What is it?
Breast Reduction is an operation that reduces the size of the breast and may improve symptoms related to excess weight of the breast.

Who is a candidate for this operation?
Who is not a good candidate for this operation? There are no real contraindications to surgery unless your health precludes an elective operation. People who have unrealistic goals are not good candidates. Having keloid producing skin can be a relative deterrent to surgery. Your surgeon can tell you if he or she think that a good result is possible in your case.

What does it accomplish?
Breast reduction can improve the shape of the breast, and reduce the discomfort and pain associated with large heavy breasts. Many women suffer from back pain, shoulder pain, postural problems, and skin rashes under their breast as a result of their large breasts. These functional problems often make the appearance of the breast a secondary issue in their minds. Furthermore many women find that the large size of their breast poses difficulties with such issues as finding clothes that fit or exercising. Breast reduction not only eliminates these functional problems, but can also give the woman a more aesthetically pleasing breast appearance.

Will Breast Reduction cure my back pain or shoulder pain?
There is a good chance that your back and shoulder pain will improve. However no surgeon can guarantee that this will indeed happen. Pain is a subjective complaint that is difficult to quantitate. If your back pain was mainly a result of the excessive weight and postural changes due to the breasts, then it is very likely that you will have significant improvement in these symptoms after surgery. However if the pain is due to other arthritic changes in your spine as a result of years of bad posture, then it may not go away completely.

What happens during the first consultation?
In the first consultation you will get a chance to discuss your concerns with our patient care coordinators and Dr, Marefat. We will tell you what you need to know about your procedure and will help you determine what is best for you. You will receive information booklets and pricing on the procedures.

How is it done?
The incisions are placed around the areola (pink skin surrounding the nipple) and under the breast. Depending on the amount of skin and breast tissue that needs to be removed the extent of the skin incisions may be shortened in certain circumstances. New techniques of breast reduction have been developed in order to shorten the scar associated with this surgery. In these operations the component of the incision in the breast fold is eliminated. This has a great advantage and can produce a very natural youthful shape without the long scars of traditional operations. The objective of the surgery is to reduce the volume of breast tissue to the extent that can be safely accomplished while the nipple and its surrounding skin remain healthy. The nipple is then moved to a more appropriate location and the incisions are closed.

What are the goals of surgery?
Our objective is to reduce the size of your breasts so that it is more suited to the frame of your chest. By removing the excess weight off your chest you will see a significant improvement of your neck pain, back pain, shoulder pain and strap marks on your shoulder. You will be less likely to have skin related problems such as rashes or sores under the breast. In addition this surgery will enable you to exercise more and live a healthier life.

What kind of anesthesia will I have?
General anesthesia. In certain, small reductions it may be possible to do this surgery under straight local or local sedation.

Procedure: Breast Reduction continued

What can I expect after surgery?
After surgery you will have a minimal to moderate amount of drainage from the incisions. You will need to rest for the first two or three days, but most people are up and about shortly after surgery. We generally recommend our patients to take off 7 days from work. Heavy lifting and exercising should be avoided in the first two weeks. You body will tell you when you are ready to get back into your regular exercise routine. You will have a supportive bra or bandage for the first few days. This helps in the attachment of the skin back to the underlying tissues after surgery and reduces the chances of fluid collections under the skin. Once the dressing is off you can shower normally. We usually remove the dressings in the first 2 or 3 days after surgery. There will be some numbness associated with the surgery. This numbness usually persists for about four to six weeks. A moderate degree of swelling is normal after this operation. This swelling is related to accumulations of fluid in skin and subcutaneous tissues. Most of the swelling resides in the first two or three weeks after the surgery. Minor asymmetry between the two sides can be seen after breast reduction. No one has completely symmetrical breasts and you have to accept these minor differences in size and shape.

Will it be natural?
Unnaturalness and imperfection in the result of breast reduction is not a common aesthetic complication. The breasts heal quite well and minor differences and irregularities usually resolve by themselves after several weeks. Most surgeons try to get the best possible result in the initial operation. However even when everything is done right there is still a chance that you may develop some irregularity and if this does occur you may need to fix this problem in a touch up procedure. This touch up procedure is done approximately 3-6 months after the initial procedure.

What are some of the complications of breast reduction?
Before I tell you about the complications of breast reduction let me tell a little bit about how to digest these bits and pieces of information. Reading about complications can be quite scary. Many people cannot comfortably sit through a consultation session without having real doubts about surgery. This is a natural response. But it is different when you have these complications explained to you by a Doctor. He or she can put it in perspective for you and tell you the likelihood of such complications occurring. Most complications are very rare. Some are less rare and need to be explained to you in more detail so that you know how we would tackle these problems if they occurred. The purpose of explaining risks and complications is for you to know what steps we take to treat you and put you back on the road to recovery. Remember that every surgeon has his or her own way of treating problems. You must go over these potential risks with your surgeon to gain better insight and understanding.

Bleeding is very uncommon with breast reduction because we are generally not cutting deeper breast tissues. However we have had some reports of bleeding in the literature about this complication. There are those who are at higher risk of bleeding. The use of certain medications such as aspirin or coudamin (a blood thinner) could put you at higher risk of bleeding. Some people with history of uncontrolled hypertension can be at higher risk of bleeding after the surgery. There are some individuals who have some problem with their coagulation system that they were not aware of and consequently have had bleeding after surgery. If you do not have any of these risk factors you should not be at high risk for bleeding. However if you do have bleeding for whatever reason, we will treat it immediately
Infection is a rare complication of this surgery. We give you antibiotics both before and after surgery to prevent this possibility, however even when this is done there may be a minor chance that your incision may get infected. If this happen we will treat you with stronger antibiotics and we will try to find the source of the infection.
Sometimes with breast surgery there may be a small degree of trauma to the breast tissues or the fatty tissues in the area and this may result in late calcifications. Occasionally, these calcifications may create some doubt as to the presence of breast cancer and may necessitate a biopsy.
There are risks associated with anesthesia. With modern equipment and techniques available in modern hospitals risks from surgical anesthesia are minimal.
There may be scars around your areola (the darker skin around the nipple) and under the areola. Sometimes there may be a scar under the breast fold. Anytime that you have incisions and scar there is the potential for poor healing and obvious scars. This happens very rarely however, and it does improve with time. Sometimes we may need to revise the scar at a later date. I generally do this after nine to twelve months from the time of the initial surgery.
There will be temporary breast and nipple sensory changes that usually resolve in 6-8 weeks. Very rarely there may be permanent loss of nipple sensation. Unfortunately there is no relationship between the type of incision used and the development of this problem
Loss of the nipple due to inadequate blood flow is a rare complication. With newer techniques of breast lifting this complication has been virtually eliminated. However if there is an extensive amount of surgery and lifting of the skin the circulation to the nipple may be compromised. If this occurs there are ways in which a new nipple can be reconstructed.
A few patients in the literature have been reported to have chronic pain as a result of Breast reduction.
Most women have minor asymmetries in their breasts and this is completely natural. If there is a major difference between the two sides of the breasts this can be corrected to a certain extent. Major problems of asymmetry cannot be completely corrected and may persist after the operation.

Some patients are disappointed with the results of their surgery. This is sometimes related to the fact that they had unrealistic expectations in terms of the outcome of the operation

When and where are touchup procedures done?
Touchups are done after three months. These procedures are usually much simpler than the first procedure and are not as painful. I can do them in the office with a small amount of local anesthetic solution if it is a minor deformity or problem. However if the problem or irregularity were more complicated or difficult to anesthetize, I would do it in the outpatient surgery center under general anesthesia.

When are the sutures removed?
Breast sutures come out in 10-14 days. Sometimes you may have absorbable sutures that do not need to come out.

How many visits do I have after surgery?
We like to see our patients frequently after surgery. You are seen by the Doctor or nurse within 2-3 days of surgery. Then the normal postoperative routine is: 1 week, 1month, 3 months, 6months, and 12 months. Of course if there is a need you may be seen more. After a year we encourage our patients to come for routine follow-up visits every 3-5 years.

When can I wear make-up?
You should be able to wear makeup if you have had breast surgery. We do not recommend your putting makeup on your incisions however, because this may result in tattooing of the skin by the pigments of the makeup.

Am I a good candidate?
You are a good candidate for breast reduction if you have large and heavy breasts, good general health, and realistic expectations. This does not mean that you cannot perform liposuction if you do not meet these criteria. However, the best results are seen in individuals who have moderate to major enlargement of the breasts with good quality skin. Generally the younger you are the better a candidate you are for surgery. But the physiologic age of person is more important than the chronological age. That is to say you may be 60 years old, but your skin and general health could be better than most who are 50 years old.

Procedure: Breast Reduction continued

What does the surgery cost?
The cost of surgery varies but here are some guidelines that will help you determine roughly what you could expect. Remember that these are only rough estimates. These estimations include the cost of the operating room and the anesthesia. The fee may be subject to change without notice. The best way for you get an accurate cost analysis is to see a doctor.

Breast Reduction: $6,000.

You may be able to get insurance coverage for reduction of your breast. Ask our financial advisor about this possibility. You should contact your insurance company and ask for the criteria that they use to qualify their clients for breast reduction. For example they may need a note from your Internist. Such inquiries may help expedite the approval process.

How do I pay for surgery?
You can pay for surgery by certified check, Credit card, or cash. Payments for cosmetic surgery are expected prior to the procedure. If you are scheduling several weeks in advance of surgery you can pay by personal check.

Are there scars?
Yes. However most of the scars are around your nipple and areola or under your breast. After several months this scar fades and are less visible. The scars with operation need to be viewed as a necessary evil. There is no way that the nipple can be moved to a higher position on your breast without making an incision.

Does it hurt?
The pain involved in breast reduction is very tolerable. We have heard our patients describe it as ‘muscle aches’ or just ‘soreness in the chest’. Many patients do not finish the pain medications prescribed to them for pain relief. But having said that remember that pain is very subjective, and it is not easy to predict what degree of pain you will have.

Will I be awake during surgery?
If you are having just a small area of your breast removed and this can be done in the office then you will be awake. However if you are having a normal breast reduction you will most likely be done in an outpatient facility under general anesthesia. Breast reduction can be a complicated and time-consuming procedure. If you want a good result it is better to let the surgeon concentrate on your breasts and not on your level of discomfort during the case.

Where is the surgery performed? (i.e. office suite or hospital)
This operation is usually done in an ambulatory surgery center. Unless there are medical risk factors, Dr.Marefat does not perform this surgery in the hospital. Occasionally, the amount of reduction is so minimal that it may be possible to perform this operation in the office. This would be an exception however, and you should not count on it.

Are medical photographs taken?
Yes. In all cosmetic and reconstructive cases medical photos are taken. Photographs are mandatory because this is the only way for us to compare you before and after results. Photographs in plastic surgery serve much the same role that x-rays serve for orthopedic surgery.

Date Revised: 1-25-07

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