Breast Reduction


The ideal breast size for reduction surgery is primarily anchored to the patient’s level of comfort. It is important to note that a good number of patients seek the procedure to remove a huge weight off their back and ultimately improve their quality of life, as suggested by celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

In addition to back pain relief, many patients also seek the surgery to improve their posture, correct their rounded shoulders, and eliminate chronic headaches.

 

ideal breast size for reduction

Before and After Photos of a Breast Reduction Surgery Patient

 

Aside from delivering the most comfortable breast size, other goals should include creating an optimal shape, hiding the surgical stigmata as much as possible (i.e., scars are placed at the border of areola and within the submammary fold), and minimizing risk of tissue regrowth.

 

Tissue regrowth may occur after significant weight gain and pregnancy, so it is in the best interest of patients that these factors are ruled out before the surgery is attempted. For this reason, women of childbearing age and those whose weight is not yet stable are advised to postpone the procedure.

 

The truth is, it is quite difficult to guarantee a cup size after a breast reduction surgery. First and foremost, cup size is not an accurate measurement as each bra company has its different interpretation.

 

The patient’s body largely determines the ideal breast size for reduction. For this reason petite women may want to have a slightly smaller size, while large-framed patients may have to choose a fuller, heavier breast if their goal is to preserve a more natural look and better proportion.

 

But if there is a high probability that tissue regrowth will occur, a scenario that may happen when breast reduction is performed in patients in their mid or late teens, they may have to choose a size that is smaller than their initial plan.

 

Some patients also choose to have a breast size smaller to their liking so their health insurance will cover the surgery’s cost (for instance, some companies require at least 500 grams of removed breast tissue per side in order to qualify for coverage).

 

While breast reduction is best reserved for women whose breasts have fully “stabilized” and they are done having children, teenagers whose overlarge breasts cause them undue discomfort can opt for it.

 

Dr. Smiley says that there are no limitations on how small the breasts can be made, although significant reduction is tied to increased risk of numbness or other sensation-related problems and poor scarring.

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Breast reduction for men is a more straightforward procedure than the surgery performed in women. Nonetheless, it entails the surgeon to have a good eye for detail and “extensive” experience (i.e., performs it on a regular basis for at least five years) to achieve a highly predictable result.

 

Breast reduction for men is generally expected to produce near permanent results provided that the factors, which have been explained below, are present.

 

male breast reduction for men

Before-and-after photos of a successful breast reduction for men

 

  • Right Surgeon

 

This is one of the most critical factors to achieve near permanent results from breast reduction for men. A highly qualified surgeon knows that each patient requires a unique approach. For instance, body builders may need complete removal of all breast gland tissue to eliminate or at least reduce tissue regrowth in the future.

 

According to some studies, body builders are susceptible to hypertrophy (excessive development) of breast tissue after surgery; hence, they require a more invasive approach compared to an “average” patient.

 

  • Avoid anabolic steroids and other drugs and treatments known to cause gynecomastia

 

Another caveat with male breast reduction for body builders is that a good number of them continue their use of anabolic steroids and hormone-laden sports drinks and supplements despite warning from their surgeons that they could cause gynecomastia recurrence.

 

  • Preoperative weight is stable for at least six months

 

Prior to surgery, the patient must be near his ideal weight, which he is able to maintain for a minimum of six months. Should male breast reduction for men is attempted despite weight fluctuations, the results are almost always less than optimal.

 

Also, significant weight gain and loss after surgery can affect if not completely reverse its results, according to experts at California Surgical Institute.

 

  • Long-term weight management

 

Long-term weight management is only possible through regular exercise and proper diet. No diet trend or unsustainable or unrealistic exercise routine can accomplish this; they only serve as a temporary fix.

 

Some patients, particularly massive weight loss patients, will need medical supervision (i.e., nutritionists and bariatric doctors) to help them stick to their long-term weight management.

 

  • Wait at least 2-3 years after the onset of gynecomastia

 

Gynecomastia is not uncommon during puberty stage and will most likely resolve on its own (about 90 percent). For this reason, the consensus is to wait at least 2-3 years before any surgery is attempted.

 

Performing breast reduction “too early” may result in tissue regrowth and possible revision in the future.

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Oftentimes, breast reduction and areola reduction are performed simultaneously to achieve a more balanced appearance. This is particularly true for patients who require significant downsizing of her “cup size,” explains leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

While breast reduction surgery comes in various incision patterns, all of them share one thing: They use incisions around the areola’s perimeter.

 

breast reduction and areola reduction

Before-and-After Photos of a Satisfied Patient Who Have Had Breast Reduction and Areola Reduction

 

And with or without areola reduction, the resulting scar around the areola must precisely lie at the dark and light skin junction for its optimal concealment.

 

To ensure that both areolas would have the same dimension and size, Dr. Smiley says he uses a round “cookie cutter” to guide him during surgery.

 

In the past, breast reduction surgeries were only accomplished with the use of an anchor technique; it has a scar that runs around the areola’s perimeter, a vertical scar along the midline of the lower breast pole, and a horizontal scar adjacent to the submammary fold.

 

While the standard or anchor breast reduction technique is still used today, it is only reserved for patients who require a drastic downsize.

 

A modified form of breast lift eliminates the submammary fold incision, which takes the longest time to heal. Referred to as lollipop technique due to the shape of the resulting scar (i.e., around the areola’s perimeter and a vertical scar), it results in less scar and shorter downtime.

 

Aside from reducing the “cup size,” the lollipop lift is also noted for its narrowing effect, hence it is ideal for patients with markedly wide breasts.

 

Dr. Smiley says he always incorporates breast lift when performing breast reduction, both of which share the same incision patterns thus additional scars are avoided.

 

The final position of the areola (starting from its lower border) is ideally 2 cm above the submammary fold to achieve a perkier, more balanced appearance. Aside from proper placement, Dr. Smiley says that the actual tissue must be reshaped and lifted to achieve long-lasting results.

 

The results of breast reduction and areola reduction are near permanent provided that the patient maintains a stable healthy weight and avoids pregnancy after surgery, explains Dr. Smiley.

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The breast reduction scars healing time is one of the most common concerns of patients. It is important to note that recovery varies from person to person, although most can expect that by three weeks their wound is mostly healed.

 

Scar is the body’s natural response to repair what has been injured, damaged, or cut; it serves as a glue that holds the tissue layers back together. Nonetheless, all efforts are made to prevent it from becoming raised and thick (keloids and hypertrophic scars).

 

breast reduction scars healing time

 

Leading Orange County plastic surgery expert Dr. Tarick Smiley says that scar placement and wound closure would play a critical role on how visible or well concealed the scars are.

 

Most breast reduction scars are placed around the areola’s border and adjacent to the breast crease for their optimal concealment. However, the vertical scar between the nipple area and the natural fold has a more visible location, which expectedly concerns most patients.

 

Despite the more obvious location of the vertical scar, proper wound closure in which there is very little tension on the skin, allows it to heal and fade better, says Dr. Smiley.

 

Dr. Smiley highlights the importance of a proactive approach in scar management; hence, he recommends the use of silicone sheets and other similar modalities once the wound is completely healed, which happens around three weeks.

 

The use of medical-grade compression garments or supportive bra is also known to reduce tension on the wound, ultimately prompting the scar to remain thin and faded.

 

To further promote favorable scars, the renowned surgeon says any factors that contribute to increased risk of bleeding and infection must be eliminated or at least controlled prior to surgery. Smoking, aspirin and other drugs known to increase bleeding, and uncontrolled hypertension are closely tied to poor healing and unfavorable scarring.

 

However, avoiding tobacco products and aspirin (and other medications with similar effects) well in advance of the surgery can lower the risk of poor healing and aggressive scarring.

 

Should the scar remain thick and unsightly, Dr. Smiley recommends steroid injections, certain types of laser treatments, and scar revision, which is viewed as the last resort because it requires additional incisions (and of course, another risk of adverse scarring).

 

Breast reduction scars healing time (i.e., full maturity) can take 1-2 years, so they should not be exposed to the sun. Studies have shown that UV rays cause slow healing, hyperpigmentation (scars becoming permanently dark), and irritation.

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Breast reduction and tummy tuck surgery are often performed simultaneously to address the major physical changes caused by pregnancy and weight loss. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate how this combo procedure is accomplished.

 

The patient shown in the video had two cosmetic problems: large pendulous breasts and saggy abdomen aggravated by the appearance of stretch marks, large navel, and redundant skin.

 

breast reduction and tummy tuck surgery

While breast reduction and tummy tuck surgery are routinely performed together, Dr. Smiley says the combo procedure is only reserved for healthy, normal weight patients due to the “intense” recovery. To further make it a reasonably safe endeavor, he says that the operative time is ideally less than six hours.

 

The patient first underwent tummy tuck in which Dr. Smiley created a hip-to-hip scar positioned very close to the pubic region so she could wear a two-piece bikini without any visible reminder of plastic surgery.

 

The hip-to-hip incisions technique not only allowed Dr. Smiley to remove large amounts of redundant skin, but also gave him sufficient access to repair the weak abdominal muscle. He tightened the pair of muscles in the midline using permanent sutures to create a more natural contour.

 

After repairing the weak or splayed abdominal muscle and removing the excess skin, he draped the now tighter skin over the navel (which remained attach to its “stalk” or blood supply) and created its new opening. All the scars are within the belly button’s inner rim for their optimal concealment, says Dr. Smiley.

 

After completing tummy tuck, the renowned surgeon proceeded with breast reduction with lift.

 

Dr. Smiley believes that it makes sense to always incorporate breast lift when breast reduction is performed because the two surgeries share the same incision sites; hence there is really no additional scar.

 

Dr. Smiley says that breast reduction usually involves the removal of large amounts of skin, in addition to the excess glandular tissue. During surgery, he made sure that the areola complex remained attached to its blood supply to minimize risk of numbness and other sensation-related problems.

 

The resulting scars from breast reduction are mostly hidden: They are within the areola’s border and adjacent to the submammary fold. The vertical scar (between the nipple area and the breast crease, so its location is more visible), meanwhile, generally fades well with the surrounding skin, he says.

 

And with a smaller breast size, Dr. Smiley repositioned the patient’s areola complex in a way that there was a decent distance between this “focal point” and the submammary fold.

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Scarless breast reduction generally refers to a liposuction-alone procedure in which the overlarge breasts are made smaller by removing the excess fat. Mammogram prior to surgery is critical to evaluate the proportion of fat [and the glandular tissue as well] in the breasts to see if the patient can benefit from it.

 

However, liposuction can produce no or very little improvement should the overlarge breasts are mainly compromised of glandular tissue, which is extremely dense that the only way to remove it is through direct excisions (with the use of scalpel, as opposed to a cannula or suction tube).

 

scarless breast reduction

Liposuction uses a cannula that can fit into a 1.5 mm round incision that typically fades into imperceptible scar after 6-12 months. To further hide any “reminder” of surgery, renowned Los Angeles plastic surgeon Dr. Tarick Smiley says that incision placement will also play a critical role.

 

In scarless breast reduction via liposuction, he says the “puncture holes” are typically positioned in the armpit, on the underside of the breast (about 2 cm above the natural crease), and within the areola’s perimeter (specifically at the junction where the darker skin meets the lighter skin) to further hide the reminders of surgery.

 

The standard liposuction technique, aka tumescent approach, is ideal for treating the highly fibrous breast fat. It involves injecting a solution into the fatty area containing epinephrine to decrease bleeding, lidocaine which is a type of local anesthesia, and saline (sterile saltwater), and then waiting for at least 10 minutes to take its full effects.

 

Properly marking the patient in an upright position is critical to avoid the danger zone—i.e., the area between the clavicle and the beginning of the breast tissue.

 

When the patient lies on the operating table, some of the breast tissue will “spill” to the so-called danger zone. But with proper markings, the surgeon can avoid this highly perforated area.

 

Contrary to popular belief, liposuction is not all about removing the optimal amount of fat; this is particularly true for scarless breast reduction in which a good surgeon should also make an effort to produce a more symmetric appearance, and to avoid skin asymmetries and sagging appearance.

 

Sagging after breast liposuction occurs when the patient has poor skin shrinkage to begin with and/or the surgeon removes too much fat without taking into account the skin’s inherent elasticity.

 

However, patients with a decent amount of skin elasticity might even expect some improvement in the “perkiness” of their breasts. Because they are smaller and lighter, it may be safe to surmise that they are less susceptible to the effects of gravity.

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