Stephen U. Harris, MD

Hello and thank you for your question.  Breast reduction is a safe and effective procedure to reduce the breast size and improve those symptoms you are describing related to your large breast size.  The endpoint with respect to cup size is related to your overall body size and maintaining aesthetic body proportion.  A physical examination by a board certified plastic surgeon would be helpful to evaluate your particular anatomy and decide the amount or breast size reduction possible.  

Best wishes and good luck.

Stephen U. Harris, MD

Board certified plastic surgeon

Breast reduction surgery can have a profound and positive influence on a woman's life.  The operation is specifically designed to improve the symptoms related to the large breast size, ranging from neck and back pain, shoulder grooving, postural changes related to the heaviness of the breasts, and limitations in performance of physical activity because of the breast size.  Breast reduction can also improve a woman's self-image, creating a better balance and proportion in the body, and allowing for flexibility in wearing different clothes, and, in your case, making costuming easier to accomplish without clothing alterations or the use of support bras.

Breast reduction does result in permanent breast scars, because incisions are used to removed the extra breast tissue, fat and skin.  By design of the operation, the nipple and areola are lifted into a more central position on the breast at the time of breast reduction.  Often the scars are limited to a lollipop pattern around the areola and a vertical incision from the areola to the natural fold beneath the breast.  In some cases, especially in larger breasted patients, a horizontal incision beneath the breast will also be necessary.  It has been my experience, that woman who are good candidates for breast reduction will celebrate the new size, shape, and contour of the reduced breasts, and not be too concerned about the scars.

In most cases, as a 20 year old, most breast development will have happened.  With pregnancy or weight changes over a woman's lifetime, the breasts can re-enlarge or droop, requiring additional surgery.  That being said, having a breast reduction at this point in your professional life and career can give you many years of new found satisfaction.

A consultation with a board certified plastic surgeon will be helpful in your decision making process.

Best of luck to you!

You mentioned that you had a FNG dressing removed after surgery.  I presume you mean that you had a free nipple graft, and the bolster dressing was used in the postoperative period.  When a patient has a free nipple graft, the nipple and areola have to re-establish blood supply from the tissues where the graft is placed.  Occasionally, there will be partial loss of the skin graft as the new circulation is established, and this will typically manifest as a purplish or blackened area of skin.

The blackened area will typically separate from the underlying tissues where there is healthy blood supply.  In your case, because the blackened areas are small, you should see healing of the residual open wound quickly from the wound base or from the peripheral edges of the open area.  You might see scar tissue or flattening of the central nipple when this occurs.

3 weeks is in fact early in the course of postoperative healing.  Things will settle in as the swelling improves, so reassurance is in order.  Open communication with your plastic surgical care team is important!

Best of luck in your postoperative healing!

YES!  It is not uncommon for reconstructed nipples to flatten over time.  There are different flap techniques to create projecting nipples, and in most cases, secondary or revision nipple reconstruction can be performed to add projection to a flattened nipple.  Occasionally, fat grafting or the use of acellular dermal matrix are used to add support to the flap reconstruction.

Good luck!

Stephen Harris, MD

It seems that your concerns are mainly related to the fullness in the cleavage area, and how the reconstructed breasts fill out your clothes.  There are several strategies to  improve your result.  First, an implant exchange to a larger size would fill the pocket more completely, and this would make a difference in the medial cleavage fullness.  I think a 650 cc implant could be accommodated into your existing pocket.  Second, some tightening of the pockets, especially of the right lower outer breast, could be done to reduce the volume of the pocket and "force" the implant volume towards the upper, inner breast.  Last, fat grafting would offer great benefits in your case, besides being useful in the cleavage area, the fat would make the upper pole transition from your chest to the implants more natural in appearance.

A detailed history and physical examination by a board certified plastic surgeon, with particular expertise in breast reconstruction, would be helpful in creating a customized treatment plan for your particular case.