Gigantomastia (overly enlarged breasts) can create physical, emotional and self image issues. Women with very large breasts are subjected to unnecessary ridicule, unwanted attention, discomfort and extreme difficulty finding properly fitting clothing. Breast Reduction Surgery carries one of the highest satisfaction rates among women of all ages. In 2016, over 100,00 breast reduction operations (cosmetic and reconstructive) were performed in the U.S. according to The American Society of Plastic Surgeons. There are some misperceptions about this operation, and hopefully the facts listed below will clear up any confusion.
1. Breast Reduction surgery is usually covered by most health insurance plans because it can cause backache, neck and shoulder pain, headaches, ridging of shoulders from bra straps and posture abnormalities. Usually, your plastic surgeon must submit photos of your breasts (face not in photo) to obtain authorization. Some health insurers try to discourage surgery by requiring physical therapy or weight loss prior to authorizing the operation. It is sometimes necessary to document the need for surgery by obtaining consultations by orthopedic surgeons or physical therapists, confirming that breast girth must be reduced before therapy can help. The bottom line, be persistent and advocate for yourself when dealing with health insurers. Remember, you or your employer are paying steep premiums to be covered, and this operation is considered a medical need!
2. The operation is performed on an ambulatory basis, meaning that you go home after surgery once you recover from anesthesia. The procedure is usually performed under general anesthesia, and can take anywhere from 2.5-5 hours. Breast tissue is reduced and skin is removed, and the breasts are lifted and contoured to smaller, perkier shape. Sometimes, small soft rubber drains are placed beneath the tissue, to be removed 1-3 days later. Some surgeons apply bulky dressings to be removed in 2-3 days, while others prefer lighter dressing combined with surgical bra. Either is acceptable and reasonable.
3. Recovery from surgery usually requires 1-2 weeks of convalescence, with no heavy lifting for one month. Many patients are able to return to work within one week, as long as they are not required to lift objects greater than 5 pounds. Pain is well controlled with analgesics, and it is best to taper off of them as soon as possible to avoid opiate induced constipation. Swelling after surgery takes 3-6 months to completely resolve, but the majority is gone in 6 weeks.
4. Scarring after surgery is an inevitable necessity, but the majority of women gladly accept the scars in exchange for the freedom of weight literally lifted from their neck and shoulders! The scars have either an anchor or lollipop shape, and with attentive care such as massage and scar creams, most do reasonably well. It takes a full year for the scars to completely form or mature, and for that reason, the scars should be protected from the sun during that time. Breast feeding is usually possible after healing is complete, but pregnancy and subsequent breast feeding may affect the result of the surgery.
5. As long as patients are healthy, age is never an issue regarding breast reduction. It is best to wait for girls to turn 16 before surgery to allow hormones to stabilize, but surgery can be done earlier in extreme cases. Women over 40 should obtain a baseline mammogram and usually require medical clearance to assure them to be healthy candidates. Women in their 60's or 70's can have the surgery as long as they are medically cleared. Smoking has serious deleterious effects on healing and scarring, and cessation of all tobacco for a minimum of 2 weeks before and 2 weeks after surgery is imperative. This has been a brief synopsis regarding an operation that carries many benefits, both physically and psychologically. For a more detailed description and specifics regarding your particular needs, seek the advice of a board certified plastic surgeon.
Robert Tornambe, MD is a New York City Plastic Surgeon and Medical Advisor for Trueself. Certified by the American Board of Plastic Surgery, Dr. Tornambe has been practicing plastic surgery for more than 25 years. He is a fellow of the American College of Surgeons, was featured in NYMAG's "Best Doctors" issue, and was the Chief of Plastic Surgery at NYC's Cabrini Medical Center for 20 years.