Breast Reduction Beverly Hills

Conveniently located to serve the areas of Beverly Hills and Los Angeles

Contents

Description

For many women, the condition of large breasts (macromastia) can cause a number of physical and aesthetic complications, including: chronic back pain, headaches, breathing problems, poor posture, neck strain, skin irritation, and deep, painful indentations from bra straps.  Macromastia may also inhibit lifestyle choices, and make physical activity, sports, and exercising extremely challenging, leading to decreased mobility and increased potential for weight gain.

Fortunately at Gabbay Plastic Surgery, Dr. Joubin Gabbay M.D. offers breast reduction surgery (reduction mammoplasty) as an option to decrease the size of one’s breasts and make the breast size more proportional to the rest of the body by surgically removing excess breast tissue, fat and/or skin. Breast reduction surgery can also reposition the nipple to a cosmetically appropriate position, and address the aesthetic issue of enlarged nipples, which sometimes accompanies the condition of macromastia.

The American Society of Plastic Surgeons (ASPS) reports that breast reduction surgery has increased 146% in the last decade, and classifies breast reduction surgery as a reconstructive, rather than cosmetic, procedure, because in most cases, it is performed to correct a physical or medical problem, rather than strictly to improve one’s appearance.

Options

During your breast reduction surgery, Dr. Gabbay will remove the necessary amount of fat, glandular tissue, and skin from your breast, and then reshape your breast to better contour to your specific body size and shape. There are many variations to breast reduction surgery, and the amount of reduction needed to restore your breast health, in conjunction with your specific breast reduction aesthetic goals, will determine your unique surgical details.

Breast reduction surgery consistently ranks at the top of patient satisfaction surveys for all procedures performed by plastic surgeons. The American Society of Plastic Surgeons recently surveyed patients after their breast reduction surgery and over 95% responded that they would have the surgery performed again if they needed to. This very telling statistic lends further evidence to the fact that breast reduction surgery continues to increase in popularity as a surgery with both medical and cosmetic benefits. At Gabbay Plastic Surgery, Dr. Gabbay and his dedicated team are committed to helping you achieve your aesthetic and medical goals, and will tailor your treatment plan to meet your unique needs and objectives.  If you would like additional information about breast reduction surgery, please contact Gabbay Plastic Surgery today. We look forward to speaking with you, and to scheduling a complimentary initial consultation with Dr. Gabbay.

Indications

Breast reduction surgery can address and correct many health complications resulting from enlarged breasts (macromastia):

  • Cystic breast infections (polycystic mastitis)
  • Loss of sensation in the arms or fingers
  • Insomnia
  • Striae (scar-like lines) on the breasts
  • Chronic back pain
  • Headaches
  • Stasis ulcers (skin irritation or death of skin tissue due to pressure)
  • Shoulder pain
  • Poor posture
  • Neck aches
  • Pigmented bra-strap grooves
  • Numbness in the breasts or upper chest
  • Skin rashes under the breasts
  • Inability to exercise
  • Difficulty breathing
  • Breasts that are too large in proportion to the body frame
  • Pendulous breasts with nipples and areolas that point downward
  • Asymmetrical breasts
  • Restriction of physical activity due to the weight of the breasts
  • Dissatisfaction or self-consciousness about breast size

If you have any of the symptoms listed above, you may be a good candidate for breast reduction surgery; however, the ideal breast reduction candidate must be in good health with no current or pre-existing medical conditions and with good skin elasticity. Contraindications for breast reduction surgery include: smoking, blood clotting disorders, or heart or circulatory disorders.

Evaluation

If you think a breast reduction may be right for you, the first step is to call Gabbay Plastic Surgery and schedule a consultation with Dr. Gabbay.  During you visit, Dr. Gabbay will discuss your specific surgical goals, take a detailed medical history, and assess your physical and emotional health. If it is determined that breast reduction surgery is a good option for you, Dr. Gabbay will explain to you how much breast tissue should be removed in order to achieve your desired outcome and will provide instructions on how to prepare for the surgery and plan for your recovery.  You will be encouraged to voice any concerns in an open discussion so that you and Dr. Gabbay can reach an understanding for the best treatment options to achieve your aesthetic goals. He will then create a customized treatment plan based on the size and shape of your breasts, the quality of your skin, the position of your nipples, and your individual needs.

Option Details

Common breast reduction surgical techniques include:

  • Inferior Pedicle Technique: the inferior pedicle is a section of the breast that contains a blood vessel supply that reaches the nipple or areola.  Breast reduction is performed through this area by making an incision along the border of the areola where quantities of tissue can be excised and reshaped, and will provide a youthful lift to the breast.
  • Vertical Technique: one of the goals of a vertical scar technique is maintaining the functionality of the nipple-areolar complex. This technique involves the removal of small quantities of internal tissues using a “lollipop” incision that encircles the nipple and extends vertically beneath it.
  • Horizontal Technique: for the horizontal scar technique, incisions are made along the inframammary fold, as well as around the areola. This procedure works best for women whose breasts are too large for the vertical scar technique.
  • Standard Breast Reduction: also known as the anchor incision reduction, this procedure involves three separate (joined) incisions to remove interior breast fat and glandular tissue, as well as to surgically place the nipple in a higher and more aesthetically pleasing location on the breast mound.  The incisions for the anchor reduction run around the areola (periareolar), vertically down from the bottom of the areola to the inframammary fold, and along a large curved line across the natural breast crease.   This procedure is best suited for women with large breasts suffering from severe breast ptosis (sagging).
  • Free Nipple-Graft Technique: this technique allows large amounts of tissue to be removed, thereby creating a dramatic reduction in breast size.  However, this technique does leave the nipple without functionality because it affects the sensitivity in the area.  This technique is recommended for women who have macromastia to such an extent that massive amounts of repositioning are deemed necessary.
  • Liposuction: liposuction is an effective technique for women who only require a small amount of tissue removal, and it is often used for patients who adversely react to anesthesia.  Breast liposuction is a minimally invasive option for women who do not require a full or vertical reduction surgery, and it can be performed in conjunction with other breast reduction techniques.

Procedure Details

Breast reduction surgery is typically performed on an outpatient basis under general anesthesia and (depending on the extensiveness of the procedure) can take 2-3 hours to complete.  Once the incision is made, Dr. Gabbay will remove excess skin, tissue, and fat, and will shift the nipple-areolar complex to a higher position for cosmetic purposes.  Excess fat may also be removed through liposuction (along with various excision techniques). Drainage tubes will be inserted at the end of the surgery to drain fluid (drains will be removed 1-2 days after your surgery).  The incision site will then be sutured with dissolvable stitches and your breasts will be wrapped in special gauze before you are taken to the recovery room.

Recovery

After your breast reduction surgery, you may experience pain and discomfort, which can be controlled with pain medication as needed.  Following surgery, your breasts will be significantly smaller, but the final shape and size may not be evident until healing is complete (this can take up to six months).  All dressings should be kept clean and dry for at least 1-2 weeks to assist with optimal healing, and you will be required to wear a support bra for at least six weeks.  Numbness can occur on the actual nipple and surrounding breast area, but in most cases this is temporary.

Post-operative instructions for breast reduction surgery call for rest and limited movement in order to speed up the healing process and reduce recovery time.  You may feel tired for 1-2 weeks and should plan to take off at least one week of work.  You must avoid heavy exercise for at least six weeks, although light activity (i.e. walking) will help in your recovery.  After several weeks, bruising and swelling will diminish, and after a few months, you should be able to resume most of your regular activities.

Breast reduction surgery is generally a very safe procedure; however, rare complications include: inadequate healing of the nipple area, blood clots, bleeding, infection, and adverse reaction to anesthesia.

Frequently Asked Questions (FAQs)

What is breast reduction surgery?

Breast reduction surgery is a highly safe and effective means of permanently reducing breast size in patients for cosmetic and physical reasons.

Is breast reduction surgery covered by insurance?

Because overly large breasts can lead to several medical conditions, breast reduction surgery is often covered by some insurance companies, however, most require that a certain amount of breast tissue has to be removed in order for the procedure to be covered.

Will the scars from my breast reduction surgery be noticeable?

The incision lines will be permanently visible, although they will fade over time, and they are placed so that clothing can hide them.

Will I be able to breastfeed after breast reduction surgery?

There is a risk that you will not be able to breastfeed following breast reduction surgery, and this is dependent on your unique anatomy.  If this is a concern, you need to discuss this with Dr. Gabbay during your consultation.

What type of anesthesia is used for breast reduction surgery?

Usually, a general anesthetic is administered meaning that you will be asleep throughout your breast reduction surgery, and upon completion, you will be taken into a recovery area where you will be closely monitored until the anesthesia wears off and you wake up.

Why do some patients have drain tubes after surgery?

In many instances, small drain tubes will be placed in your breasts to help avoid the accumulation of fluids, and they will be removed a few days after your surgery.

What will I wear on my breasts to protect them after my surgery?

Gauze dressings will be placed on your breasts, and they will be covered with an elastic bandage or a surgical bra for protection.

How will I feel after my surgery?

Immediately following your surgery you will feel tired and groggy from the anesthesia and that is why it is required that a family member or friend drive you home.  It is also important that you arrange for a caregiver the first few days, as you will need help, and it would be best for someone to monitor you as well.

The day after surgery, you will be encouraged to get out of bed for short periods of time, because walking will help prevent blood clots from forming.  After several days, you will be able to move about more comfortably, however, straining, bending, and lifting must be avoided since these activities can cause increased swelling or even bleeding.  You will also be instructed to sleep on your back to avoid any pressure on your breasts.

If you had surgical drains inserted during your surgery, they will be removed in 1-2 days, and your dressings will also be changed during that office visit.  You will be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminishes. If necessary stitches will be removed in stages over a period of approximately three weeks, beginning one week after surgery, unless dissolvable sutures were used.

When will I be able to return to work?

Most patients are able to go back to work within one week but it is important to remember that the full results of your surgery may not be evident for several months, and as your body adjusts and heals: you must listen to it. Dr. Gabbay will monitor your progress and he will explain that patience is crucial, because taking on too much too soon, may impede or even impair your healing process, requiring additional surgery.

Is it normal for my breasts to lose sensitivity after breast reduction surgery?

Breast reduction surgery does run the risk of nipple sensation loss, and the amount of risk depends on your particular breast size and shape, so it is important to discuss this with Dr. Gabbay during consultation.  You may notice that you feel less sensation in the nipple and areola areas, and this is usually temporary although it may take weeks, months, or even up to one year before sensation returns to normal. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color, and they too eventually fade and heal after several months.

What is a good age to have a breast reduction surgery?

It is advised that breast reduction surgery be performed after the age of 20 because the breasts are usually fully developed after that age.  Exceptions can be made however, for teens who suffer significant emotional and psychological effects from having breasts that are too large.

Can I have a breast reduction before I have children?

It is usually advised that if you want children you should consider postponing breast reduction surgery, because changes to breast tissue during pregnancy could alter your surgical results.  Another risk is that after breast reduction surgery breastfeeding may be difficult.

What kinds of incisions are used in breast reduction surgery?

There are several different incision techniques used in breast reduction surgery, depending on the amount of tissue reduction you need.  One common incision is the vertical or “minimal scar” incision that involves a scar around the nipple, and another incision leading down in a straight, vertical line resembling a ‘lollipop’ shape.  Women with extremely large breasts need the more standard “anchor” procedure, involving an incision around the nipple, a straight vertical line, and a horizontal incision along the inframammary crease; resembling an anchor.

Is the nipple left attached to the breast during the breast reduction procedure?

In the vast majority of breast reductions, the nipple is left attached to the breast, with the exception being in patients that have extremely large breasts.  In this case, occasionally the nipple needs to be removed and reattached in a free nipple graft procedure.

When will I be able to resume normal activities?

After breast reduction surgery, it is often possible to return to work within a week (depending on your job), and in many instances most normal activities can be resumed after several weeks, including various forms of mild exercise.  You must be extremely gentle with your breasts for at least six weeks, and you may experience some discomfort during this time. Any severe pain should be reported to Dr. Gabbay immediately.

Will I have to have additional surgery to keep my breasts the same shape and size after breast reduction surgery?

Unless you gain or lose a significant amount of weight, or become pregnant, your breast size should remain the same, although gravity and the effects of aging may eventually alter the size and shape, as it does every woman’s breasts.  If after a period of years you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift procedure to restore a more youthful contour.

What will my breasts look like after surgery?

Breast reduction often makes a dramatic change in your appearance and for this reason: it may take some time to adjust to your new body image, even though you finally have the smaller, lighter breasts you have always wanted.  Although most women love their new figure, your body may not feel like “you” at first, but eventually, women love their new figure.  The level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure performed.

What are the most common incisions used in breast reduction surgery and where are they located?

A breast reduction typically involves three incisions: one around the areola, one vertical incision from the bottom edge of the areola to the crease under the breast, and one incision beneath the breast in the crease following its natural curve. This is commonly referred to as the “anchor” incision. Newer techniques are used to remove the lower horizontal incision, giving a “lollipop” shaped incision.  Once the excess tissue and skin are removed, Dr. Gabbay will close the incisions, paying meticulous attention to the shape and overall appearance of your breasts.

How do I know if a breast reduction is right for me?

Women with very large breasts are often limited in the type of clothing they can wear, they feel inhibited in their ability to participate in sports or other activities, they are extremely embarrassed by the size of their breasts, and/or they suffer from many medical issues from debilitating back and shoulder pain to irritating skin rashes.  Whether you are self-conscious about your breast size or you would like relief from the excess weight of your large breasts, Dr. Gabbay can help you decide if breast reduction surgery is right for you during your consultation.

If I decide I want a breast reduction, how soon will I be able to have the surgery?

After you consultation with Dr. Gabbay, you will be able to schedule your surgery at your convenience, based on availability.

When will I see the results of breast reduction surgery?

You will notice your smaller, firmer breasts immediately after surgery and as you continue to heal you will enjoy the freedom of a more “normal” bust line that allows you to be more active, eliminate the physical ailments associated with large breasts, and you will be able to finally wear the latest, flattering new fashions.

Will I have to do anything special before my surgery?

You will have to stop taking blood thinning medication and NSAIDs (such as aspirin, Advil® or ibuprofen, Aleve®) at least two weeks before your surgery and if you smoke, you will have to quit at least one month before and one month after your breast reduction, to eliminate the possibility of bleeding complications and other risks.

How is a breast reduction performed?

During your breast reduction, Dr. Gabbay will remove excess breast tissue from the top and sides of the breast, through a series of incisions. Once the desired size and shape are achieved, he will reposition the center breast tissue, areola, and nipple to achieve a youthful, lifted appearance.

How long does breast reduction surgery take?

Depending on the complexity of your surgery and the technique used, breast reduction surgery takes approximately 2-3 hours to perform.

Why should I undergo surgery to reduce my large breasts?

If you are a woman with overly large breasts, breast reduction surgery can be a life-changing option for you.  Smaller, firmer breasts will give you significant relief from numerous physical and emotional discomforts, a new sense of freedom for participating in physical activity, and the ability to wear clothing that fits, instead to baggy clothing that you wear to hide your breasts because you are self-conscious about their size.

What will happen during my first consultation?

When you are considering breast reduction surgery, your first step is to call our office and schedule a consultation with Dr. Gabbay.  During this visit, he will assess your physical and emotional health and discuss your specific goals, to determine if they are realistic and can be achieved.  He will examine your breasts, consider their size and shape, the quality of your skin, and the placement of your nipples, before measurements and photographs will be taken for your medical records.

What is a traditional breast reduction?

Some women with very large breasts, may be better candidates for a traditional breast reduction surgery. This procedure requires general anesthesia, a longer recovery period, and a large vertical scar around the nipple to remove the excess fat and tissue.  All options will be discussed during your consultation to determine which technique is right for you.

Is breast reduction permanent?

Breast reduction surgery should be considered permanent, although the remaining fat cells will swell and enlarge if you gain weight, and if you become pregnant the tissues will increase in size because they take on fluid and store milk.  Natural or synthetic hormones may also cause breast tissue to swell, and if you take hormonal supplements, it is quite possible to gain small amounts of breast tissue back.

How can a breast reduction be performed with liposuction?

In some cases, liposuction is effective in removing fat from the breasts and this will be determined during your consultation.  For the liposuction technique, small incisions are made within the natural fold underneath the breast, and in some cases on the outer side as well.  One procedure is a tumescent technique, where a solution of saline (delivery and tumescent agent), Lidocaine (pain reliever) and epinephrine (prohibits excessive bleeding and excess absorption of Lidocaine) are injected into the targeted area.  The solution expands the tissues for a firmer working area, and the softer fat cells are then suctioned out.  Another liposuction technique involves ultrasonic energy waves that energize the fat molecule,s and literally melt the fat into a liquid, that is removed by suction.  The manual technique is similar to a breast lift operation, with more internal tissue removed, and in all techniques, after the targeted breast tissue and fat is removed, sutures are used to close the incisions.

Will I be able to handle the pain?

Pain tolerance is different for every person and any breast reduction pain connected with breast reduction surgery is minimal to moderate, which can be controlled with oral pain medication.  You will also be prescribed antibiotics that you will take postoperatively for several days, to prevent infection. Discomfort is minimal if you rest, limit your activities, and strictly follow the instructions provided by Dr. Gabbay.

How long does it take the swelling and bruising to go away?

It takes 1-2 weeks for most of the swelling to subside. Some people are more prone to bruising than others, so results vary from patient-to-patient.

Are there any risks involved in breast reduction surgery?

Complications are rare but with every surgery there are some risks involved that may include asymmetry, blood loss, swelling, bruising, infection, blood clots, and permanent numbness.  These and any other complications will be discussed in detail during your consultation at Gabbay Plastic Surgery.