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Breast Reduction / Mammaplasty

Breast reductionBreast reduction surgery is sought by many women to relieve the physical restrictions and painful strain on neck, shoulders and back caused by excessively heavy breasts. This strain that can be so severe that it leads to chronic headaches, back and neck deformities, shoulder indentations, breathing problems, skin irritation and a variety of other medical problems.

Breast reduction surgery, technically called mammaplasty, is usually performed for physical relief rather than for cosmetic reasons. This procedure involves removal of excess breast tissue to reshape and lift the breasts. The results are smaller, lighter, better-shaped breasts that are in better proportion with the rest of the body. Because of the functional problems associated with extremely large breasts, insurance will often cover the cost of this surgery. If you're considering breast reduction, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you schedule a consultation with Dr. Kremer.

FAQFrequently asked questions about Breast Reduction (Mammaplasty) by Dr. Michael A. Kremer:



What are some of the most common benefits of breast reduction?

    Breast reduction is quite successful at reducing the weight of very heavy breasts, making it easier to enjoy an active lifestyle. Many women find that this surgery relieves chronic back, neck, and shoulder pain. The primary benefit of the operation is functional, but you also get a breast lift, which may enhance your appearance and improve your body image.

    What will happen at the initial consultation?

      During the consultation, you and Dr. Kremer will discuss the changes that you would like to make in your appearance. Because this is a highly personal decision, you'll want to take time to discuss all of your concerns and desires, including what size and shape you would like your breasts to be.

      Show Dr. Kremer pictures of breast sizes you like. You should also tell him about any medications you currently are taking, and any health conditions you have.

      During the consultation, Dr. Kremer will explain the different options available to you. He will explain how your age, the size and shape of your breasts, and the condition of your skin may affect the results. He will discuss the procedure in detail, explain the risks and limitations, and explain the type of anesthesia that will be used.

      Dr. Kremer will then examine and measure your breasts, and photograph them for reference during surgery and afterwards. He may also require you to have a mammogram (breast x-ray)

      Be sure to ask all the questions you have about the surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

      Note: Some insurance companies will pay for breast reduction if it's medically necessary, but they may have specific requirements such as a letter from Dr. Kremer, a referral from your general practitioner, and/or photos or other documentation. Be sure to find out what your insurance company requires if you intend to use insurance to pay for this surgery.

      How is breast reduction done?

        Most often, the incisions for breast reduction are similar to those used for the "keyhole-anchor" breast lift technique. This procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Excess glandular tissue, fat, and skin are removed, and the nipple and areola are moved into their new position. Dr. Kremer then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast.  This results in an inverted T-shaped wound or scar.

        In some cases, techniques can be used that eliminate the horizontal part of the scar. Whether or not a so called vertical mammoplasty can be done is dependant on the size of the breast, the amount of tissue to be removed as well as the quality of the breast tissue and will be discussed with you by Dr. Kremer.

        In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. This will result in a most likely permanent loss of sensation in the nipple and areolar tissue as well as definite inability to breast-feed.

        Liposuction may be also be used in breast reduction.

        The periareolar or doughnut reduction method may also be effective if there is not a large excess of skin. This method has the advantage of hidden scars; however it tends to flatten the breast shape a bit. Dr. Kremer will discuss the different methods used for breast reduction and describe the technique that is best for you.

        How long does surgery take?

          Breast reduction surgery generally takes about 3-4 hours, depending on extent of the repair and the techniques being used.

          Do I have to stay in the hospital?

            It depends on your situation. Most breast reduction surgeries are performed as outpatient procedures, allowing you to go home within hours of the operation. However, if an extremely large amount of breast tissue will be removed, Dr. Kremer may want you to stay overnight in the hospital where medical personnel can monitor your initial recovery.

            Breast reduction is most often performed under general anesthesia.

            How much pain is there?

              Although the surgical incision for this surgery may be quite large, it is placed in areas of the breast that are not too sensitive. In addition, due to the fact that the nerves to the breast skin have been stretched out by the weight of the breasts over a long time, the skin is less sensitive. Thus, the pain after surgery is usually easily managed with oral pain medications. Initially, there is discomfort in walking, getting out of bed, and any activity that causes the breasts to move. You may continue be sore for the first few days after surgery.

              What can I expect after surgery?

                Your breasts will be wrapped with gauze bandage, plus a tighter bandage for protection and support. You also may have small drainage tubes coming out of the incisions, to help drain some of the excess fluid.

                It is important to take the medication prescribed to you by Dr. Kremer. Someone will need to drive you home, and you may need assistance at home over the next couple of days.

                What is the recovery period like?

                  Your bandages will be removed after a day or two, and you will continue wearing a surgical bra around the clock for several weeks, until the swelling subsides and the breasts heal inside.

                  Light activities can be resumed within a few days, although your chest will be sore. Routine physical activity and exercising (especially lifting, pulling and pushing motions) should be avoided for at least 6 weeks. This will help the scars to heal. Dr. Kremer will advise you on the level of physical activity that is appropriate for you.

                  Some women experience random, shooting pains for a few months, especially around the time of menstruation. Expect some loss of feeling in your nipples and breast skin, caused by swelling. This usually fades over the first few weeks, but occasionally lasts a year or more.

                  What is the long-term outcome like for most people?

                    Of all plastic surgery procedures, breast reduction has the most immediate dramatic results. The chronic physical discomfort is gone, the body is better proportioned, and clothes fit better. Some women find that as much as they have desired these changes, they need time to adjust to their new body image. After this adjustment period, most women are very happy with the results.

                    Dr. Kremer will make the incisions as inconspicuous as possible, but the scarring from this surgery is fairly extensive and permanent. These scars are long, and they remain pink or brown for several years. For some women, the scars become wider; but for others, they fade and become less noticeable. Poor healing and wider scars are more common in smokers. Fortunately, the scars are placed in areas that are not seen unless you are topless, and can be hidden by most bathing suits.

                    Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.

                    How long do the results last?

                      The breasts will remain smaller forever than they would have been if surgery had not been performed. Unfortunately, gravity continues to work, and the breasts will sag again with time. In addition, the remaining breast tissue will continue to respond like any breast tissue: it will get bigger if you gain weight, take hormones or get pregnant

                      What are the ideal conditions?

                        In general, the best candidates for breast reduction are women:

                        • 18 years of age or older
                        • Mature enough to fully understand the procedure
                        • Whose activities are limited due to large breasts
                        • Experiencing physical discomfort due to large breasts
                        • Not currently pregnant or breastfeeding
                        • Not intending to breastfeed in the future
                        • In good physical and psychological health
                        • Wanting to improve their appearance and/or comfort
                        • Realistic in their expectations

                        The above is only a partial list of the criteria that Dr. Kremer will consider in determining whether or not this procedure is appropriate for you.

                        Are there any alternatives to surgical breast reduction?

                          Weight loss can often reduce the size of the breasts, and should be tried first. Hormonal manipulation is not currently recommended apart from a prophylaxis against recurrence in very young patients after breast reduction.

                          Liposuction of the breasts can reduce the size of the breasts without causing significant scarring, but most women do not choose this option because it makes the breasts sag more since the size of the skin is not reduced. Liposuction may give excellent results in certain patients, especially younger women with fatty but firm breasts.

                          What risks are there, what complications can occur?

                            All surgery has some potential risks, including the risks of bleeding, reaction to the anesthetic, and infection. In this surgery, serious complications are quite rare, but there is often significant blood loss due to the magnitude of the surgery. In addition, small areas of infection or delayed healing in the incisions is not uncommon. There is also a possibility of developing small sores around the nipples, which can be treated with antibiotic creams. If you carefully follow all Dr. Kremer's instructions both before and after the surgery, you can minimize the risks.

                            Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die.

                            Cigarette smoking decreases blood flow to the skin and subcutaneous tissues (just under the skin) that carry blood flow and leads to an increased risk of the skin scabbing, and can lead to permanent scarring as well.


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