Breast Reduction from 36DD to an A?

Question

My 29-yr-old daughter is a 36DD and wants to have reduction down to an A cup. Is that feasible? She would rather have a double mastectomy than have breasts larger than A. She has been planning on this surgery for many years.

Steven Teitelbaum, MD · Answer

You really couldn't make a DD an A. Why? Because a DD breast has a very wide diameter. The base diameter of a breast gets narrowed somewhat in a reduction, but it can't be narrowed enough such that an A bra cup would fit, even if you reduced the volume enough so that there were almost no projection, it would still be so wide that pracdtically speaking it would require a larger bra.

	The best thing an augmentation patient can do for herself is to leave the concept of bra sizes at the door when she sees her plastic surgeon. She should select an implant that optimally fills her breast envelope, neither overfilling and stretching it, nor underfilling it so that the breast is not proportionately augmented.

	Similarly, a reduction patient should want the surgeon to reduce her to the size which creates the best shape for her body.

Steven H. Williams, MD · Answer

Thanks for your question -

	Such a dramatic change is possible but not without consequences that would make most plastic surgeons defer to treat her.

	A breast reduction from a DD to an A cup is unlikely to leave enough tissue to keep the nipple/areola complex alive. This means the nipple and areola would need to be removed and put on as a skin graft. This would mean that they would be insensate, the patient would not be able to breast feed and some patients can experience depigmentation (changes in color).

	In addition, it would be very difficult to get a good cosmetic result from such a large reduction.

	A careful discussion with a plastic surgeon regarding why she would like such a large reduction should take place. The most common reason for breast reductions are to improve neck and back pain, reduce shoulder grooving and intertrigo (rashes and infections in the folds) and to improve shape. All of these could be achieved with a more reasonable sized reduction.

	I hope this helps.

Michael S. Beckenstein, MD · Answer

This magnitude of a change is drastic and would probably not be proportional to her body. She should consider being reduced to a size that is in proportion to her body and maybe slightly smaller. This will alleviate her symptoms and make her look much better.
Pondering mastectomies instead of being larger than an A cup is alarming. There may be some issues here that need to be explored!

Armando Soto, MD, FACS · Answer

Hi there-

	One of the primary considerations in breast reduction surgery is maintenance of the blood flow to the remaining breast tissue and nipple. With greater tissue removal, there is a greater risk of losing blood supply and therefore losing the remaining breast tissue and nipple to necrosis. The alternative of removing the nipple and replacing it as a free skin graft at the conclusion of the procedure exists, but I would never recommend this to a young woman, as all nipple sensation and function would be lost.

	I think that it would be much better to reduce her breasts to a size which provides both the symptomatic improvement she desires, while maintaining a feminine and natural appearance. The only thing worse than breasts which are too large, would be to end up with breasts which are too small and the need to place implants later (!).

Trevor M. Born, MD · Answer

Dear Wondering Mom, Breast Lift and reduction in size is an excellent procedure and patients who have had symptoms for years do very well.  A complete consult with the risks of the procedure is necessary and perhaps some photos of what shape/size your daughter would like would be helpful for the surgeon.
With Warm Regards,
Trevor M Born MD

James F. Boynton, MD, FACS · Answer

I perform a large number of breast reductions and I would counsel the patient  carefully into why trying to reduce her to an "A" cup would NOT BE RECOMMENDED.  It is never good to go to extremes.  Many patients that are quite large breasted can't wait to be smaller and they say things like "make them as small as you can".  I agree the breast has to be properly proportioned to the patient's frame and chest wall and they are happy.
I do not think it is possible to do this and still get a nice or even safe result. Sufficient "pedicle" breast tissue must be preserved to support the blood supply to the nipple. I perform all "medial pedicles" on my breast reductions which preserves much of the tissue in the upper inner aspect of the breast and because it cones and shapes the breast. Sometimes, in young patients, this pedicle can even have the appearance of "implants" because of the nice round shape and forward projection. It also doesn't lead to "bottoming out" like inferior pedicles often do because they are on the bottom of the breast and gravity takes its effects there.
Studies have also shown that patients that are having symptoms (i.e. neck, back, shoulder discomfort, rashes, exercise intolerance) will usually have their symptoms disappear with even a modest breast reduction. Therefore, it is really not a "weight" issue as the insurance companies often try to demand from plastic surgeons.
There is a balance in any breast reduction in regards to shaping and size. As you try to remove more tissue to make the breasts too small, you often flatten the breast and can loose projection and shape. Sometime if the "skin flaps" are thinned too much there can be contour irregularities as well. 
Also as a  young person of 29 likely has more glandular component to her breast rather than fatty which means that a modest breast reduction will most often give excellent shaping and uplift as well as several size decrease in the breasts which allow patients to feel better about themselves, find the clothes they want, and also feel better as far as symptoms.
Hope this helps!

Raffy Karamanoukian, MD, FACS · Answer

Breast reduction is designed to reduce female breast volume while maintaining an aesthetic contour and form of the breast.  The breast is an anatomic structure with glandular properties that should not be underestimated.  Reduction of the breast from a DD to an A cup is very close to performing a mastectomy.
A board certified plastic surgeon would be remiss in performing a surgery that would physically debilitate and deform a young female for life.

Farbod Esmailian, MD · Answer

I guess you can say anything is possible, but unrealisttic. It would be hard for you to find a plastic surgeon that would do that surgery. You have to have some reasonable breast tissue after the surgery for the nipple and areola to live off of. If you reduce the breast that much, the chances of the nipple and areola dying off is very high. Most plastic surgeons would recommend going with a size that is reasonable and that fits her body well and does not compromise the blood supply to the nipple and areola.

	 

	Hope that helps.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
The best thing to do is to schedule a consultation with a board certified plastic surgeon to discuss the options. Best wishes!

Tom J. Pousti, MD · Answer

Thank you for the question.

	It is possible to reduce the breasts size very significantly.   Sometimes  when patients want &ldquo;almost nothing left&rdquo;  the reduction should be done in 2 stages.  The concern with the amount of tissue removed is related to blood flow to the remaining tissue;  if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola)  may be compromised.   Part of the tissue that is left in place is called the &ldquo;pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible)  then patient will likely have problems with tissue survival.  Doing the procedure in more than one stage allows the tissues to  acclimate to the surgically decreased blood flow before  further tissue removal (and potentially further decreased blood flow)  occurs ( with the 2nd stage operation).

	The other concern with overly aggressive breast reduction surgery is patient dissatisfaction  afterwards.  It is not unusual for patients who have lived with very large breasts to want to have as much as possible removed. Care must be taken to be judicious in this removal to avoid an outcome where the breasts  are too small in relation (proportionately) to the patient's other body parts.  Again, it is not uncommon, for patients'  breasts to become smaller ( after the breast reduction procedure) with time and/or weight loss-  breast augmentation may become necessary to achieve the patient size goals.
	 
	 
	I  hope this helps.

Breast Reduction from 36DD to an A?

Answers (18)

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