Breast Reduction

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Breast Reduction

Reduce back and neck pain from enlarged breasts with Cleveland Ohio breast surgery

Who is a candidate for breast reduction surgery?

Breast reduction, as the name implies, involves reducing the weight and size of the breasts. This Cleveland breast surgery is generally covered by insurance as medically necessary to treat back pain, neck pain, rashes, and functional impairment (interference with movement and exercise). Patients who are candidates for breast reduction in Ohio typically have these symptoms. Most insurance companies require 500 grams (1.1 pounds) or more of breast tissue to be removed per breast to consider this a covered procedure. Insurance approval involves a “pre-determination” letter from the plastic surgeon to the insurance company documenting pre-existing symptoms, prior medical treatment, and an estimate of the weight of the tissue to be removed. Clinical photographs must also accompany the pre-determination letter.

What are the different types of breast reduction?

There are multiple techniques available to accomplish a breast reduction. By far, the most popular technique in the United States is the inferior pedicle breast reduction (also known as the Wise pattern or inverted-T reduction). Dr. Goldman uses a spectrum of techniques depending on the size of the breasts and goals of the patient. Most patients are best suited to the inferior pedicle technique. Smaller volume reductions may be candidates for a vertical breast reduction in Ohio, which minimizes the size of the incisions used. Massive reductions are best suited to a technique referred to as free nipple grafting, in which the nipples are moved up as skin grafts.

For the inferior pedicle breast surgery reduction, the surgeon draws a pattern on the patient’s skin prior to an Ohio breast surgery, generally with the patient standing up. This pattern marks out the incisions and the amount of skin to be removed. In the operating room, after anesthesia is induced, the surgeon sculpts a central mound of breast tissue that is attached, at its base, to the underlying chest wall (the rib cage). Excess breast tissue is removed from the sides and top of the breast. The breast mound is then lifted, bringing the nipple and areola (the pigmented circle of skin around the nipple) to a higher, more youthful position. The areola is often made somewhat smaller. The breast skin, which was tightened according the pattern drawn preoperatively is then, in essence, wrapped around the reshaped breast mound. This leaves a circular incision around the areola, a vertical incision down to the fold underneath the breast (the inframammary fold), and a horizontal curved incision in the inframammary fold. The latter two incision are shaped like an upside-down, or inverted, “T,” so this technique is often referred to as an inverted-T breast reduction.

There are several breast surgery reduction techniques that are referred to as vertical breast reductions. In the United States, these tend to be used mainly for small volume breast reductions (reductions that do not remove much weight from the breast). These techniques are more popular in Europe, perhaps because breast reductions are commonly performed on smaller breasts there. Vertical breast reduction in Ohio techniques remove tissue from the central lower breast. The sides of the breast are then brought together to reshape the breast mound. Skin patterns are similar to those for inverted-T reductions and are also drawn prior to surgery with the patient standing. Vertical reductions generally allow for a shorter horizontal scar (at the inframammary fold); some techniques actually eliminate the horizontal scar, but this can cause an unusually long lower breast and consequently an unusual breast shape.

In patients with extremely large breasts, the nipple-areola complex actually has to be removed from the breast and replaced as skin graft, after the breast size is reduced. In such cases, the blood flow in and out of the nipple is altered significantly be removal of a large amount of breast tissue. So it is actually safer to move the nipple as a skin graft. Generally, an inverted-T skin pattern is still used.

What are the risks of breast reduction surgery?

Any surgery carries the risk of bleeding, infection, and medical or anesthetic complications. Sometimes patients may require transfusion or return to the operating room for bleeding; this is well under one percent for large series (studies) of breast reduction in Ohio patients and for Dr. Goldman’s practice. Similarly, requiring treatment for infection or anesthetic complications after breast reduction is rare. Performing this procedure in an accredited surgical facility with certified anesthesiologists or anesthetists is standard. Dr. Goldman performs a thorough history and physical examination on every patient and obtains medical clearance preoperatively whenever necessary. Our surgery centers also follow standardized guidelines in obtaining screening laboratory studies preoperatively.

Risks specific to breast surgery reduction include nipple numbness (which can be permanent), transient changes in nipple sensation, wound healing problems like keloids (thick scars) or skin necrosis (in which an area of skin can die, scab over, and then scar), fat necrosis (in which fat within the breast becomes hardened), size issues (being too big or too small or asymmetric after surgery), pain, decreased ability to breast feed, in mammograms.

Cup size. Bra cup size cannot be guaranteed for any breast surgery because it is not standardized; cup size is different between manufacturers. One company’s B-cup will not be the same size as another company’s, for instance. Furthermore, cup size is also subjective: one woman may wear a D-cup bra, but a woman of similar size may like the fit of a C-cup better. It is also important to note that the volume of a given cup size increases greatly as chest size increases, so a 34-C cup is actually a much smaller cup than a 40-C. Thus, a woman may fit into a 34-C or a 36-B, for example.

Smoking. Dr. Goldman requires that all patients quit smoking for 2-3 months prior to breast surgery. Smoking clearly increases complication rates from surgery, including skin necrosis, fat necrosis, and medical complications, like pneumonia and blood clots. We have great success with smoking cessation for our patients. In appropriate patients, Dr. Goldman will prescribe Chantix or Wellbutrin, two medications shown to help patients quit smoking.

Why choose Dr. Goldman?

Choosing the right plastic surgeon for you is like choosing any physician. First, make sure the doctor is well-trained and board certified in plastic surgery. Membership in major plastic surgery societies also lends credibility to the doctor’s qualifications. Second, evaluate the physician’s results. The internet is ideally suited for this purpose because plastic surgeons can show before and after pictures. Third, does the physician communicate well (have a good bed-side manner). This is critical because the surgeon has to understand your goals, and you have to understand the risks, benefits, recovery, alternatives, and techniques for the Ohio breast surgery you are contemplating.

So we invite you to examine Dr. Goldman’s credentials, before and after pictures, and the rest of our website, then we hope to see you in consultation to find out if breast reduction in Ohio is a good choice for you.

How do I schedule a consultation?

Feel free to email at info@drgoldman.com or call (216) 514-8899. Our friendly and well-informed staff would be happy to answer questions and expedite a consultation.