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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 breast size and lifts the nipple and areola to a more aesthetically pleasing position, often reducing the size of the areola as well, and tightens the skin envelope around the reduced volume.
Breast reduction surgeries can remove excess breast tissue as well as lift breasts to provide better size and shape while also alleviating the symptoms of breast hypertrophy. Dr. Wallach performs breast reduction mammoplasty using a limited incision technique to provide minimal scarring as a result of breast reduction procedures.
There are two common skin design patterns for breast reduction. The one chosen for your specific surgery is based on 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.
Who is a good candidate for breast reduction surgery?
Breast reduction surgery patients are typically women who have overly large breasts that desire smaller breasts, whether for cosmetic purposes or due to side effects. They often have complaints of neck and back pain and bra strap grooving, which can lead to skin irritation. Some are simply self-conscious about having enlarged breasts and want a permanent solution.
How much does breast reduction cost?
The fee for a breast reduction will vary from surgeon to surgeon. They can cost anywhere from $12000-30,000. The best way to find out how much your breast reduction surgery will be is to schedule a consultation with Dr. Wallach in New York, NY.
What should I expect during a consultation for breast reduction surgery?
During the consultation with board-certified plastic surgeon Dr. Wallach, you will spend a lot of time reviewing your surgical goals. An exam will then be performed, measurements taken, and a surgical plan will be discussed with you at length.
What questions should I ask my plastic surgeon about breast reduction surgery?
You are free to ask Dr. Wallach any questions you have about the procedure or his practice during your consultation. Key topics to discuss include options for the reduction you desire, as well as your desired result. You might want to review the various techniques as well and ask which technique Dr. Wallach feels 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 reduction 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?
Breast reduction patients should be at a stable weight and eat a well-balanced diet and exercise regularly. Dr. Wallach also wants patients 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, perhaps making the areola smaller, molding the breast tissue, and reducing the volume. Various skin excision patterns may be used based on the extent of sagging and laxity.
What should I expect during my breast reduction recovery?
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 the breasts that is commonly removed a few days to a week 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.
- 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 (the breast crease), 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 a patient has poor skin quality and the breast is very loose, or when the nipple has to be raised a significant amount in order for the breast to have a youthful appearance.
Vertical Breast Reduction
The vertical breast reduction is similar to the Wise excision pattern procedure but eliminates the inframammary incision. Dr. Wallach will commonly employ a vertical breast reduction technique that minimizes the amount of scarring on the breast using a “lollipop” pattern that uses a circular incision around the areola and a vertical incision down the lower breast. This technique is often used for smaller breast reductions when the patient’s skin quality is good, and the nipple does not have to be raised a long distance.
Horizontal incision technique
This is a technique that employs an incision at the breast crease and around the areola. There is no vertical incision from the areola border like used in the Wise or vertical pattern. This procedure 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” when fully recovered.
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 procedure because the pedicle is turned from the superomedial aspect and more tissue can be removed from the sides and top of the breasts. 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, more tissue can be removed superiorly than with the above techniques described.
Massive Weight Loss Patients
Many 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 incision pattern will often achieve the desired result. For massive weight loss patients, Dr. Wallach has used both types of incision designs to achieve beautiful and natural results for his patients.
Liposuction Only Breast Reduction
Some plastic surgeons perform breast reductions using only liposuction. This limits the need for incisions and scarring, 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 reducing breast size, but this technique will usually not consistently improve the aesthetic appearance of the breasts. If there is significant ptosis (sagging) and the nipple is low on the breast mound, liposuction only breast reduction NYC 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 nipples 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 nipple and areola are removed and replaced on the breasts at an aesthetically pleasing position as a free graft. This technique will eliminate the ability to breastfeed, and may result in partial or incomplete nipple survival. It may also lead to hypopigmentation of the nipple and areola.
Breast Reduction Surgery in New York, NY
When it comes to your breast reduction, you want an expert in charge, which is why breast reduction candidates trust Dr. Steven Wallach as their board-certified plastic surgeon. Dr. Wallach has presented and published papers on breast reduction and has presented his experience and techniques to other plastic surgeons. In addition, his patients know first-hand what natural-looking and beautiful results they receive from his procedures.
To learn more about breast reduction and to get started on your journey to reduced daily discomfort, call 212-257-3263 or fill out our contact form online today.