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.
Breast Reduction from 36DD to an A?
Doctor Answers 17
It really couldn't be done
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.
Breast Reduction and Small Cup Size Result?
Thank you for the question.
It is possible to reduce the breasts size very significantly. Sometimes when patients want “almost nothing left” 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 “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.
Large cup size change after breast reduction surgery
A large change in your cup size is possible after a breast reduction surgery you should proceed with a great deal of caution. When discussing your concerns and your post reduction goals with your plastic surgeon, keep in mind that you will want a balanced appearance after surgery. Make sure that the final cup size you select will be balanced with your hips and waist to create a pleasing figure. Also keep in mind that the larger reduction may require more extensive incisions and scarring.
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I wouldn't try to go that small for breast reduction
Extreme breast reduction, like a mastectomy, is kind of a "one way street." I would recommend to preserve the sensation and the shape of the breast and reduce it within those parameters via a conventional breast reduction operation.
The choice she is considering is not one she may be able to easily reverse later should she desire to do so.
Extreme breast reduction
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.
Not a Good Idea!
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!
Breast reduction to an A cup is not likely
Many who seek breast reduction would like to be as small as possible and I frequently hear from patients who would like to be a B-cup, or perhaps a small C-cup. The key to reduction of the breast is preservation of the circulation and sensation within the nipple as the breast is reduced, and preserving the shape or aesthetics of the breast. Shape is very important and after reduction the breast should be pretty to look at.
The skin remaining after reduction will only contract to a certain degree and also the base diameter of the breast must be considered. Therefore is is very possible that after a even a large reduction the breast may still fit into a D-cup. For some a C-cup is possible if the chest is small. This may disappoint but my own experience, and some large studies have shown these results to hold true.
We have seen some patients who have been over reduced in an attempt to reach a very small cup, though these results can be very upsetting. If your daughter would really prefer double mastectomy I would suggest very careful consultation, and perhaps counseling to explore her feelings and motivations.
Best of luck,
It isn't that women who have breast reductions are all by and large very happy with their change we try to keep some proportion. I would recommend that she pick a local board-certified plastic surgeon to have a consultation with to review her options. When a women comes in to see me basically stating that they want mastectomies, this is a concern and she may want to seek some counselling prior to any surgery. This doesn't mean that she could be a good candidate for breast reduction but proper care must be taken before embarking down the path to surgery.
Probably not in her best interests...
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 (!).
Breast Lift and Reduction in size
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