Breast reduction surgery is not just about “cosmetic” downsizing. For many patients, the procedure is also performed to provide immediate relief from chronic back and neck pain, rounded shoulder, postural problem, and systemic discomfort brought upon by breasts that are too heavy and large for their body frame.
Nevertheless, leading Inland Empire plastic surgery expert Dr. Tarick Smaili says it remains important to deliver the aesthetic goals of patients, which is almost always possible if certain variables are taken into account.
The list below tackles the 4 ways to achieve best results from breast reduction surgery, as explained by Dr. Smaili.
1. Achieve stable weight. This is always a prerequisite with any type of body contouring surgery in an attempt to achieve highly predictable and near permanent results. Also, normal weight individuals are less likely to encounter healing problems, wound dehiscence, poor scarring, infection, delayed recovery, and breast tissue regrowth than obese patients.
2. Use customized incision pattern. Despite the appeal of short-scar or minimally invasive breast reduction techniques, forcing them on women who need the most correction—i.e., drastic downsizing—will almost always result in poorly shaped breast, scar migration or overall poor scarring, and/or asymmetry.
The celebrity Inland Empire plastic surgery says any type of breast surgery is a highly customized procedure due to different anatomies, risk factors, and motives and expectations of patients.
3. Proper patient selection. Aside from being healthy, a good candidate for breast reduction should have motives that are reasonable and she understands not just the benefits but also the tradeoffs, such as the appearance of scars. To achieve satisfying results, both patients and doctors should have the same goals.
A prudent plastic surgeon will always explain the risks and inevitable tradeoffs one should accept, and the realistic goals and limitations of the surgery as well.
4. Consider tissue regrowth. After surgery, the breast will continue to change due to aging, pregnancy, weight gain/loss, menopause, and other factors. While revision surgery to address significant regrowth is quite rare, many surgeons explain to their patients the benefits of going smaller than intended.
However, the risk of “considerable” tissue regrowth can be minimized by performing breast reduction on patients who are at least in their early twenties, a stage when the breast size is most likely to have stabilized. While this “age requirement” is a standard, some women may have to undergo surgery sooner than ideal so they could enjoy a more normal life.
Body contouring surgery such as breast augmentation, liposuction, and tummy tuck is only reserved for patients who are near their ideal weight, or at least within 25 percent of their recommended weight.
Meanwhile, obese individuals—whose body mass index is 30 and higher—are considered poor candidates for body contouring surgery and other forms of elective procedures because of the higher risk of complication, as suggested by Orange County plastic surgery experts.
The list below shows why obesity is a contraindication to body contouring surgery.
* Poor cosmetic results. In general, plastic surgery to contour one’s body only works on the saggy skin and superficial fat (close to the skin; not the deeper visceral fat linked to obesity). This makes obese individuals inherently poor candidates for this procedure.
Even people whose weight fluctuates to a significant degree are bad candidates for body contouring because just gaining more than 15 lbs. could reverse its effects. For this reason, one’s discipline to stick to healthy and “realistic” diet and regular exercise is just as important as his or her actual weight.
Even in breast implant surgery, weight management plays a crucial role in the long-term results. Patients should realize that weight fluctuations could lead to higher risk of bottoming out or sagging, palpability, and visible rippling.
Also, using overlarge implants just to compensate for the large body-frame of obese patients can lead to short- and long-term complications such as prolonged recovery, bottomed-out appearance, rippling, and skin thinning.
* More follow-up cost. A recent study published in the Plastic and Reconstructive Surgery journal has shown that obese patients were 35 percent more likely to have hospital or emergency department admission within 30 days of surgery compared with non-obese individuals.
The cost difference was staggering: an average of additional $7,400 after breast reduction, $3,900 after liposuction, and $7,100 after tummy tuck.
* Higher risk of postop complication. The higher cost of care is attributed to the higher risk of complications, as obese patients are about 12 times more likely to suffer from a healing problem after elective plastic surgery than their normal-weight counterparts, according to a study conducted by scientists from Johns Hopkins University School of Medicine.
Experts believe their susceptibility to infection and wound healing problem stem from their poorly vascularized body because of their high body fat percentage.
* Reversal of results. Significant weight fluctuations can reverse the results of tummy tuck, breast enhancement surgery, liposuction, lower body lift, and arm lift. The same is true of facelift in which excess skin could reappear if one is unable to maintain a healthy weight.
Breast enhancement surgery may involve the use of breast implants, correction of drooping appearance, and reduction of breasts which are way too big relative to the patient’s body frame.
The most popular breast enhancement surgery today is breast augmentation, which is performed with the use of saline or silicone implants. And with a bigger bust size, take note that it is more important than ever to use the right kind of bra that can “distribute” the weight of the breasts through its thick band.
Breast lift, meanwhile, does not also eliminate the need for a good fitting bra. While the surgery lifts and tightens the saggy tissue and repositions the low-lying nipple, the breast still remains susceptible to the effects of aging and gravity. The same also applies to breast reduction patients.
According to one survey, up to 85 percent of women are wearing the wrong bra size—i.e., ill-fitting cup and band that is too tight or too loose.
Also, some experts suggest that going braless could lead to breast ptosis or sagging because its “weight” causes the ligaments to weaken over time, thus using the right kind of bra is crucial to maintain its perkiness. Nevertheless, this “theory” is still up for debate.
Aside from potentially preventing or at least postponing breast ptosis, remember that a good fitting bra promotes good posture and allows you to perform exercise without discomfort. This reason alone is enough for many experts to emphasize the importance of this undergarment.
Workout bras are particularly important because they are said to prevent or limit the stretching of the ligaments every time the breast bounces. When choosing a design, select something that pushes the breasts back rather than lifts them, and has elastic fabric that beautifully conforms to your body.
And while you can wear push-up bra every now and then, most experts agree that you should not treat them as an “every day” bra.
A good rule of thumb is to choose a bra that lies firmly against the rib cage so the weight of the breast is distributed across the chest by the band. In addition, the cup should cover the entire breast mound for an additional support.
Some experts recommend buying a new set of bras every six months to make sure they remain good fitting and provide the right amount of support and “comfort.” While you might find this recommendation rather strict, just remember that a 10 percent weight loss/gain in general results in change in one cup size.
Any type of breast enhancement surgery uses incisions that could disturb nipple sensation, which may lead to hypersensitivity or partial/complete numbness. However, the vast majority of patients regain normal “feeling” within three to six months due to reinnervation, a process in which the body spontaneously restores the nerve supply after it has been lost.
Breast surgery expert Dr. Tarick Smaili of the California Surgical Institute says that there are ways to avoid or at least minimize the risk of sensation-related problem, and oftentimes they involve a more “conservative” approach.
In breast augmentation surgery, which uses saline or silicone implants, Dr. Smaili says that persistent hypo- or hyper-sensitivity rarely occurs because it only uses small incisions. To further minimize such risk, the renowned plastic surgeon recommends using the inframammary crease, trans-axillary or armpit, or navel as an incision site rather than the areola.
But in breast lift and breast reduction surgeries, which involve more skin excisions and often require repositioning the nipple-areola complex, the problem is relatively more common, explains Dr. Smaili.
According to some anecdotal reports, the rate of sensation changes (increased, decreased, or loss) following a breast enhancement surgery is around 7 percent. Although, this is extremely rare in breast augmentation as long as it uses implants on the “smaller side” or at least within the margin of underlying anatomy, especially in terms of breast and chest measurement.
While partial loss of sensation is not uncommon after an extensive breast reduction surgery, this is rarely a cause for concern of many patients because their overlarge breasts often sensitivity in the first place. Also, the vast majority of them are more focused on finding relief from back pain, spinal curvature, rounded shoulders, and “mobility issue” due to their condition.
To encourage normal sensation to return sooner, Dr. Smaili is an advocate of breast massage, which often starts five to seven days after surgery. This is particularly important after breast implant surgery to prevent the scar capsule, which normally forms around any implanted device, to become too rigid and thick.
By keeping the scar capsule around the implants soft and flexible, the renowned plastic surgeon says the risk of capsular contracture is greatly diminished.
During first attempts, breast massage could lead to some discomfort since even a light touch could result in some “needle-like piercing sensation,” which Dr. Smaili describes as a good sign that sensation is gradually returning to normal.
Breast enhancement surgery such as mastopexy and breast augmentation is supposed to provide results that look not just attractive but also natural and proportionate to the body frame.
But what is the ideal breast appearance and shape?
A recent study published in the September issue of Plastic and Reconstructive Surgery journal has suggested that the “perfect breast shape” is having an “upper pole to lower pole ratio of 45:55.”
The British researchers came up with the findings after conducting a survey involving more than 1,300 respondents who were asked to rank the attractiveness of the breasts images that were altered using Photoshop.
The researchers used photos of breasts of various sizes and proportions, which were digitally altered to have ratios of 36:65, 45:55, 50:50, and 55:45. The nipple area was the dividing line between the upper and lower poles.
The vast majority of respondents chose the 45:55 ratio as the “ideal breast proportion” in which 45 percent of the breast mound was above the nipple level and 55 percent was below it.
The respondents were categorized into groups based on age, gender, and ethnicity. The study also included 53 plastic surgeons.
Despite the demographic differences, the results were consistent, with 94 percent of plastic surgeons, 90 percent of men, and 87 percent of women in their thirties favoring the 45:55 ratio.
All the racial groups also favored the 45:55 ratio, while the 50:50 ratio came as a distant second choice.
But the researchers noticed that women over 40 were less likely to choose the 45:55 ratio than their younger counterpart (76 percent vs. 86 percent), concluding that the “more mature group” favored more fullness in the upper breast poles because it could be a “reflection of their own loss of projection.”
The findings have disproved the common belief about men preferring the “oversized or fake” look.
The researchers believe the findings will help plastic surgeons plan their surgeries, particularly breast augmentation in which implants are used to increase the bust size and/or correct the deflated upper poles.
They also believe the results can serve as an “aesthetic template” not just in breast augmentation but also in mastopexy or breast lift, breast reconstruction, and breast reduction.
In a statement, the researchers said the “desire for an overfilled and oversized [breast] look” of some women has more to do with how they would look in clothing, rather than achieving a natural breast proportion.