Breast Reduction: Answering 5 Common Questions

I would like to take some time to answer a few common questions about breast reduction surgery that I am asked by patients during their consults.

1) Will my breasts still look full after the procedure?

The answer to this question is partially based on each patient’s goals.  Some patients want to look fuller than others, so postoperative breast volume is largely based on how much of a reduction each patient wants.  That being said, most patients with breast reduction have a lot of drooping.  The breast reduction involves a full breast lift, so even when the breasts are smaller, the lift moves the tissue into a higher position, giving the appearance of more fullness in the upper chest, which is a more youthful, perky shape.

2) Is it possible for breast tissue to grow back afterward?

Since there is still residual fat and glandular tissue after surgery, there is always a possibility that the breasts can grow larger in the future with a major weight gain or hormonal change.  It is also possible for the breast tissue and fat to shrink with weight loss or different hormonal changes. For most patients, however, the size of the breasts will remain stable over time.  Additionally, breasts will re-droop to some degree over the years, but most will maintain the majority of the improvement the lift created.  If these problems occur, touch up surgery is an option to further reduce or lift the breasts.  Thankfully, re-operating on breast reduction patients is a pretty rare event.

3). When is breast reduction covered by insurance?

Every insurance company is different, however most will require notes stating that breast reduction is necessary to reduce physical symptoms (neck and back pain, etc.).  These notes are usually needed from your primary care doctor, a plastic surgeon, and often a physical therapist that has tried to treat your pain non-surgically.  If you are approved for surgery, there generally needs to be 400-500 grams of tissue removed from each side, which is fine for some patients, but too much for others.   I don’t like following insurance guidelines because breast reduction is not a cookie-cutter procedure and the amount of tissue removal required by insurance companies is not right for everyone.  For my patients, since I’m not on any insurance plans, I generally provide copies of preop, intraop and postop photos, office notes, operative notes, and whatever else they need.  They can submit all this data to their insurance company, and whatever they get towards surgery and OR costs is theirs to keep.

4) Can I reduce the size of my areolas?

Breast reduction involves repositioning the areolas in the center of each breast (without detaching them).  As part of this process, an incision is made around the edge of each areola.  Many patients needing breast reduction have oversized areolas, so when they are repositioned, I also reduce their size and create a symmetrical and circular shape.  For most patients, there is a “normal” areola size I shoot for, but if patients specifically want somewhat smaller or larger areolas, I can accommodate these goals.

5) How will weight loss affect my breasts after reduction?

Weight loss and breast reduction go hand in hand.  For many patients, large breasts get in the way of effective exercise.  Once the breasts are lifted and reduced, patients can exercise better and lose weight.  This is a great side benefit of breast reduction.  With general weight loss, the breasts will usually shrink a little in a proportionate fashion but still match up nicely to the body.  In patients planning significant weight loss after surgery, I will often leave the breasts on the larger side to account for future shrinking.  In very rare cases, a large amount of weight loss can lead to excess volume depletion and / or loosening of the breast skin.  In these cases, touch up surgery such as retightening the skin, or adding volume via fat grafting or implants would be a possible option.


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