Kyle A. Belek, MD

Hi DoNMe.  Thank you for your question.  In my opinion, your request is very reasonable.  As long as you are otherwise healthy, these procedures are very safe and can be very rewarding.  Generally speaking, I like to really understand what it is that people are looking for during the initial consultation. A Mommy Makeover can mean different things to different people.  Rejuvenation of the breasts and abdomen as well any other areas of the torso that are troublesome can require extra materials (breast implants, fat grafting devices, etc.), different procedures (liposuction versus a full tummy tuck),as well as extra time in the operating room (extra facility fees and anaesthesia fees) make giving an exact price difficult.  Combined breast and body procedures can range anywhere from $8,000 to the $20,000 range.  These procedures are always performed under general anaesthesia in my practice and as an outpatient (you go home or to a hotel with a caregiver the same day) if you are otherwise healthy.  If you are traveling from out of town, there are several hotels in the Bay Area where we have negotiated reduced rates so that people can recover comfortably and affordably.  Antibiotics (Keflex usually) are provided while drains are in place (usually 3-7 days).  As far as recovery is concerned, I have found that people recover from the breast portion more quickly than the abdominal procedures.  As a rough estimate, people seem to "turn the corner" and be feeling pretty well at about two weeks and back to full activities in six weeks.  Swelling postoperatively is extremely variable and final results can take up to a year to achieve.  You are absolutely right about people with darker complexions having a higher likelihood of developing hypertrophic scars or keloids.  I have a large experience taking care of people with darker skin.  While these risks cannot be totally negated, there are some things that can be done intraoperatively as well as in the postoperative period that seem to help significantly.  I hope this helps.  If you have any other questions please feel free to ask.  Sincerely,Kyle Belek

Thank you for your question.  The single most useful question I have found to ask people in your situation is: "In a bra, are you happy with the size of your breasts?".  Depending on your answer, that will help us decide what the best procedure is for you to undergo.  If you say that you're happy with your size in a bra then that leads me to talk more about a mastopexy or "breast lift" with you.  It may be the sagging of the breasts and the position of the nipples that really bothers you.  If you tell me that you would like to be larger than you currently are even in a bra then a lift and a small implant may be reasonable.  On the other hand, occasionally people even say that they wouldn't mind being smaller than their current size but would just like their nipples in a higher location.  This is someone who could benefit from a reduction.  Either way, in order to provide you with the best long term results, I think that using a short scar "lollipop incision" technique using the glandular breast tissue for support as opposed to relying on the skin for strength would both decrease the overall scar burden and provide excellent long lasting results.  I hope this helps.  
Sincerely,
Kyle Belek

Thank you for your question.  The cost of breast reduction can vary from very little in the way of out of pocket expenses, with insurance covering the majority of the costs, to as high as approximately $10,000 to $15,000 if there are no insurance benefits available.  Generally speaking, there are three costs associated with any surgery.  

The first cost is the facility fee.  The facility is the actual location where the surgery will be performed.  This may be a hospital, outpatient facility or private operating room.  The costs associated with these locations range from being very expensive at many hospitals to much more reasonable at outpatient facilities and private offices.  I try to give people an idea of what each cost is.  Make sure that wherever you have your procedure that you verify that the facility is "accredited".  Some common accrediting organizations are "Medicare Approved", "JCAHO Approved" or "AAAASF Approved".  There are other legitimate accrediting agencies as well.  Facilities with any of these accreditations are heavily monitored and scrutinized by the state and the Federal government and are generally safe.  Please ask this question if you are considering having surgery in a private office or some place where there is no obvious hospital affiliation.  These costs are rigid but should be very transparent based on the amount of time needed for the surgery.  

The second cost is the anaesthesia fee.  Again, these fees vary based on geographic location as well as who is performing the anaesthesia for the procedure.  You should make sure that your anaesthesiologist is Board Certified by the American Board of Anaesthesia.  There are now C.R.N.A.'s (Certified Registered Nurse Anesthetists) who are responsible for the anaesthesia being performed at certain facilities.  Use of C.R.N.A.'s is certainly within the scope of practice.  Again, C.R.N.A.'s are not M.D.'s.  However, they have undergone appropriate training and have specific certification requirements through the National Board of Certification and Recertification for Nurse Anesthetists that you may ask your surgeon about and verify on-line.  I have worked with many C.R.N.A.'s in the past and have been very impressed with their abilities.  That being said, the anaesthesia fee is also very regimented and is based on the amount of time needed to perform the case.

The third cost is the surgeon fee.  You will see these fees range from very low ($1,000 to $2,000) to as high as $10,000 to $15,000.  This is a fee which is set by each individual surgeon's practice and is not always set in stone.  The best advice that I can give regarding this last piece of the cost of surgery is to look at credentials and go with your gut feeling about the provider.  If the deal seems to good to be true it probably is.  I have taken care of a number of people who have had unfortunate outcomes just to save a few thousand dollars.  Meet with the surgeon and ask questions.  Ask about Board Certification.  Make sure that the surgeon is certified by The American Board of Plastic Surgery and that he or she is in good standing with the Board.  The process of getting Board Certified by The American Board of Plastic Surgery is long and very difficult.  Please do not be fooled by other "Board Certifications".  There are many Boards that sound very legitimate but can be obtained with little to no training and little knowledge of the field and practice of plastic surgery.

In summary, the cost of breast reduction varies greatly for the reasons described above,  If you find a Board Certified plastic surgeon with whom you feel comfortable and have your surgery performed in an accredited facility by a licensed, Certified anaesthesia provider you are giving yourself the opportunity for the safest and most ideal outcome possible.  The people in my practice who have undergone breast reductions are the happiest people in my practice.  To me, talking with them after their surgeries and hearing how their lives have changed for the better is the best part of the process.  If you have further questions please do not hesitate to ask.  Thank you for your time and I hope this helps.   

Kyle Belek, M.D.