Nicholas Leonardi, DO

Based on the images provided and assuming both breasts are soft and symmetric, everything looks as expected early in the course of breast reduction recovery.  There are two opposing forces at hand for this procedure:  tightening the skin envelope while preserving an appropriate amount of breast volume suitable to your frame.  For the first several months after Wise pattern skin resection, the lower pole of the breast is designed to appear flatter with a full upper breast pole (think upside down breast).  This will round out with time due to gravity effects giving a more natural breast appearance.  The lateral breast fullness typically is due to the remaining breast tissue falling off to the side where most of the breast tissue was likely removed.  This evens out over several weeks and swelling will subside as well. Of course, have your surgeon evaluate you in person to ensure that the fullness on the side is not a small seroma (fluid collection).

The number of grafts needed depends on a number of factors like the density of the hair (follicular units per square centimeter), hair color, and recipient site location.  Hair density varies across the scalp and certain areas benefit from single or multiple hair units.  A general guideline is that it takes approximately 2000 grafts to cover an area the size of a compact disc (think crown of scalp).  To restore a receding hairline and widow's peak area may only take 1000-1500 grafts.  I prioritize frontal forelock restoration where you will get the most mileage out of the grafts.

Hi there,

Assuming normal wound healing, most surgeons will be comfortable with removing all activity and undergarment restrictions at 6 weeks postop.  You should be able to carry baby however you like.  Hope this helps and enjoy your vacation!

Regards,

Nick Leonardi

Hi shygirl161,

You do look like you would qualify for an insurance covered breast reduction and would be a good candidate assuming you are otherwise healthy.  Many insurance providers use the Schnur Scale to determine the minimum amount of breast tissue to be removed to qualify.  I estimate this to be at least 550 grams per breast for you.  Additionally, insurance carriers use some of the following criteria (which it appears you have met):

Two or more of the following clinical indications have been present for at least 12
months which have failed to respond to appropriate conservative therapy :
1. Pain in the upper back, neck, shoulders, and/or arms, which must be of longstanding
duration and increasing intensity as documented in the medical records
by the referring physician or provider (e.g. primary care MD or chiropractor).
• This pain should be evaluated to determine that it is not associated with
another diagnosis such as arthritis.
• Pain is not relieved by at least three months of conservative therapy such as
an appropriate support bra with wide straps, exercises, heat/cold treatments
and appropriate non-steroidal anti-inflammatory agents/muscle relaxants.
2. Dermatitis of the shoulder or shoulder grooving not responding to at least three
months of conservative treatment including a support bra or appropriate
dermatologic treatments, (e.g. taking steps to eliminate friction, heat, and
maceration by keeping skin cool and dry and where appropriate, topical agents).
3. Intertrigo between the pendulous breasts and the chest wall persisting despite at
least three months of conservative dermatologic treatments (e.g. taking steps to
eliminate friction, heat, and maceration by keeping skin cool and dry and where
appropriate, antimycotic agents).
4. Kyphosis documented by x-ray.
5. Ulnar paresthesia not relieved by at least three months of conservative therapy
such as an appropriate support bra with wide straps, range of motion exercises,
physical therapy, and appropriate non-steroidal anti-inflammatory agents/muscle
relaxants.

While it is great that you keep notes, the only thing that you might need to obtain is about 6-12 months of medical records demonstrating the above indications for surgical treatment of your symptomatic macromastia.  Once you have this, your surgeon will submit records/pictures along with a letter seeking authorization.  

Best wishes!

This is probably a stitch abscess or suture granuloma.  It is a foreign body reaction to (likely) absorbable suture material.  The suture typically works its way to the surface, but your surgeon can remove it or revise this portion of the incision if it persists and doesn't surface.

Best wishes!