Edward Daniele, MD

If you only want to go down one cup size and wish for more upper pole fullness, a mastopexy or breast lift would be a better option. During this, plastic surgeons remove mostly skin and a small amount of breast tissue to reshape the breasts. Depending on the amount of lift needed, an implant may be delayed to a second stage 2-3 months after the first surgery to preserve the blood supply to your nipples.
Another option for more superior pole fullness during the time of a breast lift or reduction is performing fat grafting. This is where we harvest fat using liposuction and then inject it into another area of the body. Generally, about 50% of the fat transferred melts away and 50% stays in place.

Plastic surgeons will require a mammogram before performing a breast lift usually if the patient is older than 40 or has a family history of breast cancer. Mammograms are the best thing we have to screen for breast cancer and an ultrasound screening method is most likely not enough. When we perform a breast lift, we manipulate the breast tissue so it is really important to have a baseline visual of what is going on in both breasts for oncologic reasons.

You should be okay to have the colonoscopy first. If you have your breast surgery and nose surgery first, during the colonoscopy they could move you and reposition you in positions that would put too much pressure on the implants or face. Discuss with your surgeon regarding the timing and anesthesia. For a colonoscopy they should only use MAC (IV sedation), so you should be okay to undergo general anesthesia that soon after.

Your piercing should remain in place even after your breast reduction surgery. There can be nipple sensitivity changes especially in the initial postoperative course. During the procedure the nipple and areola is repositioned. The piercing should not be affected.

A breast reduction is your best option to reduce the size and shape. Generally speaking, insurance should be able to cover it with back pain, discomfort, and bra strap grooving. If you do not want as much removed as the schnur scale would recommend, the only option would be to perform a cosmetic mastopexy/reduction.