Is 284 grams too much removed for 32DDD/G breasts? (photos)

Thank you for your pictures. Based on your pictures, I would disagree that 284  g is too much. Is a very small amount and would not lead to total removal of your breast.

Breast Reduction is a complicated procedure that is best done by those with the most training and experience. It is very difficult to determine the resultant cup size and shape based solely on the number of grams that are removed from your breast to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast reduction and lift surgeries, including different approaches, techniques and even fat transfer and implant choices if you are lacking superior breast fullness.This is because several measurements—not to mention breast characteristics such as density—are needed to determine how much and where to remove breast tissue to meet your goals. Without knowing your existing breast shape, dimensions, and the density of your breast tissue, it would be difficult to make this determination. For example, the same volume of breast tissue will weigh different amounts (measured in ounces or grams) in different people depending on its density. The existing base width of your breast and what you will ultimately want to look like will determine, in many cases, the maximal volume and weight that will need to be removed for the best result.Please click on the link below for more information!

It is difficult to tell without examining you but in general, people who are good candidates for breast reduction have shoulder notching from their bra straps and back pain. You should discuss with your MD what size you should get and how to go about it based on your body and breast proportions.

Thank you for your pictures and questions.In discussing what size to reduce the breast to, my answer to patients is always "smaller." Now I don't mean to sound flippant, but the goal of this surgery is to reduce your breasts to a size that is compatible with your frame and body type while primarily reducing them enough to help relieve some of the symptomology that led to you pursuing breast reduction in the first place. As most women know, a discussion of cup size depends only on where you bra shop, because a 34C from one store can be completely different from a 34C in another store. I can be a good idea to tell a surgeon in what range you want to be because that will give him or her an idea, but no surgeon can guarantee any certain bra size going into surgery. Have the surgery, then go get a bra fitting afterward.In performing breast surgery, there is a range that can be achieved safely. If you take too much of the tissue then it can compromise the blood supply to the remaining portions of the breast. If you do not take enough tissue, then the closure can have too much tension and the symptoms may not be relieved. In addition, if your insurance has a minimum requirement, that can be a problem. In your specific case, it might be useful to try to predict a cup size. In very rough estimates, a cup is about 150-200 grams of tissue, so a reduction of 284 grams would decrease you by about 2 cup sizes. So I think that if you want to be an A or B cup at the end of surgery, this is not an unrealistic goal. Get another consultation with a local plastic surgeon for another opinion. If after being seen by 2 or 3 surgeons, you keep getting the same answer, then that may help you make your decision. On the other hand, there may be other surgeons out there willing to help you achieve your goals.Best of luck!

Congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.  Generally speaking, a roughly 300 g reduction is not considered a "large" reduction; however, the size of reduction may be too much for you, depending on your current physical examination and your breast size goals. Unfortunately, online consultants will not be of much help to you in this regard.  Discussing current breast size and goals in terms of cup sizes is simply not helpful. I would suggest that you work closely with your plastic surgeon. Show him/her what your goals are; in my practice, I would ask that you use goal photographs.  For example, you could show your plastic surgeon what you consider "too big" as well as "too small" when it comes to your preferences. Then, evaluating your current situation and your goals carefully, you and your plastic surgeon should be able to come up with the best way to proceed with. Best wishes.

Your question illustrated one of many reasons I do not contract with insurance companies.  Isn't it nuts that they will accept 284 grams but not 283 grams?   Why not make it 513.5 grams?  You can see how arbitrary their criteria is.  I also think it's nuts for insurance companies to insist on 6 months of physical therapy for back pain related to huge breasts.  I've never seen physical therapy result in smaller breasts!  I've even had insurance companies ask for written documentation that a patient has tried a variety of bra styles!  I guess that means the bra lady at Macy's needs to write a letter.  And this leads to another issue and I have zero idea if it applies to your first consultation.  The issue is moral hazard.  If a reduction is covered by insurance and the reimbursement is 1/3 of the private pay price, isn't in the best financial interest of the doctor to say a reduction won't be covered or that a certain amount cannot be removed safely?  Years ago I did a breast augmentation on a lady who had been way over-reduced all to meet insurance criteria.  Also, over the years I have seen many patients whose breasts were huge and who were told by other surgeons that insurance would not cover their surgery.Since I don't contract with insurance companies, it's just me and the patient making the decision of how much to remove.  The patient pays my fee and then submits for insurance reimbursement.  That keeps me out of the middle and out of the moral hazard zone. Oh, and like most docs here, I don't think it would be difficult to safely remove 284 grams from your breast.  You'd be pretty small but it sounds like that is okay with you.

284 grams is not necessarily too much to remove, though it is hard to guarantee how much tissue can be removed in order to protect the blood supply to the skin flaps and to the nipples if a pedicle technique is utilized (that is, the nipples are left attached to an underlying bridge of breast tissue and transferred to the proper position after the breast is reduced in size). However, you say you want to be an A cup or a small B. It may be difficult to remove enough tissue to get you there with the pedicle approach, leaving the nipples attached, because that pedicle cannot be thinned too much or the nipples will die. If you really wanted to be that small, a free nipple graft technique could be performed, you could almost certainly go down to a small B or even A cup, and almost certainly have a reduction of at least 284 grams for your insurance company. Of course, there will be no sensation in your nipples after a free nipple graft, and no ability to nurse.

Sorry but that is an unanswerable question since we don't know how big your breasts are in weight. Cup size is not helpful. A G on a 100# person is quite different than a G on a 200# person. It takes an exam to be able to give you an answer. In general, 300 grams isn't much for most breast reductions. 

Although, 284 grams is not an excessive amount to remove in a breast reduction,  I can understand why your surgeon has concerns about performing a breast reduction under such requirements.  In designing a breast reduction, the surgeon is tailoring the breast to reduce its size and weight.  However, no surgeon can guarantee the resected tissue will weigh a certain amount.  If, after a reasonable reduction, the proscribed weigh reduction is not achieved, the surgeon has a dilemma.  If he/she doesn't remove more tissue, the insurance company may refuse to pay for the procedure, leaving the patient at financial risk.  If they remove more tissue to achieve the weight proscribed by the insurance company, they may compromise the shape of the breast and/or the blood supply to the skin and/or nipple resulting in skin or nipple loss.  In cases such as this, I or my staff contacts the health insurance company and explains that I personally won't perform a breast reduction under this condition.  We ask that the insurance company either accept or reject coverage based on the pre op photos and the medical reports from me and the patient's primary physician.  In many cases, we have been able to get insurance companies to drop the prerequisite weight requirement.  Best wishes, Dr. Lepore.