cost you can be confusing. Ultimately, it will come down to one big factor: whether your breast reduction is required for a medical condition, or if it’s considered an aesthetic procedure. 

According to 2020 data from the American Society of Plastic Surgeons, the average cash price of a breast reduction is $5,913 — but that’s just for the actual surgical procedure. It doesn’t include facility fees, anesthesia or the anesthesiologist’s fee, or other expenses that may come with the surgery (like medications or the post-surgical bra you’ll have to wear). When you include all of those factors, the cash price of breast reduction surgery in the United States is between $12,000 and $15,000 — but it will vary based on your location and the complexity of the procedure. 

Your health insurance may cover breast reduction surgery if… 

  • You have back, neck, or shoulder pain caused by the weight of your breasts 
  • Your bra straps leave lasting indentations in your shoulders 
  • You have a skin rash underneath your breasts 

Some insurance companies also require your surgeon to note how much tissue will be removed, relative to your height and weight, in order for the procedure to qualify as medically necessary. This standard is a little older, and now, many insurers use your symptoms to qualify you for the procedure, not how much tissue will be removed.  

Even if insurance covers the procedure, you’ll still be responsible for copays and deductibles — so make sure you understand the complete cost ahead of time. Your surgeon can help you understand what your total cost will be, too. 

One major cost factor to consider is how much time you’ll need to spend off work. If you work a desk job, you could potentially be back at work in about a week. But if you are on your feet (as a photographer, server, or hairdresser) you should expect to be out of work for at least two weeks. If your work is strenuous, then check with your surgeon about what your recovery timeline should look like for your situation. 

Recovering from Breast Reduction Surgery 

No matter what type of breast reduction someone seeks, it’s still surgery — which means your body needs time to rest and recover. 

You’ll be sore potentially for a couple of weeks, so give yourself permission to take it easy. Assemble a care team of people who can help keep you fed and take care of basic housework and errands so that you can relax – Dr. Parcells notes that it’s normal for you to take 4-5 days to feel okay doing some basic activities, like driving.  

Plan to schedule some time off from work, too. Even though breast reduction surgeries are often outpatient procedures, you definitely shouldn’t be returning to work the next day (and you won’t be driving yourself home from surgery, either). Talk with your surgeon about your procedure type and how long you should expect to take off work based on your job and its requirements. As a basic guideline, the more physically demanding your job is, the longer you should expect to be out.  

When it comes to recovery and your sex life, Dr. Parcells has a handy rule of thumb: “Scars heal on average 10% per week, so I recommend waiting 5-6 weeks before engaging in physical activity, including sex.” (That same guideline applies to other forms of exercise, too.) 

You might find that some sexual activities, like masturbating with a vibrator or receiving oral sex, feel manageable after a few weeks. But remember: Orgasms involve involuntary muscle contractions, so while the act itself might be totally manageable, an orgasm might cause you to move more suddenly than you’re ready for. So, pay attention to how you’re feeling overall. 

Immediately after surgery, you’ll have some bruising and swelling, plus your scars will be very noticeable. That all will decrease over time. While swelling goes away gradually over a few months, scarring can take a couple of years to fade to the point where they aren’t very noticeable. After about a month, your surgeon may recommend a topical treatment to help smooth and minimize scarring. 

While recovering from any type of surgery can feel long and arduous, it can also be incredibly rewarding. You’ll have temporary soreness in recovery, but you’ll likely be free of any pre-surgical back, neck, and shoulder pain that was caused by your breasts. 

Deciding if breast reduction surgery is right for you is a personal decision, but it’s not one that you make alone. If you’re considering a breast reduction, find a plastic surgeon and talk with them about your questions, hopes, and concerns so that you can make the decision that’s best for you! 

 

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