I Am a 36H. I Am 5'3 and Weigh 180 Lbs. Is It Possible to Get a Reduction Down to a B Cup?

At 5'3 and 180 lbs, your body surface area is 1.90 meters squared.  Aetna insurance requires 780 grams removal.  At size 36 H, each 200 cc corresponds to 1 cup size change.  Therefore, you would go down 4 cup sizes from an H to a D, which is proportionate to your body size.  I certainly do not recommend a B cup size which is too small and you would be very unhappy.

Best Wishes,

Gary Horndeski, M.D.

Starting from an H cup, there are options for you. I hate speaking in terms of cup size because everyone has her own interpretation of what a B cup looks like. Generally, for your height and weight, I would expect to reduce to a full C; a B cup may make you look pear-shaped. If your insurance company has a 1000 gram threshold, then this may have resulted in your surgeon's comments. In NY, reaching that threshold facilitates surgery without prolonged documented conservative medical management. However, the surgery must fit the patient's needs and the surgeon's medical judgment most importantly. If you do not feel that the doctor or his staff members were effectively communicating with you, then definitely seek a second opinion.

It is quite difficult to reduce the breasts that much because if you think about it,  There is a certain amount of tissue that needs to remain on the skin flaps and a certain amount of tissue that needs to be preserved to keep the nipple and areola alive.  If you have "H" breasts than the length of the nipple to the fold is probably long and that is preserved.  

From the information you have given it appears that the surgeon is going by the estimate that an insurance company would require in order to deem your breast reduction "medically necessary.". I don't believe there are typical resulting cup sizes, rather this is a discussion between you and your board certified plastic surgeon to develop a realistic plan and outcome.

If you do not think your questions fully by either the plastic surgeon or the staff, then I would suggest you seek another opinion on your options.  With my patients I usually have at least two visits with the patients prior to a surgery to make sure she understands all the risks, benefits, and treatment options, as well as answer all of her questions.  My staff also is available to answer many of the questions for the patients.  

A reduction of that size might be risky as the blood supply to the nipple-areolar complex might be compromised depending on the technique used for the breast reduction.  I would make sure that your surgeon can discuss what different type of techniques he has experience in performing.  If he says there are only two, go somewhere else.

Congratulations on your decision to proceed with breast reduction surgery; this operation is one of the most patient pleasing operations performed.

 I would suggest that you do your due diligence and select your plastic surgeon carefully. Then, communicate your goals in regards to breast size goals carefully. In my opinion, discussing your goals in terms of cup  size may be potentially confusing and/or a source of miscommunication.  Most of my patients will use goal pictures to  communicate goals as clearly as possible. Many patients will want to reduce their  breasts enough to help alleviate symptoms they are experiencing, while retaining enough breast tissue to remain proportionate with remainder of their torso. 

Yes, it is possible to reduce the breasts size very significantly.  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.  

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.