Breast Reduction

Conveniently located to serve Waldorf, St. Charles, and White Plains

Breast Reduction – Reduction Mammaplasty

Women with excessively large breasts suffer. Shoulder, neck and lower back pain are some of the symptoms which worsen over time and age. During the warm months, the women with large breasts (termed macromastia) frequently have a skin rash (termed intertrigo) where the breast skin rubs. In the past when insurance companies covered the cost of surgery for a breast reduction, a patient would first have to undergo such things as physical therapy, wearing back braces, wearing specially fitted support bras etc. These treatments rarely improved the symptoms and were all designed to either delay or prevent a woman from having the necessary surgery. In addition, the plastic surgeon was required to remove a minimum weight of 500 grams of breast tissue from each breast. This arbitrary weight could be an insignificant amount in a very large breasted woman. However, in a small petite woman with large breasts, 500 grams could be the majority of the breast. A factor in assessing breast size relates to relationship between breast size/volume and the body habitus of the woman. Today, there are very few insurance companies that consider breast reduction surgery as medically necessary. Despite many scientific articles which demonstrate the benefits of reduction mammaplasty, most insurers consider the operation to be cosmetic. A woman considering reduction mammaplasty must be prepared to spend a great deal of time dealing with her insurance company, only to find out that it is usually not covered. In Dr. Fontana’s office, we will assist the patient giving them all the appropriate diagnosis (ICD9) and procedural codes (CPT) necessary for coverage by an insurance company. Once the patient has decided to have surgery, Dr. Fontana must determine which of the many techniques for breast reduction is best suited to the particular patient. Independent of the procedure, the patient must understand;

Breast Reduction Surgery is a Trade-off

Smaller Better Shaped Breasts vs. Scars

Inverted “T” Anchor or inferior pedicle reduction mammaplasty

If the predominant drawback of breast reduction surgery is scars, then an operation which limits scar is preferred. The most common, but not the preferred surgical technique is the so-called inferior pedicle breast reduction. The scars produce the so-call “inverted T “. Generally the scars around the areola and vertical scar heal quite well. The horizontal scar can extend from the area of the breast bone to the underarm depending on the shape and width of the breast. It is the long horizontal scar which can produce very unsightly, conspicuous scars which can thicken and become painful. The overall breast shape after this operation is usually good when performed by an experienced plastic surgeon, though the breast tends to be flatter than the idealized breast shape.

Vertical or short scar reduction mammaplasty

Dr. Fontana’s preferred operation for reduction mammaplasty uses the vertical scar or short scar technique. This method eliminates or greatly reduces the length of the horizontal scar. In addition to reducing the scarring, the breasts have a better projection when compared to the inferior pedicle reduction mammaplasty. An experienced plastic surgeon is particularly important in producing an attractive result.

Other Procedures for Reduction Mammaplasty

The two less commonly utilized surgical techniques are a.) Mckissock reduction mammaplasty and b.) Reduction mammaplasty with free nipple graft. The McKissock procedure produces scars similar to the inferior pedicle technique and gives a similar result. As with the other procedures, nipple sensation is maintained in most cases. Nursing following pregnancy is generally not possible, although there are rare exceptions. Reduction mammaplasty with free nipple graft is reserved for women with huge or gigantic breast (termed gigantomastia). The nipple/areolar complex is surgically removed, the breast is reduced in size, and the nipple areolar complex is skin grafted on the newly created breast mound. There is no nipple sensation . The breast generally looks flattened and the scars are the same as the inferior pedicle or McKissock technique. Patients with huge breasts generally approve of the new shape and size of their breasts following this type of surgery.

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