Breast Reduction

Breast reduction surgery provides relief from physical discomfort caused by large, heavy breasts, such as back, neck, and shoulder pain, bra strap grooves, and skin irritation. It can also improve posture, make it easier to find well-fitting clothing, and allow for greater participation in physical activities. Beyond physical benefits, the procedure can boost self-esteem by creating breasts that are proportionate to the body.

Types of Breast Reduction Incisions

Vertical (Lollipop) Incision

The vertical incision technique involves a circular incision around the areola and a straight incision extending vertically to the breast crease. This method suits patients with moderate breast size reduction needs and good skin quality. It provides a more youthful breast shape with minimal scarring.

Anchor Incision

The anchor incision, also known as the Wise pattern, involves an incision around the areola, vertically down to the breast crease, and horizontally along the crease. This technique is suited for patients with very large breasts or significant sagging, as it allows for maximum reshaping and tissue removal.

Breast Reduction Candidates

Beast reduction patients usually seek surgical correction for their large breasts after they have tried to manage the physical symptoms with conservative treatment. Many patients experience back pain, neck pain, shoulder pain, grooving from bra straps, skin rashes, difficulty breathing when lying flat, and poor posture resulting in numbness because of their heavy breasts. Breast reduction patients may also have difficulty finding clothes that fit properly and may have trouble exercising from their large breasts.

Large breasts often run in the family but other factors such as pregnancy and obesity may contribute to large breasts. In addition to being large, the breasts may be uneven in size or have large nipple/areolas. Large breasts not only cause physical symptoms, can often cause emotional distress and self-consciousness as well.

Good candidates for surgery are healthy, don’t have severe obesity, don’t smoke, have a normal mammogram, and have realistic expectations. Breast reduction candidates should consider couple of things before they proceed with surgery such as the scars after surgery, the fact that they may lose sensation in the breast or nipple/areola complex, and that they may not be able to breastfeed after surgery. Discuss future plans to become pregnant with Dr. DiFrancesco, as pregnancy may change your results.

Preparing for Breast Reduction

Preparing for breast reduction surgery involves following pre-operative instructions, such as discontinuing certain medications, avoiding smoking, and arranging for post-surgery support. Dr. DiFrancesco’s team will provide detailed guidelines to ensure a safe procedure and optimal recovery.

About the Breast Reduction Procedure

Breast reduction surgery is performed under general anesthesia and typically involves removing excess breast tissue, fat, and skin. Depending on the technique, incisions are placed strategically to minimize visible scarring. The procedure also reshapes the breasts and repositions the nipple-areola complex for a more lifted and symmetrical appearance.

Wise Pattern Breast Reduction

Wise pattern, commonly known as an anchor incision, describes an incision which borders the areola, extends vertically to the inframammary fold, and horizontally along the inframammary fold. Wise pattern breast reduction can be used with several different types of pedicles. A pedicle describes the blood flow to the nipple areola. The wise pattern breast reduction is usually used in patients with very large breasts or patients who have severe sagging or ptosis of their breasts were the nipple/ areola needs to be moved superiorly.

The inferior pedicle is one of the most common used techniques today. The inferior pedicle breast reduction has the greatest chance of preserving sensation to the nipple/areola complex and breastfeeding after breast reduction.

The superior pedicle breast reduction is for patients with smaller volume breast reductions. The superior pedicle has a more reliable blood supply compared to the inferior pedicle.

This surgical procedure combines the advantages of using the inferior pedicle and the superior pedicle. The superomedial breast reduction avoids the boxy appearance of the breast and long-term bottoming out seen with other techniques. Dr. DiFrancesco uses this technique for very large breasts or breasts with a lot of loose skin. The wise pattern superomedial pedicle gives the best shape and size with long term results.

There are many other different types of breast reduction pedicles including bi-pedicle, lateral pedicle, medial pedicle, and superolateral pedicle.

Vertical Breast Reduction

A vertical breast reduction describes a technique which uses a lollipop incision which borders the nipple/areola and extends vertically to the inframammary fold. The vertical breast reduction is optimal for small breast volumes in patients with good quality skin and can be performed with different types of pedicles, like wise pattern breast reduction.

The superior pedicle was first popularized in France. This technique is great for smaller volume breast reductions with good quality skin. The scarring is minimal with the lollipop scar.

The supermodedial pedicle technique with popularized in Canada and allows larger breast reductions to be performed with a minimal scar. The superomedial pedicle breast reduction technique avoids the long-term bottoming out seen with other techniques and gives the breast a superior shape with a lot of upper pole fullness. Dr. DiFrancesco often combines this technique with liposuction of the lateral breast and axilla to correct the under-arm fullness present with large breasts. The final scarring is the lollipop scar.

Horizontal Breast Reduction

The horizontal breast reduction uses a horizontal incision along the inframammary fold and an incision bordering the nipple/areola complex. There is no vertical incision as seen used in the wise pattern and vertical breast reductions. Horizontal breast reductions use an inferiorly based pedicle. This technique is used with patients who have very loose skin. The disadvantage of the horizontal breast reduction is it leaves the breasts with a boxy appearance.

Breast Reduction in Massive Weight Loss Patients

Massive weight loss patients often have very loose skin and deflated breast tissue. A wise pattern breast reduction technique is used to address to lose skin and shape the breast. In patients with weight loss greater than 75 pounds, they may lose the fullness in the upper pole of their breast. An implant may be needed to restore the cleavage as breast tissue alone may not be enough.

Free Nipple Graft Breast Reduction

Breast reduction with free nipple graft is for patients with a very large breasts and a very low nipple/areola complex. The pedicle would be too long for reliable blood flow and the nipple/areola complex will not survive. The solution is to remove the nipple/areola and reposition it on the breast mound after it has been reduced and shaped. The result will be a smaller, perkier breast. This technique may cause some hypopigmentation in the nipple/areola complex and will eliminate the ability to breastfeed. The free nipple graft may be the only safe technique for breast reduction in our morbidly obese and very large breasted patients.

Combination Procedures

Breast Lift

A breast lift is often combined with breast reduction to address sagging and create a more youthful breast contour. When combined, these two procedures can provide a proportionate and well-shaped breast.

Tummy Tuck

For patients seeking overall body contouring, a tummy tuck can be performed alongside breast reduction to enhance abdominal firmness and balance the body’s proportions. This is a common combination for those looking into mommy makeovers.

Liposuction

Liposuction can be added to contour the sides of the breasts and axillary area, ensuring a smoother, more refined silhouette. Liposuction is best when combined with another breast reduction technique. It is commonly used to contour the lateral breast and axilla to prevent that “side boob” patients complaint of. Liposuction alone will remove breast tissue making the breast smaller, but it cannot shape the breast. Therefore, the breasts are left sagging.

Breast Reduction Recovery

Recovery from breast reduction typically involves one to two weeks of rest and limited activity. Patients may experience swelling, bruising, and mild discomfort, which can be managed with prescribed medications and cold compresses. Dr. DiFrancesco will provide detailed aftercare instructions to ensure proper healing and optimal results.

Final Results of a Breast Reduction

Breast reduction results are long-lasting, with smaller, lighter, and firmer breasts that are more proportionate to the body. As swelling subsides and scars fade over six to twelve months, patients often experience improved comfort, posture, and confidence.

What is the Cost of a Breast Reduction?

The cost of breast reduction varies depending on the extent of the procedure and whether it is combined with other surgeries. During your consultation, Dr. DiFrancesco’s team will provide a detailed cost breakdown and discuss financing options to make the procedure accessible for your needs.

Frequently Asked Questions

What to Expect During a Breast Reduction Consultation

During your consultation, Dr. DiFrancesco will evaluate your breast size, shape, tissue quality, and overall health. You will discuss your goals and expectations, and Dr. DiFrancesco will recommend the best surgical technique to achieve a balanced and proportionate result. This is also the time to address concerns, such as scarring or future breastfeeding plans. Schedule a consultation to learn more about how a breast reduction can help you look and feel your best.