Surgeon Recommends Re-reduction Using Inverted T Incision?

I am currently 40DD & having repeat reduction. Surgeon does not want to risk cutting nipple area. He plans to remove 200g tissue per breast but only below areolas . I fear I will be left with cone- shaped breasts. Also, such small reduction will not resolve pain caused by pressure of bands against ribcage due to chronic inflammation. Also, small amount may cause insurance to deny. Why are supposedly top surgeons so afraid of nipple incisions on second reductions?

Doctor Answers 3

Repeat breast reduction

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The procedure you are describing may be problematic.  Part of the breast reduction involves placement of the nipple in the correct alignment on the chest; nipple to infra-mammary crease distance measurement is important.  Removing tissue only from under the breast will not create an aesthetically appropriate result.  Whenever the nipple-areolar complex is involved, there is a risk of decreased blood flow.  The risk increases with reoperation but, in my opinion, does not justify the procedure you are describing. Insurance will not cover a 200 gram reduction.  I am uncertain what you mean by "pressure of bands against ribcage" and the chronic inflammation.  Perhaps you could post photos and be more specific.

Concerns about Repeat Breast Reduction?

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Thank you for the question.

As you can imagine, it is not possible to give you precise advice without direct examination and a full communication of your goals. 

Generally speaking, the concern about repeat breast reduction surgery centers on the issue of blood flow.   The  part of the tissue that is left in place during any breast reduction surgery is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue.   If this segment of tissue is “violated” during the  repeat breast reduction  procedure, a patient may end up with blood flow compromise ( and resulting wound healing problems and/or tissue necrosis).

 You may want to address your specific concerns with your plastic surgeon. Retrieving any available  previous operative report  may be helpful.  If still in doubt, seek  second opinion consultations.

 I hope this helps.

Secondary breast reduction

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A secondary breast reduction has increased risks of nipple complications. If the type of pedicle used for the first operation is known, then it makes it safer to go ahead using the same pedicle to perform a secondary breast reduction

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