Reduction versus Reduction with Augmentation

I had my consultation today, and found out that the insurance company would require 400 grams of breast tissue to be removed which would leave me with almost nothing. The doctor suggested doing the reduction of 400 grams and then placing a small implant to the size I wanted. From what I read, this is not common to do a reduction with augmentation all at once.. Anyone have any suggestions on if this is a common procedure and what the satisfaction of the outcomes are?

Doctor Answers 8

Reduction versus Reduction with Augmentation

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Thank you for your question.  I agree with the other surgeon's answers.  The combination of a reduction and simultaneous augmentation is not all that common but I have done it for several women wishing to remain the same size but achieve a more lifted, round, youthful appearing breast.  Such a procedure would not be covered by insurance given the nature of the procedure.  There needs to be a delicate balance between the amount of tissue removed and the size of the implant placed.  You would not want to remove too much tissue and risk compromising the integrity of the breast or blood supply to the skin of the breast.  Be sure to consult with a board certified plastic surgeon certified by the American Board of Plastic Surgery to discuss your options.  I'd be happy to see you for a free consultation as well.  Best wishes!

Breast Reduction and Augmentation together

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It is not super common to do a breast reduction and augmentation but it does give a nice round, lifted look when it is done! That being said, I don't think you should change your breasts simply to get the insurance coverage. It may cost you more in the long run because of deductibles and then paying for an augmentation. It is becoming more common to have to pay for breast reduction with cosmetic fees as less insurance companies are covering it. If you decide to do the procedure for cosmetic prices, you can have as little breast tissue removed as you want to look great. Best wishes!


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A reduction-augmentation is a method of reducing and lifting the ptotic, bottom-heavy breast while adding upper pole fullness without adding too much weight or volume. It is a legitimate approach but in that context I do not believe that your insurance would be the appropriate payer for the procedure. Insurance covers breast reductions to alleviate functional problems like neck and back pain, skin changes under the breast, and sometimes even comfortable breathing. Adding an implant to a reduced breast would be counterintuitive from a functional perspective, and therefore to insurance, but certainly a legitimate cosmetic approach.

Breast Reduction with Implants

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It is not common to perform a simultaneous breast reduction with implant augmentation. In some cases of a breast lift with implants, a minor reduction may be performed in order to improve the shape of the breasts. In my opinion, I would not recommend a reduction to "almost nothing" and then compensate this small volume with implants. In most cases, I would not remove normal natural tissue to replace it with an artificial implant.

Modern techniques of breast reduction and breast lifts can give you a well shaped (pretty) breast form of the size that you wish with a long lasting result. Even if insurance won't cover the cost, I think this would be a better option.

For the best results seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and special skill in cosmetic plastic surgery as well.

For more information about breast reduction please see the web link below.

Alexander G. Nein, MD, MS, FACS
Nashville Plastic Surgeon

Breast Reduction without Breast Implants

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There is no substitute for what nature has created.  If your surgeon can obtain a beautifully  shaped breast with a reduction, this will be superior to the result that would be obtained by overly reducing the breasts and compensating with implants.  Some breast reduction techniques allow for the reshaping of the upper portion of the breast with natural tissue.  I discuss some of these issues on my website.  Best of Luck

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews


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I think that if you want a reduction then that is what should be done. Adding an implant augments you.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Reduction followed by Augmentation

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You bring up several interesting points.
1. Insurance companies are in the business of MAKING money not in giving it away. They set the rules of the games and as unjust as they may seem these are the rules. Buying insurance is similar to hiring a caterer for a family function. You and the caterer discuss which food (ie medical conditions) would be served/paid for and how much you/your company would pay them. You or your party guests do not get to order off the menu BUT you can decide not to use them the next time around. When it comes to Breast Reductions, all insurance companies learned MANY years ago that some surgeons would bill them for "Cosmetic Reductions" - small reductions which were actually Breast Lifts (Mastopexy), a cosmetic operation. The result?  The insurers raised their breast weight removal criteria to the point of becoming mastectomies to weed out the in-between cases. This APPEARS to be the case here.
2. In MY opinion, breast augmentations are NOT worth doing with tiny implants OR to get a temporary fullness of the upper pole of the breast which is usually gone in a year or two with the downward pull of the implant.

The Solution - it is hard to suggest anything without an examination much less photos, BUT if losing 400grams would render you flat, it sounds like you may do VERY well with a Short-Scar (Hall Findlay) Breast Lift. The sagging breast tissue is advanced superiorly like an auto-implant and the breast is made much perkier.

Peter Aldea  MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon

Reduction versus Reduction with Augmentation

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Thank you for your excellent question.  Though rare, this combination of procedures can be done and is guided by a patient's desired appearance. The implant replaces some of your removed breast volume leading to greater fullness along the upper aspects of each breast.  Talk to your surgeon about your options, they should be able to provide you with example patient photographs.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.