Cosmetic Surgery Tips

Breast Reduction without Removing Nipple

This is usually accomplished without removing your nipples and putting them back on. The technique plastic surgeons use to accomplish this is called transposition, in which the nipple stays fully attached to the breast and only the surrounding skin is moved.

However, some patients prefer not to have any scarring on their breasts, and for these women, there is another option: breast reduction without removing nipples! This method involves using an alternative technique called SmartLipo instead of traditional surgical liposuction techniques to remove excess fat and skin from the breast area while still preserving all existing nerves, blood supply and lymph nodes. The result is smaller breasts with minimal scarring or post-operation pain!

In this post, we’ll also examine signs of nipple dying after breast reduction and nipple sensation after breast reduction.

Breast Reduction without Removing Nipple

Does the nipple have to be completely removed during breast reduction surgery?

In most cases, breast reduction surgery does not require complete removal of the nipple areolar complex. Usually, in the standard vertical and inferior pedicle techniques, the nipple is left attached to an underlying pedicle of breast tissue and shifted to a more superior position without detaching it. In a small subset of extremely large reductions, the pedicle lengths are too long to provide adequate blood supply to the nipple areolar complex and a free nipple graft technique is required.

This procedure involves a complete removal of the nipple areolar complex and a reattachment to the reduced breast mound at the appropriate level. This allows maximal reduction in these patients while maintaining the integrity of the nipple and areolar skin. The main drawbacks of this technique are that the sensation of the nipple is lost, the nipple may lose its projection and become flatter, and in patients of color, the areolar pigment can be affected.

Breast Reduction Surgery

Making Breasts Smaller and Higher Through Surgery

Macromastia (macro=large, mastia=breast)
Large breasts can cause a multitude of problems, including neck, back, and shoulder pain, headaches, shoulder-grooving (where the bra-straps dig in), postural problems (which contribute to upper extremity nerve problems), interference with activities and exercise, rashes under the breasts, inability to find clothing that fits properly, and problems with self-image. As a result, women with large breasts are often in chronic pain, have little energy, may be overweight because they are unable to exercise, and have self-image problems, all of which interfere with quality of life.

Possible Solutions to the Problem of Large Breasts

Weight loss and exercise are usually suggested (if not required) by insurance companies prior to approval for surgery, but are often futile. Weight loss, even if successful, usually does not alleviate the symptoms of macromastia. Many women are unable to exercise because of the large breasts themselves – hence, a catch-22. Aspirin, Tylenol, Ibuprofen, and other medications may benefit some, but usually their effect is limited. Powders may reduce your chance of developing a rash in hot weather. Chiropractic care is rarely of help. Invariably, surgery is the most effective, most efficient, and most successful way to treat the problem of macromastia.

Breast Reduction Surgery

Breast reduction is an operative procedure in which breast tissue and excess breast skin are removed. The removal of breast tissue results in a smaller breast. Removal of excess skin results in a breast that is higher on the chest wall and more aesthetic. This is an important component of this operation, because it allows the breast to be restored to a youthful appearance and shape. If excess skin were not removed, the breast would actually look worse following breast reduction than before surgery.

During the operation, your nipples will be moved to a higher position on your breasts. This is usually accomplished without removing your nipples and putting them back on. The technique plastic surgeons use to accomplish this is called transposition, in which the nipple stays fully attached to the breast and only the surrounding skin is moved. Because the nipple preserves its attachment, most women retain (or improve) nipple sensation, the ability to attain an erect nipple, and the ability to breastfeed.

Getting Your insurance Company to Cover the Cost

Of course, getting your insurance company to cover anything these days can be quite a challenge. Your best bet is to find a plastic surgeon who has a good track record with getting approval from insurance companies. If your plastic surgeon estimates that he or she can remove at least 500 grams (one half pound) from each breast, AND your plastic surgeon can demonstrate that you have incapacitating symptoms that are directly related to your large breasts (see first paragraph on this page), AND your plastic surgeon can demonstrate that you have tried everything in your power to resolve these symptoms yourself (see second paragraph), AND your plastic surgeon can provide photos demonstrating the need for this

Recently, however, meeting ALL of the above criteria has STILL not been enough. Most insurance companies now also require that the woman requesting this operation be at or near her ideal body weight. Unfortunately, this is where the catch-22 appears again: Women with macromastia are often unable to exercise because their large breasts are too cumbersome to allow it. So, they are unable to lose the weight necessary to satisfy the insurance company’s requirements for pre-authorization. Dr. Shay Dean has found that when she includes in her letter to the insurance company the patient’s prior history of macromastia during times of near ideal weight (if applicable), that this information verifies that IF the patient were able to lose weight, that she would still have macromastia and still be in need of the operation. You should ask your surgeon about including this information in your letter or pre-authorization (if applicable in your case).

Of course, even though it may seem unfair that you and your surgeon are made to jump through such hoops, it is critical that both you and your surgeon include only honest information in your letter to the insurance company. Also, remember that even if your insurance company pays for the procedure and even if you use an in-network physician, you may still be responsible for a portion of the cost (check your policy to find out).

FYI – Many of you have inquired about whether Dr. Dean still performs breast reductions. He does so, and this continues to be one of his most common procedures. He accepts nearly all insurances.

Breast Reduction: During and After Surgery

Anesthesia: General Location of operation: Surgery Center or hospital. Length of surgery: 2–4 hours Length of stay: Overnight Discomfort: Moderate. Anticipate 3–7 days of prescription pain medication. Swelling and Bruising: Improve in 2-4 weeks. Bandages will be removed in 1–7 days. Stitches: will be removed in 5-7 days or will be absorbable. Support: You will wear a sports bra or ace wrap for 1-4 weeks. Avoid an underwire bra until your surgeon approves it. Back to work: 1-3 weeks. Exercise: May be resumed in 2-4 weeks. Final result: will be seen after the scars have matured, which will be about 1-3 years.

Risks of Breast Reduction Surgery

Scars: The only drawback to removing excess skin is that it necessarily causes scars. Fortunately, the scars can be limited to areas that are hidden when you are wearing a bra; they are located around the nipple, below the nipple, and along the crease beneath the breast. The scars fade after surgery, but it can take years for them to do so. There are some techniques of breast reduction that may eliminate the scar along the crease, but most of these techniques are in the development stage at this time. Usually the scars are acceptable, especially when considering the benefits gained in quality of life following breast reduction, but no one can guarantee that you will be pleased with your scars. If you are going to have this operation, you simply must accept the fact that you are exchanging the problem of macromastia for scars.

Nipple or breast numbness or sensory change: Numbness is uncommon. It is more likely that your nipple sensation will improve because the nerve to your nipple will no longer be stretched due to the weight of your breasts.

Nipple Loss: This is a tragic problem, because, in it, one or both nipples lose their circulation and die. There would also be an open wound, requiring care. Eventually, the wound would close, or surgery would be necessary to close it. Then, using your own skin or by tattooing a nipple, you would artificially recreate the nipple. Nipple loss is most likely to occur in smokers, but may occur in anyone. If you smoke, you should quit at least 2-4 weeks prior to surgery to reduce your risk of this problem.

Infection, bleeding, fluid collections (seromas), asymmetry (unevenness between sides), and healing problems may occur following any surgery. If you are young and healthy and follow your doctor’s instructions, you may reduce your likelihood of these events.

Final Size: No one can guarantee your final cup size because cup size are not standardized. Have a detailed discussion with your plastic surgeon prior to surgery to communicate your desired size. Explaining your preference in comparison to your current size is sometimes very helpful. For example, you might want to be somewhere between one third and one half of your current size.

Tips and Traps of Breast Reduction

Realize that this operation involves scars. If you are unwilling to accept scars, you should not have this operation, as no surgeon can predict how the scars will heal.
Quit smoking for at least two weeks before surgery.

Breast Reduction

Symptoms, Solutions, Surgery, Preparation, Recovery, and Tips

Women and girls as young as 14 can have a breast reduction, provided their breast size has been stable for 12 months.

Symptoms of Macromastia (Large breasts)

Large breasts can cause a multitude of problems, including neck, back, and shoulder pain, headaches, shoulder-grooving (where the bra-straps dig in), postural problems (which contribute to upper extremity nerve problems), interference with activities and exercise, rashes under the breasts, inability to find clothing that fits properly, and problems with self-image. As a result, women with large breasts are often in chronic pain, have little energy, may be overweight because they are unable to exercise, and have self-image problems, all of which interfere with quality of life.

Possible Solutions to the Problem of Large Breasts

Insurance companies frequently recommend (if not demand) weight loss and exercise before approving breast reduction surgery, but these measures frequently fail. Weight loss, even if successful, usually does not alleviate the symptoms of macromastia. Many women are unable to exercise because of the large breasts themselves; hence, a catch-22. Aspirin, Tylenol, Ibuprofen, and other medications may benefit some, but usually their effects is limited. Powders may reduce your chance of developing a rash in hot weather.

Chiropractic care is of limited help, particularly in cases involving significantly large breasts. Invariably, breast reduction surgery is the most effective, most efficient, and most successful way to treat the problem of macromastia.

Breast Reduction Surgery (Reduction Mammaplasty)

Breast reduction is an operative procedure in which breast tissue and excess breast skin are removed. The removal of breast tissue results in a smaller breast. Removal of excess skin results in a breast that is higher on the chest wall and more aesthetic. This is an important component of this operation, because it allows the breast to be restored to a youthful appearance and shape. If excess skin were not removed, the breast would actually look worse following breast reduction than before surgery. So, think of a breast reduction as a breast lift in which your breasts are also made smaller.

During your breast surgery, your nipples will be moved to a higher position on your breasts. This is usually accomplished WITHOUT removing your nipples and putting them back on. The technique plastic surgeons use to accomplish this is called transposition, in which the nipple stays fully attached to the breast – only the surrounding skin is moved. Because the nipple preserves its attachment, most women retain (or improve) nipple sensation, the ability to attain an erect nipple, and the ability to breastfeed.

Women who have such markedly large breasts that attempted preservation of the nipple can threaten the entire operation may be advised to have a free-nipple breast reduction. In this operation, the nipple is actually removed at the beginning of the operation and placed at the end of the operation as a graft. But this is uncommon. Nipple sensation, appearance, and function (breast feeding) will be forever altered, but this is sometimes the best option for women whose breasts are so large that other operations would pose too great of a risk. Once again, this technique of free-nipple grafting is not nearly as common as the techniques which involve preservation of the nipple.

Preparation and Recovery from Breast Reduction Surgery

  • Anesthesia: General
  • Location of operation: Surgery Center or hospital.
  • Length of surgery: 2-3 hours
  • Length of stay: Overnight or Out-patient
  • Discomfort: Moderate. Anticipate 3-7 days of prescription pain medication. This can be reduced through the use of long-acting local anesthetics used by your surgeon at the time of surgery.
  • Swelling and Bruising: Improve in 1-2 weeks.
  • Bandages: If bandages are used, they will be removed in 1-3 days.
  • Stitches: Will be removed in 5-7 days or will be absorbable. Most plastic surgeons use stitches that absorb, so removal is not required.
  • Support: You will wear a sports bra or ace wrap for 1-4 weeks. Avoid an underwire bra until your surgeon approves it.
  • Back to work: 1-2 weeks.
  • Exercise: May be resumed in 2-4 weeks.
  • Final result: will be seen after the scars have matured, which will take about 1–3 years.

Tips on Breast Reduction

  • Probably the very best tip is that if you have large, symptomatic breasts, don’t put off having a breast reduction. Most women rate procrastination as their main regret of this operation.
  • If your insurance company does not cover this operation, do not despair. You may always choose to have it performed as a fee-for-service procedure, meaning that you pay out of pocket). In fact, many women find that the cost of having breast reduction without insurance is the same as having it with insurance. You read that correctly. This is because of high deductible fees on most plans. See our costs here.
  • Wait until you are finished child-bearing before having a breast reduction, if possible. Although this is not mandatory, pregnancy may cause breast enlargement or droop, which may in turn send you back to your plastic surgeon for another procedure. If you are able to wait until you are finished having children, you may be able to avoid this. On the other hand, young women with symptomatic macromastia who do not intend o have children for several years may appropriately choose to proceed with a breast reduction at a young age, as deferring it can take a different toll. So, in general, Dr. Loftus recommends that if you are planning to have children within a few years, hold off on the breast reduction until you are finished. If childbearing is finished or a long way off, then do proceed with a breast reduction.
  • Ask your plastic surgeon to use long-lasting local anesthetic at the time of your operation to reduce your post-operative discomfort.
  • Ask your plastic surgeon if he/she can use absorbable sutures so that they do not require removal.

I Regret My Breast Reduction

Signs Of Nipple Dying After Breast Reduction

What is the main sign of nipple necrosis? An unexpected color change.

If your nipple is paler than expected, there may not be enough blood flow into the nipple. If your nipple is purple or darker than expected, there may not be enough blood flow out of the nipple.

If a doctor or other healthcare professional concludes that you do have nipple necrosis, your surgeon can either go back in and reattach the nipple to the blood supply or perform a free nipple graft. The latter involves detaching the nipple from the underlying breast tissue and reattaching it as a graft.

Nipple Sensation After Breast Reduction

 For sensation to gradually increase after the cosmetic surgery, the damaged nerves need time to regenerate. For some patients, nipple sensation has been reported to return within 2–3 months, but this can vary. Although surgeons will try to preserve the nerves, 20–30% of patients lose some sensation. 

Leave a Comment

Your email address will not be published. Required fields are marked *