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Surgeons performed more than 144,374 breast reductions (reduction mammoplasties) in 2004, a slight decrease of 2 percent from 2003, according to the American Society for Aesthetic Plastic Surgery. Of all body image changes, patients report that breast reduction results in the quickest results. Breast reduction can change the size, weight, firmness, and shape of breasts. To remove skin and breast tissue, the surgeon usually makes an incision extending down from the areola (the colored area around the nipple) to the crease where the breast meets the torso. The surgeon then makes a U-shaped incision in the crease under the breast. After excess fat, tissue, and skin are removed, the surgeon pulls together the skin from both sides of the breast. Nipples sometimes must be removed and repositioned and the incisions are sutured. The procedure is performed under general anesthesia and lasts about two to four hours. Patients usually require a one- or two-night stay in the hospital, while some can be done as outpatient procedures.
"Breast reduction patients as a group are the happiest patients in plastic surgery," says surgeon Gary S. Berger of New York City. "Most cosmetic surgical procedures deal with self image issues alone, whether it's hip contour, small breast size, or the aging face. These are nonfunctional problems. Patients who undergo true breast reduction will also be addressing medical issues -- back pain, neck pain, rashes under their breasts, arm problems. So while breast reduction is a contouring procedure -- creating more appropriately sized breasts for a particular body shape -- it also solves many medical problems. These patients are the happiest because as soon as the surgery is over, the large weight they've carried around is gone."
Pain Level/Recovery Time: After surgery, the incisions are covered in gauze and the breasts are wrapped in an elastic bandage or surgical bra. In some cases, a small tube is placed in each breast to drain blood and fluid for the first day or two. Stitches are removed in one to three weeks. Most women experience some breast pain for the first few days, and then mild discomfort for another week. Swelling and bruising may last for several weeks. Taking pain relievers and wearing a surgical bra, a garment that offers soft support and compression, 24 hours a day may help reduce the discomfort and swelling. Most women can return to their usual routine within one or two weeks, provided they avoid strenuous activity or heavy lifting. Scars, which are considered permanent, are usually well concealed in areas covered by a bra or bathing suit. They usually fade over time. Although most swelling and bruising disappear within six weeks, many women will find that it may take six months to a year before their breasts settle into their new shape.
$5,508 (national average for surgeon's fees).** Average surgeon's fee for breast augmentation may vary by region:
For New England (CT, ME, MA, NH, RI, VT) and Middle Atlantic (NJ, NY, PA): $6,058 For East North Central (IL, IN, MI, OH, WI) and West North Central (IA, KS, MN, MO, NE, ND, SD): $5,068 For South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV): $5,232 For East South Central (AL, KY, MS, TN) and West South Central: (AR, LA, OK, TX): $5,287 For Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) and Pacific (AK, CA, HI, OR, WA): $5,838
** Note: These averages for surgeon's fees are provided by the American Association for Aesthetic Plastic Surgery. These figures do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, or other miscellaneous costs related to surgery. Some insurance companies will cover the cost of breast reduction if the surgery is performed to relieve back pain, skin irritation, or other medical problems caused by large, heavy breasts. They will not cover the cost of surgery performed solely for cosmetic purposes.
Breast reduction can help women who suffer with the consequences of large, pendulous, or disproportionate breasts. Large breasts can cause back pain, skin irritation, and poor posture. Bra straps may leave painful indentations on a woman's shoulders. Exercise and sports are often difficult for women with large breasts. Sometimes large-breasted women or girls experience embarrassment or self-consciousness wearing a swimsuit. It may be difficult to find clothing that fits well. Breast reduction can relieve the physical discomfort, as well as the emotional difficulties, of having large breasts.
Breast reduction is considered permanent, but breast size may change as a result of weight gain, pregnancy, and age. The risks of breast reduction include the following:
Scars: The severity of scars varies from patient to patient. The scars usually fade over time, but they may remain noticeable in some women. Fortunately, incisions are usually made in areas that can be concealed by a bra or bathing suit.
Uneven breasts or nipples
Loss of feeling in breasts or nipples: This effect is usually temporary (lasting a few months), but may be permanent in some patients. Nipples may permanently lose sensation if they were removed and repositioned during surgery.
Nursing after surgery: Depending on the type of breast reduction, some women may be able to breastfeed after surgery. In some cases, the milk ducts under the nipple are permanently damaged.
Audrey, 47, Pittsburgh
Audrey dreamed of having a breast reduction for 20 years. "I had old-lady breasts at the age of 16," she says. "I was always teased. My breasts pulled downward. They were never perky. I always felt like a pinhead, like my head was little and my breasts were huge." As an adult, she wore a size 38DD bra. "If I ran or did aerobics, I had to wear two workout bras to strap myself in. Otherwise I couldn't move around. I couldn't lie down or do anything face down," she says. Audrey also suffered from a chronic skin rash. Her bra straps cut deep grooves into her shoulders. When she became pregnant, her cup size increased to an F.
Audrey visited two doctors who she felt were insensitive to her problems. Then she met a plastic surgeon in Pittsburgh who listened to her needs. "He was very specific in terms of what I should expect, how I would feel afterward, and what complications might occur," Audrey recalls.
They scheduled the surgery in March 2002. "It was probably more intense than I imagined," Audrey says. She had general anesthesia and stayed in the hospital overnight. Her stitches ran in anchor shape down from each nipple, with a U-shape beneath each breast. She also had stitches around her nipples since they were repositioned. "I would not say I was in pain. It's uncomfortable, it's a healing process," Audrey says. The stitches were removed after a week. She continued to feel twitching or achiness for about six months. But today, she reports, the scars are barely noticeable.
Perhaps the biggest bonus was that medical insurance covered the $10,000 fee because Audrey met certain medical criteria. "I paid $111 out-of-pocket," she says.
She now wears a 36B or C. "There's no comparison in terms of how much better I feel about myself -- going to the gym and working out. My posture is really good. I can wear tank tops," she says. "I ask myself, 'Why didn't I do this years and years ago?'"
To Learn More: the Public Site section of the American Society for Aesthetic Plastic Surgery's Web site. Or call their toll-free referral line at 1-888-ASAPS-11.
Check out the Learn section of BeautySurg.com, the "cosmetic surgery supersite."
For physician referrals, call the American Society of Plastic Surgeons referral service at 1-888-4PLASTIC or visit them online. Click on "Learn About Procedures" to find out more.