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Surgical Procedures

Breast Reduction Surgery in Reston, VA

Women seeking breast reduction for medical reasons experience chronic discomfort usually in the neck, upper back, shoulder triangle. Women with large breasts often have difficulty performing activities at work or home. Exercise may be nearly impossible. Finding appropriate supportive bras is difficult, and these bras are usually quite expensive. Also, many of these women are not wearing the correct size. A lot of women come in wearing very loose shirts because form fitting clothes make them feel like they are advertising their breasts.

After the surgery, patients usually are sitting up straighter and are much more comfortable.  Many women tell us they didn’t realize how much discomfort they were having until it was gone.  They are able to be more active and sometimes lose weight.  Without the extra tissue in the front, many patients look thinner as well.  They frequently feel more attractive and confident!

What Happens During Breast Reduction Surgery?

The actual procedure varies based on your unique anatomy.  Generally as the breasts get larger and heavier, they get lower.  Nipple and areola tend to head south and sometimes enlarge.  The goal is to get the nipple and areola to the appropriate size and location  and reduce the overhanging tissue.  This surgery does include a breast lift.  (A breast lift or mastopexy can be done without a reduction, during the reduction the breast is lifted.) There will still be some overhang, as that is what natural breast tissue does.  

During your consultation, we will discuss your desires in terms of size.  Although a bra size cannot be guaranteed, your input will be important in determining overall result.

The major draw back of the surgery is the scar—which is generally concealed by most clothing.  You may not be able to wear every dress or bikini top but your options will be significantly greater after the surgery. The scar goes around the areola and down the front of the breast.  Often, to get the desired shape, scar is extended into the natural crease under the breast.  The scar around the areola and under the breast are somewhat camouflaged.

We will do my best to try to get you best scar possible.  We will also tell you what we want you to do to get the best healing.  Scar formation is determined by your body.  Neither you nor I have complete control.  It is rare to develop keloids in these scars. Occasionally scars may be wider or more pigmented than desired. While there is no way of totally removing the scars, they usually improve over the first year or two after surgery.

What is Needed for Recovery from Breast Reduction Surgery?

Surgery is generally outpatient.  You can go home the same day.  Although some patients require a drain, many do not.  Other than a suture holding drain (if needed) in place, no sutures will need to be removed.  You will be given a prescription for pain medication.  Most patients take it for only 1-2 days.  A soft, supportive bra will be worn for one month.  (Early on, front closure bras are easier to get on and remove.) You may shower the next day.  You may go for “gentle” walks as soon as you are comfortable.  Most patients are at their usual activity 4-6 weeks after surgery.

Should I lose weight before surgery?

It would be ideal to be somewhere around goal weight at the time of surgery.  If you are significantly overweight, it would be best to lose weight- both so that we can determine volume and nipple placement for a long lasting aesthetic result.  Also, wound healing complications are less in non obese patients.  However, it is understandable that it can be very difficult to lose weight especially if you have extremely large breasts.  If you have tried and have not made progress, this surgery may help your exercise efforts.  Major weight loss after surgery may affect the appearance of your breasts.

Should I stop smoking before surgery?

Absolutely.  I do not perform this surgery on active smokers.  If you smoke, you need to stop for 6 weeks prior to surgery and for 6 weeks after surgery.  But hey, once you have stopped for 12 weeks, you can and should stop altogether.

Note: this includes stopping the use of nicotine products (gums, patches etc)

I’m not done (or started) having children.  Should I wait?

This is a little trickier for two reasons.  First, pregnancies and breastfeeding can change the size and shape of the breasts.  Also, you may not be able to breast feed.  Of course there is no guarantee that you can breast feed even if you don’t have surgery on your breasts.  Having larger breasts doesn’t guarantee a large milk supply or easy latch.  This is a very personal decision. If a pregnancy is in your immediate future plans or if breastfeeding is crucial to you, I would recommend waiting until after pregnancies and breastfeeding.

Will Insurance Cover My Breast Reduction Surgery?

Many insurance carriers cover this surgery  Coverage criteria vary wildly by insurer and even by plan within a given company.  Some plans completely exclude coverage for this surgery. Most insurers want to see symptoms (back pain, neck pain) and signs (shoulder grooving, excoriation under the breast) of breast hypertrophy.  Almost all want to see that some attempt has been made to manage the problems without surgery (pain medication, muscle relaxant, physical therapy.)Documentation (notes from other treating physicians) of these treatments may be necessary. Most insurances want to see a certain amount of tissue resected.  Unfortunately, this requirement may bring your breasts below your desired size.  We can discuss if this situation applies to you during your consultation.

Our office participates with some insurance carriers and we are happy to submit to other insurances as well.  We are very experienced and excellent at dealing with the insurance carriers.

If you have any questions about the surgery, or would wish to set up an appointment, call Dr. Wendy Gottlieb MD at (703) 668-9499.

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