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PS is Resistant to my Size Request...Why?

I am a size 38 DDD/F. I would love to be a large C to a medium D. My PS insists upon a size D/DD. I was a DD before I had my son, and I do not want to be so large. The decreased weight in my chest will allow me to exercise without pain. Therefore, I plan to lose weight after my surgery. I do not tend to lose weight in my chest. Even when I lost weight and became a size 6, my breast remained at a DD. Are there any reasons that my breast have to remain larger?

Doctor Answers (14)

Cup size after breast reduction

+4

A D-DD cup size is, in my opinion, too large to reduce the neck, shoulder and back pain resulting from overly large breasts.  This may be a communication issue so I would encourage you to discuss sizing with your plastic surgeon. If your surgery has been improved by an insurer, it will require removal of a minimum number of grams per breast (commonly 500 at minimum).  The surgeon has discretion as to how small to make the breasts and there should be a meeting of the minds between patient and surgeon as to the desired result. 


New York Plastic Surgeon
5.0 out of 5 stars 11 reviews

Cup Size After Breast Reduction

+2

I NEVER discuss cup size with patients.  The reason is that different manufacturers use different algorithms to determine cup size.  So while you may be a DDD in one, you may be an F or DD in others.  So no surgeon can gurantee cup size and frankly shouldn't be discussing cup size.

If you were my patient and you told me you wanted to be a full C/small D I would understand that to mean you wanted your breasts to be proportionate with your body.  I feel that it is more realistic to discuss proportion than cup size.  I encourage my patients to either visit with me, call or email with their concerns, as much as they desire, before surgery.  It's very important that the patient and surgeon be on the same page prior to surgery.  If your surgeon isn't willing to spend the time with you then find one who will.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 17 reviews

Size after breast reduction

+2

As my colleagues have said, it is impossible to exactly predict breast size after breast reduction. More important than size, however, it sounds like you and your plastic surgeon are not communicating well and cannot agree on the goals of surgery for you. It is important for you to have confidence in your surgeon and it is important for your surgeon to understand and agree with your goals. Sometimes compromise is necessary so that your goals are realistic and something your surgeon feels reasonably able to achieve. But if you and your surgeon don't agree, the likelihood of an unsatisfactory outcome--both for you and your surgeon--is very high. So make sure you and your surgeon agree and if necessary, see another surgeon with whom you feel more comfortable. Good luck.

Margaret Skiles, MD
Sacramento Plastic Surgeon
3.5 out of 5 stars 10 reviews

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See another doctor.

+2
Sounds like you need a second opinion. I am sure the doctor you saw had his reasons. Maybe you need a second opinion.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

Cup size not perfectly predictable with breast reduction

+2

We are unfortunately stuck with an imperfect system for measuring breast size, because the cup is determined as much by the size and dimensions of the chest as it is by the actual volume of the breasts. In your case it may be a matter of communication rather than refusal by your plastic surgeon to go to a certain cup size. Over-reducing tends to result in flat and unnatural-appearing breasts, so your plastic surgeon may be hesitant to go too far for that reason, or it may simply not be possible to go to less than a certain size because of your chest wall shape.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 23 reviews

Breast Size After Breast Reduction?

+2

Thank you for the question. Congratulations on your decision to proceed with a breast reduction procedure; it is one of the most patient pleasing operations we perform. I think you  will also  be wise to lose any plan to wait prior to your surgery if at all possible.

Unfortunately, there is no direct correlation between the amount of tissue removed and the ultimate cup size that a patient will wear after breast reduction surgery.  In other words, it will be very hard for your surgeon to predict the exact cup size you'll be after the breast reduction procedure.

Before undergoing the breast reduction procedure it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

The concern with the amount of tissue removed is related to blood flow to the remaining tissue;  if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola)  may be compromised.   Part of the tissue that is left in place is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible)  then patient will likely have problems with tissue survival.   

The other concern with overly aggressive breast reduction surgery is patient dissatisfaction  afterwards.  It is not unusual for patients who have lived with very large breasts to want to have as much as possible removed. Care must be taken to be judicious in this removal to avoid an outcome where the breasts  are too small in relation (proportionately) to the patient's other body parts.  Again, it is not uncommon, for patients'  breasts to become smaller ( after the breast reduction procedure) with time and/or weight loss-  breast augmentation may become necessary to achieve the patient size goals.
 

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 722 reviews

Can a patient request a specific cup size for breast reduction?

+1

The answere is yes and no.  The breast size should be relatively balanced with the patients over all size.  A cup size larger is usually easier to do than making a patient smaller than the anatomy will allow.  Excessive reduction leads to dissatisfaction and the likelihood for secondary surgery including implant placement.  Remember, you can get a second opinon to better understand the risks, and possible outcome of your surgery as performed by the doctor you have selected. 

H. Michael Roark, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 5 reviews

Miscommunication

+1

I believe there is a miscommunication.   You really can only design a pedicled reduction, by the book.  O sure there can be parameters we can reach with regard to more off the pedicle or less but ultimately, we need to leave enough tissue to keep the nipple alive.   Predicting or guaranteeing a size is challenging as it isn't predictable as you have already read.    Consult a Plastic Surgeon you feel understands you and explains to you what the procedure can and cannot do, and you will be ready to accept the result it delivers.  Hope this helps.
 

Alan Weiss, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 1 review

Size requests and breast reduction surgery

+1

Hello,

Breast reduction surgery utilizes calculated geometric designs to attempt to preserve blood flow to the tissues. Making the breasts smaller than a certain limit tends to compromise blood flow and wound healing. This is likely the reasoning behind your surgeon's reluctance to go as small as you desire.

 

On the weight loss, try to get to a weight that you can maintain after surgery beforehand. This will make changes after surgery less likely. Results change with weight fluctuations after surgery beyond a certain point.

 

Best Regards,

 

John Di Saia MD

 

 

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

Breast size after a breast reduction

+1

In most cases the breasts can be reduced to a C or D cup.  I would have to examine you to know if there was a specific reason your surgeon thought you could only go down to a D/DD.  If your breast tissue is very dense and a large amount of tissue volume is necessary to provide blood supply to the nipple, you may need to stay on the fuller side. Also there is a difference in appearance in a DD perky and lifted than a DD that is very saggy and hanging on your chest.   I would discuss your concerns with your doctor and review his before and after photos to see what he thinks a D/DD looks like.  If you are still uncertain you may want to get a second opinion.

Marialyn Sardo, MD
La Jolla Plastic Surgeon
5.0 out of 5 stars 3 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.