Do most surgeons include lipo for under arm for a breast reduction?

Excision or liposuction of tissue on the lateral chest is not considered part of a breast reduction as it's not breast tissue. Treatment of this can add significant time and supply cost to the case and would normally be charged extra for should a patient so choose. I am careful to point this area out and what is not addressed during an insurance reduction case as part of a consult

Off work depends on what you do, what your pain tolerance is, and how much you like your work. Infra-axillary fat is separate from the breast, in my opinion. It is not breast tissue and liposuction is one way of treating it which requires additional time and equipment. It can also be excised but then the scar is longer and may require repositioning in the operating room. It is often done at the same time.

If there is significant fat in the axillary area under the arm then it should be addressed at the time of a breast reduction.  While most insurance companies will not cover the cost of cosmetic liposuction it is up to the plastic surgeon to determine if it is necessary to obtain a nice result for the patient despite what the insurance company dictates.