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Updated 03/31/06
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Breast
Reduction (Mammaplasty)
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Breast
reduction surgery is sought by
many women to relieve the
physical restrictions and
painful strain on neck,
shoulders and back caused by
excessively heavy breasts.
This
strain that can be so severe
that it leads to chronic
headaches, back and neck
deformities, shoulder
indentations, breathing
problems, skin irritation and
a variety of other medical
problems.
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Breast reduction surgery,
technically called mammaplasty,
is usually performed for
physical relief rather than
for cosmetic reasons. This
procedure involves removal of
excess breast tissue to
reshape and lift the breasts.
The results are smaller,
lighter, better-shaped breasts
that are in better proportion
with the rest of the body. Because
of the functional problems
associated with extremely large
breasts, insurance will often cover
the cost of this surgery.
If you're
considering breast reduction, the
following information will provide
you with a good introduction to the
procedure. For more detailed
information about how this procedure
may help you, we
recommend that you schedule a
consultation with Dr. Kremer / Dr. Zettl.
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What
are some of the most common benefits
of breast reduction?
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Breast reduction is quite successful
at reducing the weight of very heavy
breasts, making it easier to enjoy
an active lifestyle. Many women find
that this surgery relieves chronic
back, neck, and shoulder pain. The
primary benefit of the operation is
functional, but you also get a
breast lift, which may enhance your
appearance and improve your body
image.
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What
will happen at the initial
consultation?
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During the consultation, you and
Dr. Kremer / Dr. Zettl will discuss the changes that you
would like to make in your
appearance. Because this is a highly
personal decision, you’ll want to
take time to discuss all of your
concerns and desires, including what
size and shape you would like your
breasts to be.
Show Dr. Kremer / Dr. Zettl pictures of breast
sizes you like. You should also tell
him about any medications you
currently are taking, and any health
conditions you have.
During the consultation, Dr. Kremer / Dr. Zettl
will explain the different options
available to you. He will explain
how your age, the size and shape of
your breasts, and the condition of
your skin may affect the results. He
will discuss the procedure in
detail, explain the risks and
limitations, and explain the type of
anesthesia that will be used.
Dr. Kremer / Dr. Zettl will then examine and
measure your breasts, and photograph
them for reference during surgery
and afterwards. He may also require
you to have a mammogram (breast
x-ray)
Be sure to ask all the questions you
have about the surgery. Learning
everything you can about your
options, risks and benefits is the
key to making an informed decision.
Note: Some insurance
companies will pay for breast
reduction if it's medically
necessary, but they may have
specific requirements such as a
letter from Dr. Kremer / Dr. Zettl, a referral
from your general practitioner,
and/or photos or other
documentation. Be sure to find out
what your insurance company requires
if you intend to use insurance to
pay for this surgery.
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How
is breast reduction done?
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Most
often, the incisions for breast
reduction are similar to those used
for the "keyhole-anchor”
breast lift technique. This
procedure involves an anchor-shaped
incision that circles the areola,
extends downward, and follows the
natural curve of the crease beneath
the breast. Excess glandular tissue,
fat, and skin are removed, and the
nipple and areola are moved into
their new position. Dr. Kremer / Dr. Zettl
then
brings the skin from both sides of
the breast down and around the
areola, shaping the new contour of
the breast. This results in an
inverted T-shaped wound or scar.
In
some cases, techniques can be used
that eliminate the horizontal part
of the scar. Whether or not a so
called vertical mammoplasty can be
done is dependant on the size of the
breast, the amount of tissue to be
removed as well as the quality of
the breast tissue and will be
discussed with you by Dr. Kremer / Dr. Zettl.
In
most cases, the nipples remain
attached to their blood vessels and
nerves. However, if the breasts are
very large or pendulous, the nipples
and areolas may have to be
completely removed and grafted into
a higher position. This will result
in a most likely permanent loss of sensation in the nipple
and areolar tissue as well as
definite inability to breast-feed.
Liposuction
may be also be used in breast
reduction.
The
periareolar or doughnut reduction
method may also be effective if
there is not a large excess of skin.
This method has the advantage of
hidden scars; however it tends to
flatten the breast shape a bit. Dr. Kremer / Dr. Zettl
will
discuss the different methods used
for breast reduction and describe
the technique that is best for you.
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How
long does the surgery take?
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Breast reduction surgery generally
takes about 3-4 hours, depending on extent of the
repair and the techniques being
used.
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Do
I have to stay in the hospital?
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It depends on your situation. Most
breast reduction surgeries are
performed as outpatient procedures,
allowing you to go home within hours
of the operation. However, if an
extremely large amount of breast
tissue will be removed, Dr. Kremer / Dr. Zettl
may want you to stay overnight in
the hospital where medical personnel
can monitor your initial
recovery.
Breast
reduction is most often performed
under general anesthesia.
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How
much pain is there?
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Although the surgical incision for
this surgery may be quite large, it
is placed in areas of the breast
that are not too sensitive. In
addition, due to the fact that the
nerves to the breast skin have been
stretched out by the weight of the
breasts over a long time, the skin
is less sensitive. Thus, the pain
after surgery is usually easily
managed with oral pain medications.
Initially, there is discomfort in
walking, getting out of bed, and any
activity that causes the breasts to
move. You may continue be sore for
the first few days after surgery.
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What
can I expect after surgery?
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Your breasts will be wrapped with
gauze bandage, plus a tighter
bandage for protection and support.
You also may have small drainage
tubes coming out of the incisions,
to help drain some of the excess
fluid.
It is important to take the
medication prescribed to you by Dr. Kremer / Dr. Zettl.
Someone will need to drive you home,
and you may need assistance at home
over the next couple of days.
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What
is the recovery period like?
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Your bandages will be removed after
a day or two, and you will continue
wearing a surgical bra around the
clock for several weeks, until the
swelling subsides and the breasts
heal inside.
Light activities can be resumed
within a few days, although your
chest will be sore. Routine physical activity and
exercising (especially lifting,
pulling and pushing motions) should
be avoided for at least 6 weeks.
This will help the scars to heal. Dr. Kremer / Dr. Zettl
will advise you on the level of
physical activity that is
appropriate for you.
Some women experience random,
shooting pains for a few months,
especially around the time of
menstruation. Expect some loss of
feeling in your nipples and breast
skin, caused by swelling. This
usually fades over the first few
weeks, but occasionally lasts a year
or more.
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What
is the long-term outcome like for
most people?
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Of all plastic surgery procedures,
breast reduction has the most
immediate dramatic results. The
chronic physical discomfort is gone,
the body is better proportioned, and
clothes fit better. Some women find
that as much as they have desired
these changes, they need time to
adjust to their new body image.
After this adjustment period, most
women are very happy with the
results.
Dr. Kremer / Dr. Zettl will make the incisions
as inconspicuous as possible, but
the scarring from this surgery is
fairly extensive and permanent.
These scars are long, and they
remain pink or brown for several
years. For some women, the scars
become wider; but for others, they
fade and become less noticeable.
Poor healing and wider scars are
more common in smokers. Fortunately,
the scars are placed in areas that
are not seen unless you are topless,
and can be hidden by most bathing
suits.
Future breast-feeding may not be
possible, since the surgery removes
many of the milk ducts leading to
the nipples.
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How
long do the results last?
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The breasts will remain smaller
forever than they would have been if
surgery had not been performed.
Unfortunately, gravity continues to
work, and the breasts will sag again
with time. In addition, the
remaining breast tissue will
continue to respond like any breast
tissue: it will get bigger if you
gain weight, take hormones or get
pregnant.
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Ideal
candidate:
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In
general, the best candidates for
breast reduction are women:
- 18
years of age or older
- Mature
enough to fully understand the
procedure
- Whose
activities are limited due to
large breasts
- Experiencing
physical discomfort due to large
breasts
- Not
currently pregnant or
breastfeeding
- Not
intending to breastfeed in the
future
- In
good physical and psychological
health
- Wanting
to improve their appearance
and/or comfort
- Realistic
in their expectations
The
above is only a partial list of the
criteria that Dr. Kremer / Dr. Zettl
will
consider in determining whether or
not this procedure is appropriate
for you.
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Alternatives:
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Weight loss can often reduce the
size of the breasts, and should be
tried first. Hormonal
manipulation is not currently
recommended apart from a prophylaxis
against recurrence in very young
patients after breast reduction.
Liposuction
of the breasts can reduce the size
of the breasts without causing
significant scarring, but most women
do not choose this option because it
makes the breasts sag more since the
size of the skin is not reduced. Liposuction
may give excellent results in
certain patients, especially younger
women with fatty but firm breasts.
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Risks:
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All surgery has some potential
risks, including the risks of
bleeding, reaction to the
anesthetic, and infection. In this
surgery, serious complications are
quite rare, but there is often
significant blood loss due to the
magnitude of the surgery. In
addition, small areas of infection
or delayed healing in the incisions
is not uncommon. There is also a
possibility of developing small
sores around the nipples, which can
be treated with antibiotic creams.
If you carefully follow all Dr. Kremer / Dr. Zettl’s
instructions both before and after
the surgery, you can minimize the
risks.
Some patients may experience a
permanent loss of feeling in their
nipples or breasts. Rarely, the
nipple and areola may lose their
blood supply and the tissue will
die.
Cigarette smoking decreases blood
flow to the skin and subcutaneous
tissues (just under the skin) that
carry blood flow and leads to an
increased risk of the skin scabbing,
and can lead to permanent scarring
as well.
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Be
sure to:
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- Tell
Dr. Kremer / Dr. Zettl about any allergies
you have (to foods, drugs,
environmental elements)
- Tell
Dr. Kremer / Dr. Zettl if you have a history
of bad scarring, such as keloids.
- Tell
Dr. Kremer / Dr. Zettl about all
medications, herbal supplements
or natural supplements you are
taking (both prescription and
non-prescription)
- Carefully
follow any instructions Dr. Kremer / Dr. Zettl
gives you regarding
eating and drinking and smoking.
- Avoid
aspirin and aspirin-containing
medicines for
two weeks prior to surgery.
- Try
to schedule surgery at a time
other than your menstrual
period.
- Arrange
for someone to drive you home
after surgery or after discharge
from the day surgery center or
the hospital.
- Please
inform Dr. Kremer / Dr. Zettl immediately in
case you should experience fever
or symptoms of an infection
after surgery.
The
information on this web site is only
intended as an introduction to this
procedure and should not be used to
determine whether you will have the
procedure performed nor as a
guarantee of the result.
The
best method of determining your
personal options is to schedule a
personal consultation with Dr. Kremer / Dr. Zettl. He will be able to answer
specific questions related to your
situation.
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