How small to go for breast reduction? Still want to feel like myself while alleviating pain. (photos)

Hello,
Thank you for the question.
Based on your photos, you appear to be a great candidate for breast reduction surgery. During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller. It is easiest to think of breast reduction as including the breast lift.
Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management.
The goal of breast reduction surgery it to make the breasts smaller and lifted, but also proportionate with the rest of your body. It is reasonable to to expect full C/small D cup breast size after the breast reduction surgery.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Hello, thank you for your question. Great job with your weight loss! Usually with breast reduction and trying to achieve a certain size, we mostly approximate how much comes off and reassess during surgery for symmetry and for size. It is very difficult to know how much is required to alleviate your neck and back pain. It varies from person to person. We always advise to wear a supportive bra after surgery. Speak to your plastic surgeon about their prior experiences with breast reduction.

Thanks for your question! I wouldn’t focus too much on the cup size. Cup size can really vary brand to brand. Often times, the amount of breast tissue that needs to be removed is dictated by your insurance company. Be sure to have this conversation with your plastic surgeon to see what you can expect. Good luck!

Hello @riah.wood, thank you for your question and showing your pictures. Depending on the surgical technique developed by the specialist, depending on the shape of the breast, a greater reduction will be made on one segment than on the other in order to achieve the best aesthetic result. The best aesthetic result for me would be a breast that has a good shape and proportion, that is slightly conical, and that has a slight descent in the upper part so that it looks aesthetically pleasing. When these volumes are reduced, it becomes necessary to rearrange all the tissues, keeping the areola and the nipple together. The cup that you will have depends on your expectations and what the specialist recommends. For more information and recommendations, it is best to consult one or more board-certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

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.

Best Wishes,

Gary Horndeski, M.D.

This is a good and common question regarding breast reduction. And the short answer is: it's really up to you within a few parameters. First, to define what we're talking about, a breast reduction is the removal of breast tissue along with a lift to result in a smaller breast. This is different than a breast lift, which also requires the removal of some tissue, but generally much less and only for the purposes of lifting, not to remove tissue or make the breast smaller. This is a key distinction, because a breast lift is essentially never covered by insurance. However, a breast reduction is sometimes covered by insurance if certain criteria are met, such as taking off enough tissue to qualify the procedure as a reduction. The guidelines for how much is required is determined by a patient's height, weight, "body mass index," and body surface area and outlined in the Schnur Scale, which is a list of breast tissue removal weights that are required to qualify for an insurance-covered breast reduction. So that is the direct answer to qualify for an insurance-covered breast reduction. However, if you're paying for your reduction directly to your surgeon, then you can really have any amount taken off that you want, from the minimal amount in a breast lift to the maximal amount preserving only about enough tissue for blood flow to the nipple and areola. It's really a continuum: the more that's removed the less back, shoulder, neck pain and other symptoms, the less you take off the more significant breast size you have after surgery. Given the size that most women are when they want a breast reduction, the most common requested size is typically a "C," which is a cup size discussion that is not highly precise (because different bras are made different sizes), but if this helps guide a discussion with your surgeon, then that's really the most important thing.

Dear riah.wood,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I would recommend a large C cup. You should review your surgeons before and after photos to see what size your surgeon typically creates for breast reductions.

Most surgeons won’t guarantee a breast size or a volume that can be removed that will result in significant symptom relief. I think the important thing to realize is that tailoring the remaining tissue to meet your aesthetic goals, as well as removing some volume and changing the position of the breast to bring it back up onto the chest wall should help meet your aesthetic and functional goals. Understand that it is difficult for us to make perfect predictions as surgeons. Also, bras come in several different sizes and therefore promising a certain bra size is fraught with difficulty since the range is so great between manufactures. I think the important thing is that you express your goals to your surgeon and also feel comfortable with the plan. Have a conversation about your goals with a board-certified plastic surgeon. We are happy to help in any way we can.

You have 500-600 to remove…maybe a little bit more.. you would still be a full C cup. With stretch marks i would also offer you Galaflex scaffold. It’s an additional cost for the mesh but definitely worth it as your stretch marks make me want to provide additional support to your breasts.

Best to see a board certified plastic surgeon . good luck ! You should do very well.

Andrew Cohen, MD