Breast reduction surgery involves removal of skin, fat, and glandular tissue to make the breasts smaller and perkier. It has a very high patient satisfaction rate: 95% of patients would have the surgery again. You may be a good candidate for breast reduction if you suffer from symptoms due to disproportionately large breasts, including back pain, tension headaches, or difficulty finding clothing that fits.
How do you know if you need a breast reduction?
Women seek out breast reduction for a variety of different reasons. Some women feel self-conscious about their large breasts, or find it difficult to find clothing that fits. Large breast size can also make it difficult to work out (and forget finding a sports bra that actually supports a DD or E cup size!) You may notice you have difficulty maintaining good posture, as heavy breasts pull your shoulders forward. Large breasts can also cause pain in a multitude of places, including pain in the shoulders where the bra strap rests, tension headaches, back pain, neck pain, and pain in the breasts themselves. I also hear women complain about rashes and irritation under the breasts and even occasional numbness in the fingers.
How do you know if your breasts are too big?
There is no wrong answer when it comes to breast reduction. Simply put, if you want smaller breasts, then you might benefit from a breast reduction. Insurance companies do have specific criteria to determine whether breast reduction is considered medically necessary (i.e. whether they will pay for it). But I have treated many women who feel disproportionate and feel physically better after a breast reduction, even if insurance doesn’t consider it medically necessary. I’ll talk a little more about insurance criteria later in this post.
How many cup sizes can you go down with breast reduction?
Breast reduction is done in two different ways:
- Pedicled reduction; in a pedicled reduction, the nipple stays attached to the breast. This means the nipple maintains sensation after surgery, and it is usually possible to breastfeed after this type of reduction. But with a pedicled reduction there is a limit to how much breast tissue can be removed, because I need to leave enough tissue to support blood supply to the nipple.
- Free-nipple reduction; in a free-nipple reduction the nipple is removed from the breast and placed back on as a skin graft. There is no limit to how much tissue can be removed after a free-nipple reduction. The nipple will be numb after surgery, however, and because the milk ducts are severed, breastfeeding is no longer possible.
I perform a pedicled breast reduction the vast majority of the time, and I have seen women go from an H or even J cup down to a D or full C cup after surgery. That’s a decrease of six cup sizes! That may mean removing six or seven pounds of breast tissue, which results in an enormous improvement in symptoms.
Will my breasts be perkier after reduction?
Yes! Your breasts will absolutely be perkier after breast reduction surgery. Not only are the breasts made smaller, but they are lifted as well. The areola is also reduced in size to match the new, smaller breast.
What size will I be after breast reduction?
Postoperative breast size is an important consideration if you’re thinking about breast reduction surgery. Your bra size is determined by the measurement around your chest underneath your breasts, combined with the measurement around your bust. The chest circumference determines your band size, and the bust minus the band determines the cup size. So after a breast reduction usually only the cup size changes. This is complicated by the fact that band and cup size are interdependent: as one changes, so does the other. So a 36C bra and a 38B bra actually accommodate the same size breasts.
All this to say bra sizes are anything but straightforward! So when it comes to postoperative breast size, I advise my patients to think about proportionality rather than actual bra size. Patients tend to fall into one of three categories:
- Women who want to be proportional: this depends a bit on your frame, as a woman with curvy hips will be more balanced by slightly larger breasts than a woman with a boyish figure. But women who want to be proportional usually end up in the C-cup range after reduction.
- Women who want to stay a little busty: it’s not unusual to want to be a little busty after breast reduction surgery. After all, you’ve been living with large breasts most of your life! This usually translates to a D cup bra.
- Women who want to be as small as possible after surgery: if you want the freedom of no longer needing a bra after surgery, you likely fall into this category. This will be somewhere in the B-cup range after surgery.
Should I get breast reduction surgery?
If you want improvement in the symptoms listed above, or simply want breasts that are more proportional for your frame, breast reduction surgery may be a great option for you. One question I hear frequently though, is, “Am I too young for breast reduction?” along with “Am I too old for breast reduction?”
Breast reduction surgery is appropriate for a wide variety of ages. But there are a few criteria to make sure you’re a good candidate:
- Your breasts should be stable in size for a least a year. So if you’re in your teens and still developing, it may make sense to wait a couple years until your breast size stabilizes. Exceptions do exist however. If I see a young teenager with extremely large breasts, I may recommend reduction at a younger age because the tremendous improvement in quality of life outweighs the slight risk that she may need reduction again after her breasts finish developing. It is not at all unusual to have a breast reduction at age 16 or 17.
- You should be physically healthy enough to undergo surgery. As long as a woman is physically healthy, I do not have an upper age limit for breast reduction surgery.
- If you smoke or use other nicotine products, you will need to quit for at least six weeks around the time of surgery (I recommend two weeks before and four weeks after surgery). Nicotine decreases blood supply to tissue, increasing the risk of healing problems or even necrosis (i.e. death) of the nipple.
- If you have diabetes it should be well-controlled. This translates to a hemoglobin A1c of 7 or less. Uncontrolled diabetes increases the risk of infection and healing problems.
- You aren’t currently breastfeeding, or it’s been at least six months since you stopped breastfeeding. Not only does breastfeeding change breast size, but operating on breasts that are currently producing milk may result in milk collecting in the breast and causing an infection.
- You’re okay with visible scars on the breast. The scars from breast reduction are shaped like an anchor: they go around the nipple, down the front of the breast, and there may be a scar underneath the breast as well. They ultimately fade pretty well, but scars stay pink for about a year. Check out some of our before-and-after photos to see what I mean.
- You’re not 100% dead-set on breastfeeding in the future. As I mentioned previously, breastfeeding is usually possible after a pedicled breast reduction. But removing some of the glandular tissue can affect milk supply, meaning you might have to supplement with formula. If breastfeeding is very important to you, I recommend avoiding any breast surgery until you are through that phase of life.
Should I lose weight before a breast reduction?
There are three reasons to take your weight into consideration if you’re thinking about breast reduction. The first reason is to mitigate risk. The risk of postoperative complications such as infection and healing problems increases with increasing BMI. For this reason, many surgeons have a BMI cutoff of 35-40. My personal cutoff is a BMI of 40. If your BMI is higher, I recommend losing weight prior to surgery to decrease the risk of complications.
Another reason to consider preoperative weight loss if you have a higher BMI is your end aesthetic result. Removing breast tissue changes the proportions of the body, meaning it may make a round tummy look larger in comparison, or even result in a slightly masculine figure in women who are heavier.
Finally, if you are planning on losing weight, you should try to get within 15-20 pounds of your goal weight prior to surgery. Weight loss has varying effects on breast size depending on the composition of your breasts. If your breasts have a higher proportion of fat than glandular tissue they will become smaller as you lose weight, which could affect your end result. That said, many women find it much easier to lose weight after breast reduction, because they become more active. As long as you understand there is a risk your breasts may become smaller with weight loss, you don’t necessarily need to lose weight prior to surgery as long as you’re in a weight range where the risk of complications is low.
How much weight do you lose with a breast reduction?
Breast reduction isn’t a weight loss procedure, per se, but the amount of tissue removed may range from as little as two pounds to as much as seven or eight pounds. I would not, however, expect to see a change in the number on the scale. Unless you are incredibly consistent with your diet and activity level, your normal variation in weight will obscure any change due to breast reduction.
How much does breast reduction cost, and will my insurance cover breast reduction?
If you’re thinking about breast reduction surgery, the first step is to call your insurance company and see if it’s a covered procedure. Some insurance plans exclude it entirely, meaning it’s not covered even when it would be considered medically necessary.
If your insurance covers breast reduction surgery, the next step is to set up a consultation with a board-certified plastic surgeon. She will ask about your history of symptoms due to large breasts as well as any treatments you may have tried. Even though treatments such as physical therapy or using over-the-counter medications such as motrin don’t generally provide a lasting improvement in symptoms, most insurance companies require that you try these interventions before having surgery. She will also measure your breasts and estimate how much tissue will be removed. Insurance company requirements on how much tissue is removed vary among companies and may even vary by patient height, but a reasonable estimate is around 500 grams per breast, which translates to a pound of tissue.
After evaluating you, your surgeon will likely be able to predict if insurance will cover your breast reduction surgery. If the answer is no, don’t despair! You can still have breast reduction surgery; you will just need to pay out of pocket for the surgery. The average cost is $5,000 – $7,000 depending on your geographic location.
Breast reduction is a popular procedure with a high rate of patient satisfaction. It not only results in smaller, perkier breasts that are more proportional to your frame, but it also alleviates symptoms of back pain, tension headaches, neck pain, shoulder pain, and breast pain. If you’re interested in setting up a consultation for breast reduction, call us at (440) 336-8373 or email firstname.lastname@example.org for more information.