Patients with very large breasts may suffer from back pain, neck pain, or bra strap grooving and could benefit from breast reduction surgery by Dr. Wallach in Manhattan New York.
What is breast reduction surgery?
A breast reduction is a procedure that reduces the volume of the breast and lifts the nipple and areola to a more aesthetically pleasing position often reducing the size of the areola a well, and tightening the skin envelope around the reduced volume.
This surgery can remove excess breast tissue as well as lift the breast to provide a better shape and size while also improving the underlying symptoms. Often, Dr. Wallach can use limited incision approaches to minimize the amount of scarring around the breast. There are two common skin design patterns for breast reduction. These are based upon the amount of skin that needs to be removed, the distance the nipple areola complex (NAC) needs to be lifted to place it in an aesthetically pleasing position, and the amount of breast tissue that needs to be removed or repositioned. The tissue that supports the blood supply to the NAC can usually be brought on a leash of tissue commonly referred to as a pedicle from superiorly, inferiorly, centrally, medially, or laterally.
Who is a good candidate for breast reduction surgery?
A good candidate is someone who has large breasts that desire smaller breasts. The often have complaints of neck and back pain and bra strap grooving.
How much does breast reduction cost?
The fee for a breast reduction will vary from surgeon to surgeon. They can cost from $12000-30,000.
What should I expect during a consultation for breast reduction surgery?
During the consultation, you will spend a lot of time with the doctor reviewing your surgical goals. An exam will then be performed and a surgical plan will be discussed with you at length.
What questions should I ask my plastic surgeon about breast reduction surgery?
You should ask if they are board certified first, and then discuss options for the reduction you desire. You might want to review the various techniques as well and which technique they feel will give you the best breast reduction results with the least amount of scarring.
What are the risks of breast reduction surgery?
The main risks of breast lift surgery are unfavorable scarring, asymmetry, infection, bleeding, nipple loss, skin loss, fat necrosis, fluid collections, dysesthesias, and need for revisions.
How should I prepare for breast reduction surgery?
I tell my patients to eat a well-balanced diet and exercise regularly. I also want them to avoid any medications or supplements that may cause excessive bleeding.
What are the steps of a breast reduction procedure?
The breast reduction procedure usually includes raising the nipple areola complex, maybe making the areola smaller, molding the breast tissue and reducing the volume. Various skin patterns may be used based upon the extent of sagging and laxity.
What should I expect during my breast reduction recovery?
Most patients can go back to light duty within 3-5 days. I have patients avoid aerobic type of activity for 3-4 weeks and then avoid exertion of heavy lifting for about 6-8 weeks.
What results should I expect after breast reduction surgery?
The goal of surgery is to lift, reduce, and tighten the breasts.
What words should I know about breast reduction surgery?
Words include areola, nipple, skin incisions, lollipop or “T” incision, and pedicle.
What does the process of breast reduction look like?
A patient goes through the consultation and then the procedure and has a recovery period that will vary depending upon the extent of the procedure.
- Breast Reduction Skin Excision Patterns
- Wise Pattern Breast Reduction Techniques
- Vertical Breast Reduction Techniques
- Special Situations
Breast Reduction Skin Excision Patterns
Wise Pattern Breast Reduction
The Wise pattern places incisions along the inframammary fold of the breast, a vertical incision from the fold up to the areola border, and an incision around the border of the areola. The resulting incision looks like an inverted –“T” or an anchor after final closure. This pattern is usually employed for patients with very large breasts, but can be used for almost any reduction volume. In addition, this technique is commonly used when the patient has poor skin quality and the breast is very loose, or when the NAC has to be raised a significant length in order for the breast to have a youthful appearance.
Vertical Breast Reduction
The vertical breast reduction eliminates the inframammary incision. Dr. Wallach will commonly employ a vertical breast reduction technique (usually a modified LeJour technique) that minimizes the amount of scarring on the breast using a “lollipop-type” pattern that encompasses a circular incision around the areola with a lower breast vertical incision. This technique is often used for smaller breast reductions, when the patient’s skin quality is good, and the NAC does not have to be raised a significant length.
Horizontal incision technique
This is a technique that employs an inframammary incision and an incision only around the areola. There is no vertical incision component from areola border to the breast fold that is seen with the Wise pattern or vertical pattern. This is performed using an inferior pedicle technique, and can be used for larger breast reductions and long pedicle lengths. A disadvantage of this technique is that the breast can look a bit “boxy.
Wise Pattern Breast Reduction Techniques
There are numerous named reduction techniques employing the Wise skin pattern excision based upon the
orientation of the blood supply feeding the pedicle to the nipple areola complex (NAC). The three most common are:
The inferior pedicle technique is probably the most popular one used today because it is considered the most versatile. Some studies suggest that patients undergoing this technique have the best post-surgical sensation of the NAC and also have the best chance to adequately breast feed.
Is a reasonable approach for patients who only need the NAC moved a short distance. It is good for smaller reductions than what can be achieved with the inferior pedicle technique.
Is a technique that employs a pedicle based superomedially on the chest. It can be used for large reductions and in those with low hanging breasts.
“I always wanted to be a physician because I wanted to help people. Plastic surgery gives me the ability to help people in very positive ways.”
There are other pedicle designs including those using the central mound, the lateral pedicle, the medial pedicle, various bipedicle forms, and the supero-lateral pedicle.
Vertical Breast Reduction Techniques
There are many procedures that can incorporate the “lollipop” skin closure. The three most common are:
Superior Pedicle Technique (LeJour)
This is a great technique to be used for patients who have moderately good skin quality, require a relatively short pedicle, and do not require a very large reduction. The pedicle is based superiorly and the skin closure results in a lollipop design. Dr. Wallach uses this technique often and has published his modifications on the LeJour technique and has presented it to other surgeons at the Aesthetic Society’s national meeting.
Superomedial Technqiue (Hall-Findley)
This is a very versatile technique that can be used for larger reductions than the LeJour technique because the pedicle is turned from the superomedial aspect and more tissue laterally and superiorly can be removed. The closure is similar to the Lejour in that the resulting closure looks like a “lollipop.”
SPAIR Technique (Short-Scar Periareolar Inferior Pedicle Reduction) (Hammond)
This is different than the superior pedicle or superomedial techniques described above because the pedicle is inferiorly based. Similar to the inferior pedicle technique using the Wise pattern skin closure, more tissue can be removed superiorly than with the above techniques described.
Massive Weight Loss Patients
Most massive weight loss patients are often not good candidates for a vertical breast reduction technique because they often have poor skin quality and the skin envelope is very loose. For these patients, a Wise pattern skin incision pattern will often achieve the desired result. For massive weight loss patients, Dr. Wallach has used both types of skin incision designs to achieve nice results for his patients.
Liposuction Only Breast Reduction
Some plastic surgeons perform breast reductions using only liposuction. This limits the use of breast incisions. However in the majority of patients, it will not adequately “lift” the breast or reduce the skin envelope. Thus, the breast will potentially be looser after the procedure. If the breast is primarily fatty tissue, then liposuction can be successful in removing the excess breast weight, but this technique will usually not consistently improve the aesthetic appearance of the breast. If there is significant ptosis (sagging) and the NAC is low on the breast mound, it will not provide the lift needed to create a more youthful look.
Free Nipple Graft Technique
The free nipple graft technique is used for patients that have extremely large breasts and whose NAC are very low on the chest. When the potential pedicle length is too long, there is a risk that the NAC will not survive. Therefore, a free nipple graft technique is an option. A pedicle of tissue is used to restore an aesthetic breast mound. The NAC is removed and replaced on the chest skin at an aesthetically pleasing position as a free graft. This technique will eliminate the ability to breast feed, and may result in partial or incomplete NAC survival. It may also lead to hypopigmentation of the NAC.
In general, breast reduction surgery takes between two and four hours to complete with a recuperation time of one to two weeks. Often patients will have a drain in each breast that is commonly removed a few days after surgery. Patients wear a support bra without an under-wire or a sports type bra for about three to six weeks before they can go back into an under-wire bra. Dr. Wallach recommends that patients avoid aerobic type exercise for at least three weeks and strenuous exercise for at least six weeks after surgery. Dr. Wallach has presented and published papers on breast reduction and has presented his experience and techniques to other plastic surgeons. For many years, Dr. Wallach has given an instructional course to fellow plastic surgeons on his preferred techniques at the American Society of Aesthetic Plastic Surgery (ASAPS) national meeting.