Reduction Mammoplasty/Breast Reduction

Dr. Sian has been performing breast reduction on patients from Fresno and the California Central Valley area since 2002. There is a consistently high satisfaction rate among women undergoing breast reduction.

Breast reduction is also known as reduction mammoplasty. It is a surgical procedure done to reduce the size of the breast. Women who have large breasts may experience a variety of problems due to the weight and size of their breasts, such as back, neck, and shoulder pain as well as skin irritation. Breast reduction is usually performed to help relieve these symptoms. As a side benefit, it can also help reshape breasts that are sagging and droopy.

This procedure can affect one’s ability to produce milk and important consideration must be taken for women who plan to get pregnant and would like to breastfeed in the future. The best candidates are those who are mature enough to understand the procedure and have realistic expectations about the results. There are a variety of different surgical techniques used to reduce and reshape the female breast.

Questions covered on this page:

  1.  Am I a good candidate for breast reduction?
  2. How will Dr. Sian evaluate me for breast reduction surgery?
  3. Will my insurance help cover the cost of surgery?
  4. How is breast reduction performed? Where are the incisions placed?
  5. I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?
  6. How should I prepare for surgery?
  7. What will the day of surgery be like?
  8. How will I look and feel initially?
  9. When can I resume my normal activities?
  10. How long will the results last?
  11. Maintaining a Relationship with Your Plastic Surgeon

 Am I a good candidate for breast reduction?

You may be a good candidate for breast reduction if you have one or more of the following conditions:

  • breasts that are too large in proportion to your body frame
  • heavy, pendulous breasts with nipples and areolas that point downward
  • one breast is much larger than the other
  • back, neck or shoulder pain caused by the weight of your breasts
  • skin irritation beneath your breasts
  • indentations in your shoulders from tight bra straps
  • restriction of physical activity due to the size and weight of your breasts
  • dissatisfaction or self-consciousness about the large size of your breasts

Breast reduction can be performed at any age, but plastic surgeons usually recommend waiting until breast development has stopped (at least 18 years of age). Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this with Dr. Sian.

During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help Dr. Sian understand your expectations and determine whether they can be achieved realistically.

How will Dr. Sian evaluate me for breast reduction surgery?

Dr. Sian will examine, take measurements and photographs of your breasts for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. It is important for you to provide complete information.

You should tell Dr. Sian if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss. Dr. Sian may recommend that you stabilize your weight before having surgery.

Will my insurance help cover the cost of surgery?

Medical insurance may sometimes cover the cost of a breast reduction surgery. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed. A pre-authorization from your medical insurance for the breast reduction is usually required prior to your surgery. Dr. Sian or his staff will discuss these matters with you.

How is breast reduction performed? Where are the incisions placed?

Dr. Sian’s preferred technique is the Short Scar/Vertical mammoplasty technique (by Dr. Hall-Findlay). Unlike traditional breast reduction procedures that leave an anchor shaped scar, the Hall-Findlay technique utilizes a “lollipop shaped” scar that eliminates the long horizontal scar underneath the breast. An incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. After the removal of excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola is usually reduced in size. Thus, a breast lift is part of the breast reduction procedure.

This procedure is usually done under general anesthesia on an outpatient basis and surgery time is approximately 2 to 3 hours. Recovery time is approximately 3 to 4 weeks.

I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

Fortunately, significant complications from breast reduction are infrequent. Every year, hundreds of women undergo successful breast reduction surgery in the Fresno area. They experience no major problems and are pleased with the results.

Dr. Sian has been performing breast reduction surgery in Fresno since 2002 and his patients are usually very pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and the risks. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and Dr. Sian, or with his staff.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Rarely, a patient may require a blood transfusion during the operation.

Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time. Permanent loss of sensation in the nipples or breasts may occur rarely. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

You can help to lessen certain risks by following the advice and instructions of Dr. Sian, both before and after surgery.

How should I prepare for surgery?

Depending on your age, or if you have a history of breast cancer in your family, your Dr. Sian may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast reduction, you will still be able to perform breast self-examination. Breast reduction surgery will not increase your risk of developing breast cancer.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin, anti-inflammatory drugs (Ibuprofen, Alleve, Advil, Motrin, Mobic etc), and blood thinners (Coumadin, Warfarin, Plavix, Eliquis, Xarelto, Pradaxa etc.) can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Other food supplements can also cause bleeding such as Gingko biloba, garlic, ginger, Omega 3 fatty acids, fish oil, ginseng, Vitamins C & E, Glucosamine, Chondroitin, Saw Palmetto etc.. Discuss the pros and cons of discontinuing these medications with Dr. Sian. Dr. Sian will provide you with additional preoperative instructions.

Breast reduction surgery is usually performed by Dr. Sian on an outpatient basis. Majority of Dr. Sian’s breast reduction patients are able to go home on the day of surgery. If you do stay in the hospital or surgical facility, it will most likely be for only one night. Whether you are released the day of surgery or the following day, you will need someone to drive you home and to stay with you for the next day or two.

What will the day of surgery be like?

Your breast reduction surgery is performed by Dr. Sian in the hospital (i.e. Clovis Community Hospital).

A general anesthetic is administered so that you will be asleep throughout the procedure. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. In many instances, small drain tubes are placed in your breasts to help avoid the accumulation of fluids. Gauze dressings will be placed on your breasts and covered with a surgical bra.

How will I look and feel initially?

The day after surgery, you will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts.

Any surgical drains will be removed a few days after surgery, as long as there is minimal amount of fluid being collected in the drain reservoir. Make sure you bring the drain record sheet to your appointment so that Dr. Sian is made aware of how much is being collected from the drains. This will help him decide if the drains can be removed.

Dr. Sian recommends that all the surgical dressings be removed or changed after two days. You can take a shower 48-72 hours after surgery as long as the incisions are intact, dry and healing well. Tub baths and/or swimming are not recommended. After taking your shower, dry your surgical incisions thoroughly with a clean towel, place a clean, dry gauze over the incision and wear your surgical bra to hold the gauze in place. Dr. Sian discourages the use of any tape on the breast as these can cause “tape burns”.

You will be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminishes. Most of the sutures used by Dr. Sian are buried absorbable sutures so no sutures need to be removed after surgery.

You may notice that you feel less sensation over the nipple and areola areas. This usually is temporary. It may, however, take weeks, months or even more than a year before the sensation returns. Permanent loss of sensation over parts of or the entire nipple and areolar complex is possible in some patients. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery and gradually lighten in color thereafter.

It is recommended that the patient wear a support bra for at least 4 to 6 weeks after the procedure. Patients should avoid bras with underwire or push-up bras.

When can I resume my normal activities?

After breast reduction surgery, it is often possible to return to work within just a couple of weeks, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor.

Any sexual activity should be avoided for a minimum of two weeks. Dr. Sian may advise you to wait even longer. Care must be taken to be extremely gentle with your breasts for at least six weeks.

How long will the results last?

Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman’s breasts. After several years, if you become dissatisfied again with the appearance of your breasts, you may choose to undergo a breast “lifting” procedure to restore their more youthful contour.

Breast reduction surgery will make your breasts smaller and firmer. Without the excessive weight of large breasts, you may find greater enjoyment in playing sports and engaging in physical activity.

The incisions from your breast reduction surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing, even low-cut necklines.

Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most women eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure.

Maintaining a Relationship with Your Plastic Surgeon

You will return to Dr. Sian’s office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Once the immediate postoperative follow-up is complete, Dr. Sian encourages his patients to come back for periodic checkups to observe and discuss the long-term results of surgery.

Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.