Breast Reduction vs Breast Lift: Which is best for you?
What is Breast Reduction and How Does it Work?
Breast reduction is a really commonly requested procedure. Most of my patients who want a breast reduction are highly motivated to have it because it's very uncomfortable to live with daily back pain. Breast reduction is an interesting surgery because there's definitely a cosmetic component of it. Everyone wants symmetrical, perkier and appropriately sized breasts that's appropriate for their body size, but they want the size to be reduced and the pain to go away - that's the medically necessary part.
Breast Reductions and Insurance Coverage
Breast reduction surgery is often covered by insurance, however, it's much more difficult than just coming into a plastic surgeon's office and requesting smaller breasts. It's no guarantee that it will be covered by insurance, usually, we need documentation.
It's always helpful if we have a referring primary care physician who has notes, saying, “This patient does have back pain, we tried physical therapy, we tried this other treatment,, etc..” Some of my patients have had ancillary procedures performed by chiropractors or acupuncture, and it's documented that the pain relief was temporary, but it almost always comes back.
A lot of times insurance companies do want some kind of proof that “conservative therapy”, meaning anything short of a breast reduction, has been tried, but the patient is still having pain.
Differences in a Breast Lift and Breast Reduction, and how it related to insurance
One of the barriers to getting breast reduction is, unfortunately, most insurance providers do require a minimum amount of breast tissue that needs to be removed for the breast reduction to be considered medically necessary. This is likely because of breast lift and a breast reduction are very similar procedures.
In both a breast lift and breast reduction, the skin is tailored on the breast, the areola can be resized and lifted up so that the entire breast looks perkier. In a breast lifts case, we just tend to remove a very small amount of breast tissue so that it has a very cosmetic result. Volume reduction and weight reduction are usually not the goal of a breast lift.
A breast lift, also called a mastopexy, is considered a cosmetic procedure and is not covered by insurance. The surgical technique is similar so by necessity we need to delineate which patient is a breast reduction patient versus which patient is a breast lift. That's where that came from the minimum grams of tissue that needs to be removed.
We can only assess how much needs to be removed with an in person consultation so coming into our office is required. An experienced plastic surgeon can examine the breast and have a ballpark figure that this will be 300 grams of tissue removed, 450 grams, 600 grams or even higher amounts that can be safely removed and it still looks aesthetically round like a breast.
In some cases, the insurance company says will accept and cover a breast reduction. In other cases they say no.
How is a Breast Reduction performed?
Many of my patients are very curious about how breast reduction is performed. The easiest way to describe it is there's two components.
Reduction of the breast mound
We want the breast mound to be smaller so have to actually remove the breast gland and the fatty tissue around it. We call that the parenchyma.
On the inside, in general, we remove a horseshoe shaped or C shaped area of breast tissue. That horseshoe shape can be open towards the middle, bottom, or top, and we can tailor that to surgeon preference or what's best for the patient. If you imagine if we remove the breast tissue on three sides, you're going to be left with a smaller amount of breast tissue on that open end of the “C”.
Oftentimes, we do our best to try to keep the nipple and areola, which is the colored part around the nipple itself, still attached to that remainder the breast tissue. Now the breast tissue is removed.
Removal of skin
The second part is we have to tailor the skin around the breast. Since the breast tissue has been removed, we're going to have way too much skin and it will be baggy for a much smaller breast mount. There are variations on how to do this, but a very common way is called a “wise pattern skin reduction.”
Finally, the areola and nipple is placed in a higher position on the breast. There are a few final incisions
a circle around the new areola
a vertical line that goes from the areola down to the crease underneath the breast
a semi circular incision at the crease itself
All 3 incisions combined make it looks kind of like a “ship's anchor.”
A component of a breast reduction also tucks the excess skin so the breasts actually look more lifted and smaller. This is more of a pleasant side effect, having lifted breasts, but the primary goal of a breast reduction is relief of pain.
How are Breast Lifts Performed?
A breast lift is an outpatient procedure. It can take about one and a half to two and a half hours to perform and the patient can go home the same day. A breast lift is performed just like a breast reduction except there is no removal of the breast mound as the primary goal of this procedure is improving the appearance and making the breasts appear more youthful and perky - not making them smaller.
What is the Recovery Timeline for a Breast Reduction or Breast Lift?
In general, breast reduction is an outpatient procedure. Sometimes I perform this procedure in the hospital if my patient has other health issues and it will be safe to observe overnight. In general, if a patient is in good health, we can do this as an outpatient procedure and she goes home the same day, wearing a supportive bra that we actually supply at the surgery center.
I asked my patients to refrain from heavy exercises, lifting anything heavier than a bag of groceries for a couple of weeks. I always encourage patients to walk even on the day of surgery, because circulation in the legs does wonders about making it safer, and preventing dangerous blood clots in the legs that can happen with longer procedures. In general, six weeks is enough for a full recovery but it can take longer, depending on the patient.
Risks of a Breast Reduction or Breast Lift
Both breast lifts and breast reductions are pretty standard surgeries. I always counsel my patients that there is always a risk of loss of sensation to the nipple, or decreased ability to breastfeed.
When patients come in, we always talk about our future for fertility concerns before a patient decides to make the decision to get the surgery.
In some cases, in women who especially have very large breasts and very long breasts, it's not possible to keep the nipple attached to that remaining amount of breast tissue. In those cases, what we do is we have to actually temporarily remove the actual nipple, and then graft it back on, and it still looks aesthetically pleasing, but you would not be able to have any sensation or breastfeed after surgery in that form.
Who is a good candidate for a breast reduction in Columbus Ohio?
A good candidate for breast reduction is somebody who:
Has reasonable expectations
Has back pain that they wish to relieve and that's the primary reason for the breast reduction
Is a relatively healthy person
If a patient has any medical issues, sometimes I will have a conversation with a primary care physician to find out what’s going on and best optimize their surgery to make it as safe as possible.
Who is a good candidate for a breast lift in Columbus Ohio?
Most of my patients who require a breast reduction or breast lift fall into one of two categories:
Pregnancy
A woman has been through pregnancy and experienced an enlargement in the breast, and then some deflation, but often saggier breast remain. She realizes that the breast volume is something that she likes, but it's just saggier and does not look the same as before.
Weight Loss
The other one has to be the woman who is very motivated after losing weight. She is excited to able to lose it but when she loses weight, we actually have a deflation in the breasts. And it's actually looking a little bit saggier than she would like.
For either procedure, I do require all my patients to be non-tobacco users as this can lead to adverse consequences.
Conclusion
If you have any questions about getting either a breast lift or a breast reduction, please reach our to our office. We’ll be happy to schedule a consultation so you can get any questions you have answered directly by Dr. Okada.