What Should I Consider Before Having DDD Breast Reduction?

I am 20 yrs old and I'm seriously looking into having breast reduction. I have always had very large breast but now that I've had a child and breastfed my bra size is 34DDD. I am 5'3 and I weigh about 140 lbs. I have been hunching more than ever and now it hurts to sit up straight in addition to severe back pain at the end of the day. My husband is worried about me regretting the surgery and I do not know anyone who has had breast reduction.

What should I consider before having the surgery? What questions should I ask my doctor? Any information is welcomed and thank you in advance!

Doctor Answers 24

Important facts about Breast Reduction

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If you have excessively large breasts, you may consider breast reduction surgery if you have the following symptoms:

1) Back pain

2) Bra strap grooving on your shoulders

3) Severe rashes of the skin in the lower breast folds


Things to consider that may affect your breast reduction results:

1) Weight gain or weight loss can affect your breast results over time.

2) Sagging can occur after breast reduction over time.

3) Nipple sensation can be reduced after breast reduction (Although some women have improvement).

4) You may lose your ability to lactate after surgery, should your decide to become pregnant again.

Breast Reduction for 20 year old?

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Thank you for the question.

It sounds like  you are dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing  both physical and psychological distress.

As  you think  about  breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with  the procedure.  Unsatisfactory scarring is  one of the potential complications. Make sure you also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age).
Sometimes breast  reduction surgery is covered through health insurance. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.

Make sure you are  working with a well-trained/experienced board-certified plastic surgeon.

I hope this helps.

Before breast reduction, consider the resulting scars.

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Breast reduction patients are generally quite happy to be relieved of excess weight on the chest.  The operation is safe and the convalescence is pretty easy.  Most patients maintain nipple sensibility and the breasts look more youthful.   However, because skin removal is a requirement of the procedure, incisions proportional to the amount of skin removed result.  Make sure you understand the resulting incisions.

Breast Reduction General Information

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the most important consideration is finding the best possible plastic surgeon. See the below link for help on this.
Candidates for Breast Reduction surgery are women who wish to have smaller breasts to achieve a more proportional appearance or to alleviate physical discomfort. Breast reduction can correct symptoms from excessively large, heavy breasts that may cause the inability to do certain exercises, or create back, shoulder and neck pain, poor posture, bra-strap shoulder indentations and chafing or rashes under the breasts. Women experiencing these discomforts may benefit from Breast Reduction, also called Reduction Mammoplasty. Furthermore, large breasts may interfere with normal daily activities or exercise and will be more comfortable when reduced. Women who feel that their excessive breast size decreases a sense of attractiveness and self confidence, or results in unwanted attention are also candidates.
Intended ResultAlso known as reduction mammoplasty, Breast Reduction is an operation intended to reduce the size of a woman’s breasts and improve their shape and position. Frequently, the areola (dark skin around the nipple) is also made smaller. Functional symptoms (medical problems) caused by excessive breast weight may be relieved or improved by this operation. Mammoplasty patients will experience a more attractive contour and smaller breast size, freedom from health problems associated with excessively large breasts and improved self image. There is an extremely high rate of patient satisfaction from this surgery. They are some of the happiest group of patients we see at Pacific Center for Plastic Surgery.
Procedure DescriptionBreast Reduction is performed as an outpatient procedure and the vast majority of our patients tell us that there was far less discomfort in the early recovery period than was anticipated. Dr Nichter and Dr. Horowitz use a minimal incision surgery using a “vertical” or “lollipop” scar technique this method has been used in Brazil and France for many years but is performed by a minority of Plastic Surgeons in this country. The benefits include: approximately fifty percent less scarring, a narrower breast, better forward projection and shape, longer lasting improvement, shorter surgery time and less complications. In general, we have stopped using the older traditional “anchor” or inverted “T” incisions as these provide inferior results. The procedure is done under general anesthesia on an out-patient basis or in the hospital it there are additional medical conditions.
Liposuction may be used during the procedure to reduce the size of the breast in selected patients. Liposuction alone has the least number and size of scars but has the greatest limitations in shaping and reducing the breast. Liposuction may be combined with the vertical method to give an optimal shape to your breasts. Adjustments of the Nipple and/or Areola can also be done at the same time.
In rare circumstances for extraordinarily large or bulky breasts, gigantomastia, for technical reasons, we sometimes remove the nipples completely and reattach them as “free grafts”. The sensory nerves are all cut, and even though a certain amount of sensation returns after healing, it will never be normal and erotic sensation if present prior to surgery (many of these patients preoperatively do not have this due to stretch of their nerves) is lost completely. The milk ducts are interrupted in this operation, so nursing would be impossible. You will be amply informed in advance if your breasts are in this category. This may be one of the exceptions where the inverted T or Anchor technique is utilized.
Post-Operative HealingThe incisions are covered with light dressings, and you will be place in a bra, which you should bring to the surgery center with you. Our staff at the Pacific Center for Plastic Surgery will help you select the proper size. The bra holds the breasts symmetrically during the initial healing. The initial discomfort subsides daily and can be controlled with oral medication.
Some discomfort, swelling and discoloration of the breasts are to be expected for several weeks. Usually, our patients return to almost normal activity within two weeks. The scars at the incision lines typically become reddish and few weeks after surgery are raised and firm. After many months they become pale and soft. After 8-12 months, the scars are relatively inconspicuous. The nipples and some areas of the skin may be numb or sensitive after surgery. Sensation may return within a few weeks or months, but may be diminished or overly sensitive.
Breast reduction may prevent your ability to breast feed, however the newer short scar techniques that we use lessens that risk.
Gravity continues to have its effect, and there is a tendency for the skin of the breasts to stretch over a long period of time. This can be slowed by regular bra use when upright. Although, women very a great deal in this respect, in general, the smaller the breasts the less the tendency for sagging to recur. If the breasts sag again, further excision of the skin on an outpatient basis can be used to correct the problem. If we try to lift heavy breasts without making them smaller at the same time, sagging will return soon. One key to a satisfying result is realistic expectations.
Risks of SurgeryThe specific risks and suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
InsuranceLarge breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance though insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

Things to consider when planning a breast reduction

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I would discuss your concerns with your gynecologist or internist first and obtain recommendations from them based on their knowledge of practitioners in the community. Alternatively, you can call them with a list of plastic surgeons from the American Society of Plastic Surgeons (plasticsurgery.org).

Then you should schedule a consultation with at least 2 if not 3 and proceed based on the information provided.

Find the board certified surgeon for you

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There are a lot of things to keep in mind when it comes to breast reduction surgery. You want to make sure you consult with several board certified plastic surgeons to find the one that is best for you. Bring pictures of what you want to look like after surgery and ask to see pictures of the surgeons past patients and their results. Look into whether your insurance company would any of the procedure and if they do, find a surgeon in your network and in your area. Be advised of what the scars will look like and the recovery time.

What to consider before having a breast reduction

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If you are having significant back pain and problems with your posture, you may benefit from a breast reduction surgery.  This procedure may also be covered by your medical insurance since it would be considered a reconstructive and not cosmetic surgery.  You should discuss this with your health insurance carrier and plastic surgeon as policies vary significantly.

As far as the surgery itself, you should be aware that you may have changes in your nipple sensation and your ability to breast feed in the future may be decreased.  You will also have permanent scars on your breast , sometimes these are noticeable and sometimes they are not; this depends on your skin tone and type of incision used for the breast reduction.

Consult with a board certified plastic surgeon to determine if you are a good candidate for breast reduction.

Best wishes,

Dr. Bruno

What ToConsider Before Having Breast Reduction Surgery

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It sounds like you are an ideal candidate for breast reduction since you've been hunching more than ever and now it hurts to sit up straight, not to mention suffering from severe back pain at the end of the day.

Because it's used to relieve medical problems, breast reduction is considered a reconstructive surgery and is often covered by insurance. So why are so many women still reluctant to undergo the procedure?

The short answer is that most are turned off by the large amount of scars (“anchor” or “T” shaped scar) and flattened breast shape after reduction. You will definitely want to ask your board certified plastic surgeon about the technique that will be used for your breast reduction surgery.

I use the Vertical Scar technique, or “lollipop” scar, which eliminates the horizontal scars under the breast used in other techniques. The vertical incision also gives a more youthful and perky shape to the breast. Read more about why I feel the single vertical scar technique is superior to the traditional Weiss breast reduction technique in my blog article web reference noted here.

Considerations before undergoing breast reduction

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Breast reduction surgery may be of great benefit in alleviating back and neck pain and improving posture. However, there are many issues that need to be addressed, including scars, potential impact of future pregnancies, and other complications. Seek out a board certified plastic surgeon with expertise in this field before making any decisions.

Olivia Hutchinson, MD
New York Plastic Surgeon

Breast reduction considerations

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Prior to consulting with a PS, ask your friends if they can refer you to women who have had breast reduction.  Find out about their experiences, both good and bad aspects.  Ask your mother and 1st degree female relatives about their breast health, including any history of breast cysts, biopsies and cancer.  Optimize your health.  Many insurance companies will deny coverage of breast reduction if you are over the recommended weight for your height.  You can find the Body Mass Index charts on the internet, so it can motivate you to weight reduction, if indicated. 

Think about the nonsurgical activities which you have done to address your heavy breasts and document these as fully as possible.  Letters from the chiropractor, physical therapist, primary care physician can support your preauthorization letter.  Keep a track of the heavily engineered bras, which you have used to try to offload the weight on your chest, as well as the visits, if any to the dermatologist because of heat rash under your breasts.  Insurance companies need to be presented a complete case of why conservative therapy has failed, prior to authorizing surgery.

Figure out where you are in your family cycle, i.e. if you have finished having children for the following reason: pregnancy with its subsequent weight gain/loss and lactation can change the results of breast reduction.  Moreover, you may not be able to lactate, depending on what technique is used.  Discuss the possibility of scars with your spouse, to ensure that he is on board with this. 

Finally, interview 2-3 PS.  Look at their best and worst scars/results.  Ask to speak to some of their patients.  Choose a practice where you feel your care will be optimized.  Oh yes.  Do make sure that you have adequate help for your child and duties in the post-op period.  Good luck.  

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.