125lbs, 5'4, 27, 32DDD, want minimal scarring & proportionate results, what techniques do you suggest? (Photos)

Thank you for your query. A vertical scar only technique will give you good results with less scarring and a good lift. More tham 200 grams of tissue can be removed from each side , based on your photographs. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

The Schnur Scale is often used by surgeons and insurance companies to help assess the medical necessity of breast reduction surgery. It takes into account factors like body weight, body mass index (BMI), and body surface area to determine how much tissue should be removed for the procedure to be deemed medically necessary. It is important to note that the final cup size after the surgery will depend on several factors, including your body’s proportions and the amount of tissue remaining, as well as your surgeon's techniques.
As for techniques, there are several options for achieving a natural shape with minimal scarring, which is a common goal for many patients. The most common technique for a breast reduction with minimal scarring is the "lollipop" or vertical lift, which removes excess tissue and reshapes the breast with a scar around the areola and a vertical line down to the breast fold.
A better result would likely be achieved with the traditional Wise pattern or inverted T or anchor incision, which would involve the following scars:
-Periareolar (around the areola): A circular incision around the nipple.
-Vertical (from the bottom of the areola to the breast crease): A vertical incision running from the areola to the breast fold.
-Horizontal (along the breast fold): A horizontal incision along the natural crease under the breast.
The Wise incision technique allows the surgeon to remove a significant amount of excess breast tissue, reduce the size of the areola, and reshape the breasts for a more youthful and natural appearance. It also provides excellent access to tissue for lifting and repositioning the breasts. With 200 grams removed from each breast, you may end up with a "cup size" smaller, but this will depend on how much tissue is removed. Be sure to have a thorough discussion with your surgeon to set realistic expectations for your desired outcome.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Thanks for your question! I do think you would be a great candidate for a breast reduction. I would need to see you in person to determine a vertical scar or wise pattern. I think you have more than enough breast tissue to hit insurance requirements. Good luck!

You will be very happy with a breast reduction. You will have significant lifting, improved shape and symmetry. The amount of tissue removed is somewhat not variable if you are going for the highest, tightest result, but we usually end up at a proportionate, "C" cup. You will have a very nice result and I would not hesitate to proceed. Thank you.

The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question and for providing the photos; they are very helpful. Based on the information you've shared, your body surface area is estimated to be between 1.55 and 1.60. This indicates that tissue removal for each breast would be approximately 284 to 300 grams. This amount is typically the minimum required by insurance unless the surgeon submits a note indicating a need for removal of only 200 grams, which insurance may then approve pending other symptoms and treatment failure.
The surgical technique used is important, but it ultimately depends on what the surgeon is most comfortable with. Personally, if the distance from the sternal notch to the nipple is longer, indicating that I need to move/lift a longer distance, I prefer using the inferior pedicle Wise pattern (also known as the anchor-type incision). On the other hand, if the lift needed is moderate—less than 4 to 5 cm—I would use the superomedial pedicle with the same Wise pattern incision, this is my preference, other surgeons might think differently.
While I don't have your exact measurements, my impression, based on the photos, is that an inferior pedicle breast reduction would be appropriate. If your goal is to achieve a reduction that is proportionate to your body and you prefer not to place pressure on your surgeon regarding the required insurance amount of breast tissue removal, you might want to consider consulting a non-insurance-based aesthetic surgeon.
Predicting cup size is quite challenging, even at an examination, as many factors come into play. Breast tissue can vary significantly; for example, it might be heavier if it's more fibrotic. Therefore, without a physical exam, it's difficult for anyone to accurately gauge your size in terms of cup sizes.

From the submitted photos you appear to be a good candidate for a breast reduction. This can help improve asymmetry as well as remove excess tissue and lift the nipple. You can anticipate the standard anchor pattern incisions for the best result. It is hard to determine cup size without further information but you will probably be approximately a C/D with 200 grams removed.

Removing 200 grams of breast tissue and the excess skin will probably drop you down 2 cups in size. One breast is larger, so more can be removed on that side. Your insurance company is being very generous in just asking for only 200 grams. Most require at least 500 grams.

You would be a candidate for a breast reduction, but I think you would need to have more than 200 g of tissue removed specially from your right breast to get to a D cup from a DDD. You would have a standard anchor or inverted 'T' pattern of a scar.

Your nipple would be the same size, but your areola would be smaller and your nipple and your areola would be in a higher position on your chest, and it would help with neck, pain and back pain and shoulder grooving and overall give you a much more balanced appearance to your body as your breasts are much larger than your torso and your breast are currently on your abdomen, and we would want to get them back up on your chest.

For me to focuses on the shape, so I remove as much tissue as needed to get the proper shape that I desire and to get the proper reduction that the patient would like, and whatever that final amount of tissue ends up being is what the final amount of tissue ends up being. It's really not about how much tissue you remove, but it's more important about how much tissue you leave behind.