Reduction Mammaplasty

Much is written about augmentation mammaplasty, or breast enlargement. A favorite past-time of some individuals seems to be speculating as to whether a woman’s breasts are “real” or “fake”. Less publicized is the procedure for making large breasts smaller, called reduction mammaplasty. Women with small breasts often complain, and truthfully so, of feeling of insecurity because of the breast size. Women with large breasts, however, often have actual, physically debilitating problems with their breasts.

Psychologically and mentally, they complain that they appear larger than they really are in their clothes, have to buy clothes bigger at the top than the bottom, and have to wear expensive, super-supportive bras. They also describe feeling that they are constantly being stared at in public, probably accurately in many instances, and always feeling self-conscious.

Physically, patients complain of severe back and neck pain, shoulder grooving from bra straps, dermatitis in the folds below the breasts due to constant moisture, and the inability to exercise.

Most of the original work for developing a reliable procedure with predictable results when reducing breasts was done here in Houston, TX, as was the original work on breast enlargement surgery.

Large breasts present two problems: one, of course, is the large breast itself; the other is that due to the large size and weight of the breasts, the breast sag below where they should be. Breast reduction procedures obviously most correct both problems. A Larger, saggy breast would not be very attractive. Therefore, the breasts are reduced in size, and the nipple and the areola, the pigmented skin around the nipple, are elevated back to their correct position. (For Simplicity, the nipple/ areola complex from here on will just be referred to as the nipple).

Basically, depending on the size of the breasts, two principal methods are used. One called the nipple transplant technique and used for extremely large breasts, require removing the nipple from the breast, reducing the breast to its desired size, and then reapplying the nipple in its proper place as a skin graft. This procedure is safer to use with very large breasts because if enough breast tissue is removed, there may not be enough blood supply left to allow the nipple to live.

The other method, and the most common, is the nipple transportation technique. With this technique, the nipple is left attached to the bridge or “pedicle” of the breast tissue. The excess breast tissue is removed, the nipple is relocated to its proper place, and the incisions are closed.

The advantage of the nipple transportation technique is that the blood vessels, nerves, and milk ducts are left attached to the nipple. Nipple sensation is preserved, and one can theoretically breast feed since the ducts are left intact. Obviously, with the nipple transplant technique, breast feeding is not possible and nipple sensation is lost.

Of course, a procedure of this magnitude requiring surgical wounds and they are permanent. Some can be hidden in the breast folds and most fade with time. However, most patients readily accept the “trade-off” and the most frequent post-op comment is, “I only wish I had done this year’s ago.”

Most insurance companies, but not all, will pay for at least part of this procedure. All require a physician’s letter describing the complaints and findings, and they also require photographs documenting the size of the breasts.

This description is, of course, only a brief overview of a fairly complex procedure. For a thorough discussion and evaluation we will be happy to see you in our office at anytime.