Why was I not able to choose my size? (Photo)

Question

I had a breast reduction as a minor at 17 that was covered by insurance. I told my doctor I wanted to be as small as possible but told me he would only make a D and no less. I was very over weight at the time by maybe 30-45 pounds (36 now) after losing 44 pounds. I am now needing implants due to sagging caused by weightloss. Why did my surgeon only agree to make me a D and why did they not force me to lose weight before the procedure?

Ajaya Kashyap, MD · Answer

Thank you for your query. The fact that your surgery was covered by insurance means you had medical issues and needed a significant reduction. When we do breast reductions at a very young age we try to leave as much of central glandular breast tissue as possible, so that lactation would be possible later. This would be my best guess as to why your surgeon did not reduce your breasts more. Also losing weight is especially difficult with large pendulous breasts. It may be best that you have a discussion about your concerns with your surgeon. All the best!

Caner Kacmaz, MD · Answer

The original size and shape of your breasts affect the process as well as your height and weight  into deciding what size will be proportionate to your body shape and frame. In general, patients will go down at least one or 2 cup sizes after breast reduction surgery

Krishna Vyas, MD, PhD, MHS · Answer

First, when performing breast reductions, surgeons often consider both the physical and aesthetic aspects of the procedure, as well as your body’s ability to heal. Surgeons might be hesitant to remove too much tissue, especially if they think it could affect the stability of the breast structure or result in complications, such as poor healing. Your surgeon may have taken into account that your body composition might change over time, and keeping your breasts at a D might have been a balanced option, given your weight at the time.

As for not requiring weight loss before the procedure, many surgeons are focused on helping you achieve a result that’s best for your health and well-being. However, they typically recommend weight stability (at least 3-6 months) before surgery to ensure the most predictable and lasting outcome. If you were overweight, they may have felt that your body might undergo further changes as you lost weight, and they didn’t want to make irreversible changes to your breasts before knowing what that would look like post-weight loss. Weight fluctuations after a breast reduction can affect the final result, as you’ve experienced with the sagging after weight loss.

You will want to discuss with your surgeon your goals after weight loss (for example, if you want a breast lift with the same volume, or want the breast to be larger). There are also options for some patients using their own tissue (like the side breast or back roll) to augment the breast without an implant. It will be helpful to have an open conversation with your current surgeon to discuss how you feel now and explore options that might be better suited to your current body and goals.

ABOUT DR. VYAS
Dr. Krishna Vyas, MD, PhD, MHS, is a highly trained plastic surgeon specializing in aesthetic surgery and breast surgery, including breast augmentation, reduction, lifts, and gender-affirming surgery (such as chest masculinization and feminization). With advanced training from institutions like Harvard, Mayo Clinic, and Johns Hopkins, Dr. Vyas is recognized for his expertise in breast and chest sensory nerve restoration. His PhD in clinical and translational science focused on stem cells, fat grafting, and improving outcomes in aesthetic surgery and breast surgery. Dr. Vyas has served on the editorial board for several medical journals and platforms and has over 200 research papers and talks. His research focuses on aesthetic surgery, regenerative medicine, stem cell biology, fat grafting, breast surgery, and gender-affirming surgery. Recognized for his expertise, Dr. Vyas was appointed an Instructor of Surgery at Mayo Clinic and served as an Assistant in Surgery at Harvard Medical School and Massachusetts General Hospital.

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

Ellen Ozolins, MD · Answer

Thank you for your question. For insurance-covered breast reduction procedures, surgeons must adhere to guidelines regarding the amount of breast tissue to be removed. Reducing breast size excessively, especially in overweight patients, can lead to disproportionate-looking results. Your surgeon likely considered your BMI and frame size to determine the appropriate breast size. Additionally, removing too much tissue may affect the blood supply to the nipple-areolar complex and could impair healing. While surgeons may recommend weight loss for optimal outcomes, it is generally not required unless a patient's weight presents a direct surgical risk. Also, as a minor, being asked to lose 30 to 45 pounds could be challenging, considering the psychosocial factors involved and the urgency to improve your quality of life. Over time, weight loss and aging can lead to a loss of volume and elasticity in breast tissue, contributing to sagging. If sagging is significant, combining breast implants with a breast lift may help restore fullness and improve breast shape.

Gary M. Horndeski, MD · Answer

If you were covered by insurance then the insurance requires a minimum amount to be removed. Your doctor probably removed the amount the insurance required based on their criteria. I do not understand why you would need implants now due to sagging. It sounds like you need a lift not implants. Unfortunately, you have not provided photographs. The breast lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

Only your surgeon can specifically tell you why he did what he did. However, insurance companies do require a certain amount of tissue to be removed to cover the procedure. Also, your surgeon wants to keep enough tissue to keep the blood flow to your nipple area. Most of us take ladies down to C to D, sometimes DD, cup size for safety to the nipples.  Also, no one can "force" you to lose weight.  This is something you must chose to do for yourself.

Scott C. Lindsay, DO · Answer

Thanks for your question! If that was your stable weight at the time, performing the surgery then was not the wrong choice. And it's not uncommon as we age, our breasts change, etc, to need some sort of revision/secondary procedure. I would suggest an in-person consultation with someone who does a lot of breast revision surgery. Good luck!

Camille Cash, MD · Answer

When a breast reduction is covered by insurance the insurance company often dictates the minimum amount of tissue that needs to be removed.  Enough tissue needs to remain after the reduction in order for the surgeon to maintain blood supply and shape the breast. You would have to ask your surgeon why he would not reduce you below a D cup.  A patient's weight is considered as a criteria for surgical candidacy but if you were otherwise healthy and were within limits considered safe with regards to weight, then weight loss would not have been required to proceed.

Darryl J. Blinski, MD · Answer

Without posting photos, very difficult to respond. But in most cases board certified plastic surgeons would’ve asked you to lose your weight before the reduction surgery because any weight loss could cause more tissue, descent, or sagginess. As far as choosing a size, it depends on what your breast look like before surgery therefore very again hard to answer your question. Best of virtual consult with for further detail details.

Why was I not able to choose my size? (Photo)

Answers (9)

More Breast Reduction Questions

WE SEND PRETTY
EMAILS

Answers (9)

More Breast Reduction Questions

Am I a good candidate for breast reduction?

Compression vs no compression after breast reduction?

Breast Reduction - what's the smallest you can go?

What are the benefits and risks associated with liposuction to the breasts?

What percent of your patients were able to only take OTC medication and gabapentin without any opioids?

Red around ribs around reduced breast + back - any thoughts what it is? (Photos)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS