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Breast Reduction

BREAST REDUCTION INDICATIONS

Breast reduction patients are amongst the happiest patients in our institute. Women who suffer from large breasts complain of pain due to the heaviness of the breasts affecting their neck, back, and shoulders. Some patients may also experience numbness in their hands. They are often dissatisfied with their body image and may be unable to wear the clothes that they desire because of their enlarged breasts.

These factors may hinder a woman with large breasts from participating in sports, playing a more active social role, and simply enjoy life to the fullest. Breast reduction surgery will decrease the size and weight of the breasts to make them more proportion to your body, provides a breast lift, and reduces the size of the areola if it is enlarged.

BREAST ASYMMETRY OR UNEVENNESS

Very rarely are a woman’s breasts perfectly even, or symmetric. Sometimes, the lack of symmetry can cause women significant distress. Many go to great lengths such as adding prosthetic implants in their bras to achieve symmetry. This is a common situation that women do not like to discuss. The solution is straight-forward. If a woman with uneven breasts seeks a breast reduction, it is simple to reduce one breast more than the other to make the breasts as symmetric as possible. The treatment plan is agreed upon during the consultation.

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THE INITIAL CONSULTATION

An initial consultation is set-up where we discuss the breast reduction procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop medications that cause bleeding, such as aspirin, or aspirin-like products (Motrin or Ibuprofen), a week before this procedure. You are asked to stop smoking two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.

BENEFITS OF THIS BREAST REDUCTION TECHNIQUE

There are different ways of performing a breast reduction. The two main techniques are either a vertical breast reduction with a scar around the areola and a lower vertical scar (“lollipop” incision) or a “Wise” pattern technique with an “anchor” incision. The rationale for performing a breast reduction with a “lollipop” incision is to spare a patient the horizontal scar at the bottom of the breast. The horizontal scar can heal unfavorably in some patients, so if it is unnecessary it can be eliminated. The advantage of a vertical breast reduction is less scar and a rounder shaped breast with more projection. The disadvantage of doing the “lollipop” incision (vertical breast reduction) is that it takes slightly longer for the breast to look natural. Additionally, a small amount of excess skin below the breast may need to be removed at a later time.

The advantage of the “Wise” pattern technique is that it is a simpler technique with few complications and consistent results. It also allows for more skin removal in cases of severe breast enlargement. The main disadvantage is the lower horizontal scar and some risk of bottoming out in the long term.

HOW WE MINIMIZE COMPLICATIONS OF BREAST REDUCTIONS

At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.

General Complications
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center, with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.

Bleeding
Bleeding after a breast reduction is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. In our practice the rate of significant bleeding is less than 1%. Very rarely, we will put drainage tubes in the breasts during a procedure, if we feel there will be some bleeding after the surgery, so the blood will be drained into a plastic bulb that the patient can empty. Those drains are removed in the days after surgery.

Infection
The most important step in avoiding infections, in my opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are given antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after a breast reduction is extremely rare.

Open Wounds
In a breast reduction, there is manipulation of a relatively large amount of breast tissue with a resection of 1-2 lbs of skin, fat, and breast tissue, and the closure of skin under some mild tension. Because the incisions are under tension, as well as the weight of the breast causing pressure, there can be either loss of some skin or a small opening of the wound at the base of the breast. This is treated with dressing changes and cleaning of the wound in the office as needed. This can occur in about 2-4% of patients. Usually, the wounds heal very well, and nothing further needs to be done.

Ability to Breastfeed
Women are sometimes concerned that if they get a breast reduction that they will not be able to breastfeed afterwards. The likelihood of losing the ability to breastfeed after a breast reduction is about 4% in the literature. With the techniques that are described above, inability to breastfeed after breast reductions that we have performed has not occurred with any of our patients to our knowledge.

Loss of Nipple Sensation or Nipple / Areolar Skin
Similar to what has been said about ability to breastfeed, loss of nipple sensation is a potential complication after breast reduction. Due to the technique with which we perform this procedure, it is a rare complication, with less than 1% occurrence. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks. Cuts in the breast tissue will divide blood vessels and may cause loss of the nipple or areolar skin. Fortunately, there are multiple blood vessels to the nipple, so the risk of nipple or areolar skin loss is extremely rare. If it does occur, it is treated with dressing changes and cleaning of the wound in the office.

Smoking
Smoking is an absolute contraindication in breast reduction. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, loss of nipple tissue, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.

RECOVERY

Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure. We also offer scar creams at an additional cost to optimize results.

To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.

MAXIMIZING POSITIVE OUTCOMES

At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.

There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.

We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.

We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.

BREAST REDUCTION FAQS

What does a breast reduction accomplish?

 
What does a breast reduction not do?
A breast reduction will not give you top fullness, or the same look as an implant. Some women have large but pendulous breasts, which means the majority of their breast tissue and nipples are pulled downward and sag. In this situation, although the breasts are large, this may lack top fullness and appear deflated on top. A breast reduction will make the breasts smaller and appear more lifted, but will not reposition the breasts higher on the chest wall. In addition, a standard breast reduction may not remove the excess fat underneath the armpits. However, a breast reduction can be combined with axillary liposuction to slim down the “bra roll” bulge.

Is it covered by insurance?
While we are not a practice that accepts insurance, a breast reduction may be covered by insurance if it is considered medically necessary. All cosmetic procedures covered by insurance must be done at medical facilities that accept your individual insurance. Insurance companies usually use the Schnur scale to determine how much breast tissue needs to be removed to qualify for insurance. The Schnur scale takes into account a woman’s body surface area, which is a combination of her height and weight, to determine how much breast weight needs to be removed. Different insurance companies have different requirements. If the amount does not meet the minimal requirement, the reduction is considered cosmetic and not covered by insurance.

Can I have a breast reduction without the scars?
The majority of breast reductions involve scars around the nipples and usually on the breasts. However, a selected group of patients may be candidates for breast reduction via liposuction. Liposuction only removes fat, not glandular tissue. As women age, the dense glandular tissue in the breast is replaced by fat. Good candidates for breast reduction with liposuction are women who:

WHY CHOOSE BITAR COSMETIC SURGERY INSTITUTE?

Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.

For more information, call our office at 703-206-0506.

Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.