Robert Cohen, MD

Hello! While losing weight for health is a good idea in general, studies of patients with higher BMIs have shown that breast reduction for patients suffering with back and neck discomfort is still helpful, and can actually facilitate further weight loss as patients can exercise more easily with smaller breasts. Because of that, I would encourage you to seek breast reduction sooner than later, and simply continue to practice a healthy diet and exercise routine throughout the process.

Breast reduction is one of the few “aesthetic” procedures that is acceptable to perform on patients under 18 years old. This is because large, heavy breasts create a lot of problems such back, neck and shoulder pain, difficulty fitting into clothes properly, and they can attract unwanted attention. Heavy, droopy breasts will almost always get worse over time, so fixing the issue early is usually a great option when possible. Make sure you find a highly qualified surgeon who demonstrates lots of good before and after photos on their website as having the surgery done right in the first place is the key to success. Best, -RC

Hi there- so if you are downsizing from a DD to an A cup, there will be a lot less tissue for gravity to work on so re-drooping won’t be much of an issue. If a superomedial pedicle technique is used (where the upper/middle breast tissue is maintained with the nipple connected and the excess lower and outer breast tissue is removed) the breast will be naturally fuller where it needs to be. I have performed over 1000 reductions and do not routinely fix the breast tissue to the underlying connective tissue as I don’t think this makes much of a difference long term when the surgery is performed properly and a superomedial (as opposed to an inferior / lower breast tissue) pedicle is used.

Hi! You absolutely have more room for improvement in your breasts as they still seem large for your frame and seem to have a fair degree of redrooping. I would recommend a full redo breast reduction with more tissue removal from the lower and outer breast and significant skin tightening which will allow revision of all your scars. Size can be determined by showing photos of what you like proportion-wise based on other breast reduction surgery photos (see my photo gallery as an example). Revision reduction is more challenging and has a few more risks than first time reduction , so make sure you find a surgeon experienced in this type of procedure! Best, -RC

If you have large breasts (DDD would definitely fit that!) and are having back, neck or shoulder issues, a breast reduction will significantly relieve or eliminate those issues. As you get older, the problems often worsen, so I would recommend looking into surgery sooner than later as my older patients who have this feel so much better and almost always wonder why they didn’t do it sooner!

Combining upper pole fat grafting with breast lift surgery is a very common way to create the best possible result without the use of an implant. I would suggest that the best surgical option would be a one stage technique. To avoid asymmetry, the breasts are lifted first and the larger breast is reduced to match the size of the smaller breast. After this, an even amount of fat is injected into each breast. In my opinion, this is the most effective and efficient way to perform the surgery with the minimum amount of long term asymmetry. Hope that helps! -RC

Based on your photos, it appears you have underlying scar tissue that is tethered to the skin and becomes tighter / worse with arm elevation. Fat grafting would likely soften some of these issues, and if combined with a breast lift you would likely get an even more powerful correction. Trying to soften the scar tissue with stretching and steroid injections could be potentially helpful as well, but obviously any recommendations would need to be verified with an in-person exam. Hopefully this information can help get the process started though. Best, -RC

There is not one right answer for what is proportionate, and patients will have a wide range of what they find attractive and aesthetic with regards to breast size. Some patients prefer to remain on the fuller side while others wish to be as small as possible. You should look through a lot of surgical photo gallery pictures to give your surgeon a sense of what looks good to you personally. Also, keep in mind that the smaller you go, the more weight reduction and back / neck pain symptom relief you will have, so this should be factored into your decision making as well. Best! -RC

Based on your physical symptoms and aesthetic concerns, you are absolutely a candidate for breast reduction surgery. Obviously you would also have to be medically stable for surgery, but assuming you are healthy, a breast reduction is an excellent surgery to improve physical wellbeing and body aesthetics at the same time! Best, -RC

The skin excision (lollipop vs anchor scar) will have no impact on breast feeding as this is just what is going on at the surface level above the breast tissue. The deeper tissue resection is what can affect breast feeding. While it is true that a reduction can impact breast feeding, if performed properly it should not have a major impact if the nipples, mild ducts, and immediate underlying breast tissue are left intact and connected. With a superomedial pedicle technique is used (leaving the central / upper tissue intact while removing the excess outer / lower breast tissue), breast feeding ability is usually preserved. That said, if you have never breast fed in the past and cannot in the future, it will be very difficult to know if it was just your anatomy, or damage from surgery. Statistically you should still be more likely to be able to breast feed than not after a standard breast reduction surgery. Hope that helps! -RC.