What is the smallest possible cup size for a breast reduction, given my size and type of breasts? (Photo)

Question

I have currently have 38GG (Freya brand sizing) breasts. I am 31, 5'-5" and 215 lbs. When I've weighed less, for example 180 lbs about 3.5 years ago, my bra size was perhaps only a cup or two smaller. I am interested getting a breast reduction. However, I've heard vaguely there are limits to how much reduction can be achieved. Ideally, I would love to have essentially no or fairly small breasts I don't know if anything like that is possible.

Keith M. Blechman, MD · Answer

The most straightforward technique to perform a large breast reduction and still maintain good aesthetics is to remove approximately half the breast.  In doing so, this will also accomplish a significant lift.  In most women with large breasts, the combination of removing half the volume of the breast, as well as lifting the breasts in the process, will give them a completely different feel and appearance that they're very happy with.  Although some effort can be made to make the breasts even smaller, aesthetics can be compromised in the process, and may ultimately leave the patient unhappy with the result.A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what aesthetic outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

Michelle Zweifler, MD · Answer

Bra size is variable by each brand and style.  Breast reduction patients frequently request "B to D cup" size.  The nipple stays attach to a pedical to keep it alive, preserve sensation and try to preserve breastfeeding.  The pedical may limit finally Breast size.  Breasts are frequently left proportionate to the patient's body and trying to achieve the desired patient size.  There are no cup size guarantees, but most patients are highly satisfied with Breast reductions.

Richard J. Restifo, MD · Answer

Thank you for your question. Firstly, it is difficult to converse in terms of bra sizes, because that is such an inaccurate parameter and varies from maker to maker. That being said, there is no real limit to how small a breast reduction can make a patient, but as more and more breast tissue is removed, some of the good qualities of the breasts are lost, such as shape and sensation to the nipple complexes.Best wishes.

Robert Stroup, Jr., MD, FACS · Answer

In theory, you could get as small as an "A" cup if you are willing to undergo a procedure that involves free nipple grafting (with resultant loss of sensation).  However, in my opinion, this would leave you disproportionately small and unbalanced.

Steven Wallach, MD · Answer

Can the breast be made really small?  If you have very large breasts and want a nice shape, it i can be difficult to make them really small without potentially comprising the healing. Can they be removed?  Yes, but then you are talking about a subcutaneous mastectomy and probably removal of skin since you are very saggy.

Jean Paul Giudicelli Saba, MD · Answer

Hi, thanks for sharing your concern and photos with us!
First I want to congratulate you for making this important decision. Deciding to get an aesthetic procedure to change your body and get a new life style is a big step!
  
Looking at your photos I might say that you´ll be a great candidate to get a breast reduction because you have enough tissue to reshape to reduce and lift it, it seems like a C cup post op. Before all this, of course, you need to get a complete medical evaluation and laboratory exams to check everything is fine. For us your safety, always, is going to be first.
  
Have a great day! 
  
Dr. JPG

Robert L. Kraft, MD, FACS · Answer

Generally, I would expect someone of your proportions to be a large C cup after breast reduction. Keep in mind that you will be way over the insurance requirements but the breasts do need to fit your shape. Depending on your insurance, you may need to establish the failure of conservative medical management and your BMI could come into play.  Best wishes.

Reza Momeni, MD, FACS · Answer

Breast reduction eligibility and coverage by insurance varies from one insurance carrier to the next, and cannot be determined based on cup size, but only based on an in-person examination to figure out how much tissue the surgeon needs to remove.  You also often have to qualify for multiple other criteria from your insurance carrier, so be sure to request their breast reduction coverage policy ahead of time before your plastic surgery visit to ensure you meet all the other non-size related demands that they have.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

William B. Rosenblatt, MD · Answer

I usually try to fulfil your wishes, but often the final breast size is in the range of a C - cup, Although this is only an estimate. At your consultation I show photos of pre and post op patients so you can have an idea of how large or small you want to be.

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. 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.  Based on the sophistication of your question, I think you may already understand that 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.
I think that you are wise in understanding the importance of preoperative communication when it comes to achieving an outcome that you will be pleased with. 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.
 It will be very important to communicate your size goals with your surgeon. Most patients wish to achieve a enough of a reduction to help with their symptoms while remaining proportionate with the remainder of their torso. Again, I suggest that you do not communicate your goals in terms of achieving a specific cup size. For example, a “A or B cup” may mean different things to different people and therefore may be a source of miscommunication.
In my practice, I ask patients to communicate their goals with the help of  computer imaging and/or goal photographs,  as you have done here.  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", "essentially no", "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.

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