Would breast removal or breast reduction be easier to perform on me? (Photos)

Question

Currently I'm 45 (no kids, don't plan on any). Since a long time now dealing with neck/shoulder pain and feeling restricted in my breathing due to the weight of the breasts pressing on my ribs, I want to either have them completely gone (best option) or want them to be reduced to a tiny and flat size (No more than 34 A; currently I'm 34D/DD ). Please let me know which one is the best option, what would the procedure be, recovery times and costs? Please help, I need them gone.

Kenneth Hughes, MD · Answer

Recommend a reduction over removal.  The cup size measure has inherent variability. Tissue density will always play a big role in the number of grams removed.  Going too small can sacrifice the shape of the breasts.  The nipple has to have a blood supply to survive from the underlying tissue.Recovery generally is one to two weeks. Your incisions must be healed before doing any strenuous activity.  I recommend that my patients wait six weeks before performing strenuous exercise and limit lifting to less than 10 pounds during that period of time.
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Woo Jung Kim, MD, PhD · Answer

Based on your pictures, it seems you would need to get an inverted T breast reducttion which is the best way to reduce the size of the chest. I t hink it's best if you went and got a consulation in person.

Urmen Desai, MD, MPH, FACS · Answer

I think you would benefit from a reduction/lift. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with. Finally, make sure your surgeon is a Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS).
Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Daniel Barrett, MD · Answer

Dear Luminous2474,
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

Scott C. Lindsay, DO · Answer

Thank you for your question.
The best thing for you to do is to schedule a consultation/evaluation with a board certified plastic surgeon to discuss your options. Best wishes!

Matthew A. DelMauro, MD, FACS · Answer

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) Based on your photos, breast reduction surgery may be a good option to improve the shape, contour, and perkiness of your breasts. The surgery can be designed to minimize scar appearance. It may also help improve your back pain. If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!
Matthew A. DelMauro, M.D.

Andrew T. Cohen, MD, FACS · Answer

Thank you for your question.Based on your pictures, my suggestion for you would be to get a breast reduction. I would remove both breast tissue and skin to get a very nice lift. I would either use an anchor or wise pattern lift and use mesh to prevent the breasts from falling. If you want them completely removed my suggestion would be a mastectomy with a free nipple graft which will leave you flat.It is best to see a board certified plastic surgeon for a formal consultation to help you reach your desired goal.Good luck to you!Andrew Cohen, MD

Tom J. Pousti, MD · Answer

Thank you for the question. You may be surprised to know that your goals/requests are not that unusual.   I see several patients every year who wish to achieve as small of a breast appearance outcome, for a variety of personal reasons.
 Generally speaking, 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.   Occasionally, a staged procedure is helpful; in others, nipple/areola grafting is helpful.
 In my opinion, successful outcomes with  etc. surgery depend on:
1.  Careful selection of plastic surgeon (and from the surgeon's  standpoint, careful selection of patient).  I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons. Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.
2.  Careful communication of goals ( which I will discuss further below).
3.  Skillful execution of procedure ( preoperative, intraopererative, and postoperative patient management).
In my practice, I would ask that you NOT communicate your goals, or evaluate the outcome of the procedure performed, based on cup sizes.  There is simply too much variability when it comes to bra sizes between bra manufacturers and even store employees doing the bra fitting measurements.
 In my practice, I ask patients to communicate their goals with the help of  computer imaging and/or goal photographs.  Obviously, the outcome associated with the breast surgery will not necessarily match that of goal photographs perfectly, but they do serve as a better communication tool that subjective terms such as "natural", "proportionate", "flat"… Evaluating goal photographs also allows for a plastic surgeon to determine the consistency of the patient's goals and allows for a discussion of realistic expectations as well.  
***Needless to say, when it comes to achieving patient satisfaction with the outcome of surgery,  it is very important that a patient has consistent goals (fully decided on what she would like to achieve) and a good understanding of realistic expectations (what outcomes can and cannot be achieved). 
 Best wishes with your decision making and for an outcome that you will be very pleased with.

Curtis Wong, MD · Answer

if you have saline implants, the first thing to do is intentionally deflate them.  That removes the weight of the implant.  If you find you're still larger than you wish to be, then a reduction (includes mastopexy) can be done to further diminish your size realistically, getting down to an A cup is not easy to do and to have a decent looking mound.  Talk to your surgeon about your options and choose what is best for you.

Vincent D. Lepore, MD (retired) · Answer

From your photos and history, you would be a very good candidate for a breast reduction.  Only if you had a very strong family history of breast cancer and was genetically prone to having a high risk of developing a breast cancer, should breast removal be considered.  If you are having back, neck and/or breast pain the breast reduction may be covered under your health insurance plan.  Seek out a board certified plastic surgeon who has extensive breast reduction experience.  Best wishes, Dr. Lepore.

Would breast removal or breast reduction be easier to perform on me? (Photos)

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