Breast Reduction and Insurance Coverage in NEW YORK CITY, NY

The weight you lose is related to the volume of tissue removed during the procedure.

Patients that desire small breasts are candidates for a breast reduction. Often patients have symptoms of neck and back pain as well as bra strap grooving and poor posture.

Patients do not usually have a lot of pain post-operatively and can often go back to light duty within a week to ten days.

Most patients can go back to light duty within 7-10 days and can go back to light aerobics within about 3-4 weeks and heavy lifting within 6-8 weeks.

I prefer patients not to wear an underwire bra for at least 6-8 weeks. I usually have patients wear a loose-fitting sports bra post-op.

I think that when patients feel comfortable and do not feel the need to have the breasts confined to the bra, then it is okay to sleep without the bra.

In many ways a breast reduction and breast lift are similar. A breast reduction reduces the overall volume of the breast parenchyma, the excess skin is excised to drape over the gland, and the nipple areola complex is lifted into a more aesthetic position. A mastopexy or breast lift is similar in that the gland is lifted and often parenchymal sutures are used to shape the breast, the skin is then draped over the gland, the excess skin is removed, and the nipple areola complex is raised to a more aesthetically pleasing position. While some tissue may be removed during a breast lift, it is often minimal in most cases. In many ways, the amount of tissue removed is really the biggest difference. There are many different techniques that are used to perform these procedures. The skin can be excised in an inverted T fashion or what is sometimes referred to as an anchor incision. This means that there will be stitches around the areola, vertically from the base of the areola to the breast fold, and also along the inframammary fold in a transverse fashion. A common alternative is a lollipop incision pattern in which there are only stitches around the border of the areola and vertically from the base of the areola to the breast fold, thus eliminating the inframammary incision. The breast parenchymal tissue can be treated using various tissue pedicles most commonly using an inferior pattern, but this can also be vertically, superomedial, or superolateral. Modifications of the breast lift procedures are sometimes performed when a patient desires breast implants as well. A circumareola lift can sometimes be offered when only the nipple has to be raised a short distance.

In order to say if a patient is a good candidate for a breast reduction, she would have to be seen in person. An examination in person will allow the surgeon to evaluate any asymmetries, and appreciate the weight of the breasts and possible volume that can be removed from each breast. Obviously, a breast reduction is performed on a patient with very large breasts that wants them to be smaller. Commonly, the patient has symptoms of bra strap grooving, neck or back pain, and potentially has rashes underneath the breasts. Symptoms like back pain or neck pain may not improve with a reduction, but there are scientific studies suggesting that it does help many women who have breast reductions. There are many different techniques that can be employed to perform a breast reduction. The skin pattern design often employs the use of an inverted T or anchor type incision, or a lollipop type of incision. Various parenchymal excision patterns can be used. They are named by the orientation of the blood supply feeding the nipple areola complex. The design of the skin pattern and the choice of the pedicle will vary from patient to patient based upon their anatomy and the surgeon’s experience.

It is difficult to predict whether or not an individual will be able to breastfeed after breast reduction surgery. Some women who are very small-breasted, before surgery, can produce a lot of milk while some very large-breasted women cannot. Inevitably during surgery some of the parenchyma is removed. There are many patients who can still breastfeed. Again, this depends upon the individual patient.

Yes, breast reduction surgery can be combined with other procedures, such as a breast lift or liposuction, to achieve optimal results. Your surgeon will discuss the best approach for your individual case during the consultation process.

For many patients, I have been using a limited incision approach that creates a lollipop type of closure (a circle around the border of the areola and a vertical line from the lower border of the areola to the inframammary fold). In other words, the entire inframammary incision of the anchor type of wound closure is eliminated! This can be done for most patients except for those with excessively large breasts requiring more than 2-3 pounds of tissue to be removed from each breast.

Patients that desire small breasts are candidates for a breast reduction. Often patients have symptoms of neck and back pain as well as bra strap grooving and poor posture.

I usually use absorbable sutures and these are under the skin and do not need to be removed. There may be drains that are secured with sutures to the skin which is often removed in one week.

The majority of the swelling will go down within 6-8 weeks but there may be some residual swelling for 6 months to a year.

The fee will vary from surgeon to surgeon in different geographic regions of the country.

A breast reduction is usually not that painful. Most patients only complain of some incisional discomfort.

For patients with symptoms of having large breasts, this can be very worthwhile. Of course, it is a personal choice.

This may be due to the weight of the breasts which can cause stress to the neck and back.

The choice to undergo breast reduction surgery is totally up to the patient. If the patient has very large breasts that she desires to reduce whether it is strictly for cosmetic reasons, or because she has symptoms such as bra strap grooving, neck or back pain, or rashes, it is a personal choice. Aesthetically, the breasts can be made smaller by removing the excess tissue and skin to alleviate the excess weight and pressure that heavy breasts can cause, as well as improve the position of the nipple and in most cases reduce the overall diameter of the areola as well. When to have a breast reduction is another issue. Again it is a personal choice. Some women undergo the surgery in their late teens and early 20s before having children, while others undergo the surgery later in life. There is no defined best time in life to have it performed. Patients choose when it fits into their life.

Patients with large breasts may have back pain. Back pain can be caused by many different things. Back pain may improve with a breast reduction. Intuitively it makes sense, because surgery will reduce the overall weight of the breasts, thus putting less stress on the back. There are numerous studies in the literature that support this concept. I do tell patients that back pain can occur for many different reasons and that symptoms may not improve after breast reduction. Fortunately, many patients do have improvement of back pain after undergoing a breast reduction.

There are several types of incisions that can be used to perform a breast reduction. The two most common are a vertical incision closure and a T incision closure. The vertical incision closure is shaped like a lollipop. The incision goes around the border of the areola and then descends in a vertical fashion from the inferior border of the areola down to the breast fold. An inverted T incision, or an anchor incision, is the other popular incision closure. This incision goes around the border of the areola and then extends vertically below the areola to the breast fold, unlike the vertical reductions; it also includes an incision along the breast fold.

Yes! Part of performing the breast reduction is not only to reduce the volume of tissue, but also to raise the nipple areola complex as necessary and tighten the skin envelope. So in effect, reduction techniques are commonly used for breast lift techniques. It’s like a two-for-one procedure. If you think of it as a car, the car headlights will hopefully be pointing forward not downward.

Liposuction alone is performed by some surgeons to reduce the overall volume of the breast. Because the breast consists of fatty tissue and glandular tissue, liposuction can be used to address this fatty portion. So reducing the volume is possible. However, skin tightening or elevating the nipple areola complex cannot be done by liposuction alone. In other words, for patients with very large breasts, low nipple areola complexes, and a lot of skin, liposuction is probably not a good choice. Liposuction may be best for small asymmetries.

Unless you are very young (in your mid-teens) and are still growing, your breasts will not likely grow after a reduction. They can get larger if you gain a lot of weight.

A breast reduction is usually performed when women desire smaller breasts. They often complain of neck and back pain.

Yes, you can drink alcohol a few weeks after a breast reduction once your surgeon gives you the okay.

Most patients maintain normal sensation after a breast reduction.

Each insurance company may have different criteria for coverage so it may not always cover the cost.

Yes, some patients undergo a second breast reduction for various reasons, like insufficient removal during the first procedure, or weight gain causing their breasts to grow.

The cup size will likely go down after a breast reduction.

A breast reduction is a very safe procedure in a healthy patient with a very low risk of major complications

A breast reduction can be performed as an outpatient and can take between 2-4 hours to complete.

The breasts can enlarge after surgery most commonly as a result of weight gain. It is extremely rare for breasts to just grow further after surgery and not be due to weight gain.

It is certainly possible to maintain fullness and a nice shape after performing a breast reduction. Taking out too much tissue may compromise the overall shape.

The length of the surgery can vary depending on the individual case, but typically takes around 2-4 hours to complete.

Yes, there will be some scarring after breast reduction surgery. However, the surgeon will make every effort to minimize scarring by carefully placing incisions in discrete locations.

A boxy breast is the shape of a breast sometimes occurring after a breast reduction. The breast can look somewhat squarish or boxy. In my opinion, the two most common causes are related to 1) the pattern design of the skin excision, and 2) making the breast too tight in the midline. Following the natural curve of the breast will hopefully eliminate the potential for a boxy breast. By not taking out too much skin in the midline will help reduce the risk of developing a boxy breast.

A T incision or anchor incision breast reduction includes a variety of techniques. The nipple areola complex can be carried on a mound of tissue that supplies blood inferiorly, laterally, centrally, superiorly, or medially. The inferior pedicle design is often considered the most versatile. It can be used for patients with large and long breasts, and also in those whose nipple areola complex has to be moved a long distance.

500 gms of tissue is approximately 1.1 pounds.

The breasts are often lifted, the volume is reduced, and the areolas are made smaller. Many times, but not always, the symptoms improve.

I think that if a patient has very large breasts, it may affect their ability to exercise and may impact their weight to some extent.

Yes, if you gain weight, your breasts are likely to grow as well.

This depends upon where you are starting from. That is hard to predict and best discussed in person based upon your exam

I prefer patients avoid an underwire bra for at least 6 weeks.

A breast reduction is often performed as an outpatient. This procedure takes about 2-4 hours to complete. Patients often go home wearing light dressings that are covered by a surgical bra. Many surgeons place drains during the procedure which are commonly removed within a week or so after surgery depending upon the amount of drainage. Most patients will be able to go back to light duty within 5-7 days after the procedure, provided that they are healing well and have had no complications. Many patients will be able to go back to light aerobic activity within about 3-4 weeks. Heavy lifting and strenuous workouts can be started about 6-8 weeks after surgery if all goes well. It is always best to check with your surgeon as you are healing to see when it is right for you.

A vertical breast reduction is one of a variety of short scar breast reductions that often refers to the type of closure performed. The name was originally derived from the pedicle or how the nipple areola complex receives its blood supply. The most common types of vertical procedures include those described by Lassus, Lejour, Hall-Findley, and Hammond. Lassus and Lejour are techniques in which the nipple areola complex is supplied by a vertical pedicle. The Hall-Findley procedure uses a supero-medial pedicle, and the Hammond technique that he calls a SPAIR (short scar periareolar inferior pedicle reduction), is an inferiorly based pedicle.

Typically, I prefer to use closed suction drains for the majority of my breast reduction patients. They are removed when the drainage is deemed low enough.

It is difficult to predict whether or not an individual will be able to breastfeed after breast reduction surgery. Some women can produce a lot of milk while some women cannot. Inevitably, during surgery some of the parenchyma is removed. There are many patients who can still breastfeed. Again, this depends upon the individual patient.

Most patients can go back to light duty within 7-10 days and can go back to light aerobics within about 3-4 weeks and heavy lifting within 6-8 weeks.