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If you are considering a breast lift in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading ...

FREQUENTLY ASKED QUESTIONS:

What is a breast reduction? Also known as reduction mammaplasty, this is an operation intended to reduce the size of a woman's breasts and improve their shape and position. Frequently, the areola (dark skin around the nipple) is also made smaller. Functional symptoms (medical disorders) caused by excessive breast weight may be relieved or improved by this operation.

What is a breast lift? A breast lift, or mastopexy, is designed to improve the shape and position of the breasts without reducing their size. It is used for breasts which sag but are not large. Sagging of the breasts may occur with normal development for some women or as part of aging. Pregnancy, breastfeeding and weight loss are other conditions which increase breast ptosis (sagging). Some patients will have a better shape to their breast if an implant is used at the time of mastopexy. This procedure is not covered by insurance.

Where are the incisions? There are a variety of techniques for these operations. Most commonly there is an incision around the areola, another between the areola and breast crease, and the third within the crease under the breast. This is an "anchor –shape" or inverted "T" incision. Occasionally, especially with mastopexy, these incisions may be modified and more limited. Some operations may require only the incision around the areola.

Will insurance pay for my surgery? Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). When the excessive size causes functional problems, insurance will generally pay for the operations. These problems may include neck pain, back or shoulder pain, hygiene difficulty and breast pain. Other problems that are less likely to be covered by insurance include: skin irritation, skeletal deformity, breathing problems, psychological/emotional problems and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.

Special note on reduction of extraordinarily large breasts: In extraordinarily large or bulky breasts, for technical reasons, we sometimes remove the nipples completely and put them back as "free grafts". The sensory nerves are all cut, and even though a certain amount of sensation returns after healing, it will never be normal and erotic sensation is lost completely. The milk ducts are interrupted in this operation, so nursing would be impossible. You will be informed in advance if your breasts are in this category.

How long is the patient hospitalized? For a reduction mammaplasty, one day of hospitalization is usually needed if there are no complications. A mastopexy can be done as an outpatient procedure, requiring no hospitalization. Usually suction drains (plastic tubes) are left in place after surgery with breast reduction, and possibly with a mastopexy.

What kind of anesthesia is used? A general anesthetic is used on all reduction mammaplasties and some mastopexies. Some mastopexies can be performed using local anesthesia and intravenous sedation.

Who is on the surgical team? Generally, two board certified surgeons will perform the operation. There may be a separate bill for the assistant surgeon's fee.

What can I expect post-operatively? Discomfort, swelling and discoloration of the breasts are to be expected for several weeks. Usually, our patients return to almost normal activity within two weeks. The scars at the incision lines typically become reddish, raised and firm a few weeks after surgery, but after many months become pale and soft. After 8-12 months, the scars are relatively inconspicuous. The nipples and some areas of the skin may be numb or sensitive after surgery. Sensation frequently returns within a few weeks or months but may be diminished or overly sensitive.

Will the breasts start to sag again? Gravity continues to have its effect, and there is a tendency for the skin of the breast to stretch over long period of time. Women vary a great deal in this respect. In general, the smaller the breasts, the less tendency for sagging to recur. If the breasts sag further, excision of the skin on an outpatient basis can be used to correct the problem. If we try to lift heavy breasts without making them smaller at the same time, sagging will return soon. One key to a satisfying result is realistic expectations - a wide based large breast will not look like a smaller, but firm narrow based breast.

What are the alternatives to surgery? Occasionally patients respond to weight loss. Some patients can be improved with liposuction or liposuction and surgery. Patients with small amount of sagging may do well with breast implants alone.

What are the risks of surgery?

Initial

1. GENERAL RISKS of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site), bleeding , reactions to anesthetic.

2. BLEEDING: When blood collects beneath the skin it causes excessive discoloration. Sometimes lumps which last many months, may occur. If blood collection is discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it. If bleeding continues, it is sometimes necessary to return to the operating room to stitch the bleeding vessels. This risk is increased in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing products for two weeks before and two weeks after surgery. (See list of medications that may increase bleeding.)

3. LOSS OF SKIN OR NIPPLE: The skin will sometimes lose its blood supply. When this happens, an area of skin or nipple will fail to survive and a number of weeks are needed for healing. Rarely, a skin graft may be needed to obtain healing. This risk is increased in smokers; therefore, you must stop smoking for 4 weeks before and 4 weeks after surgery.

4. INFECTIONS: A significant wound infection requires antibiotic treatment and a longer stay in the hospital. Sometimes the wound must be opened to drain the infection and then the healing process is slowed.

5. SEROMA: On occasion, a clear yellowish fluid collects in the wound under the skin. It may require aspiration with a needle and syringe in the office. Aspirations may have to be repeated for several weeks.

6. STITCH DRINAGE SITES: Frequently, in the center of the small amounts of fluid will drain from around a buried stitch. This is simply washed daily and covered with gauze. The usual course is for the opening to close over a period of 1-2 months with little trace.

7. NUMBNESS OR PAIN: Many little nerves are cut as part of the operative procedure. These must grow out again over a period of some months. Numbness of the abdominal skin will be noticed during this period. Sometimes the sensation does not return completely. Occasionally scar tissue forms around a healing nerve, causing pain. Usually this disappears within a period of several months.

8. FAT NECROSIS: Sometimes areas of fat in the breast liquefy,(particularly in extremely large breasts), and the liquefied fat must be drained through a small opening. Other areas may become firm or nodular. These usually soften over time.

9. ASYMMETRY OR UNDESIRABLE SHAPE: Breasts and nipples/areolas are never symmetrical to start, and although we make every effort to make them match, we rarely succeed totally. The difference is usually small, but sometimes the match is poorer that expected or the shape is not as good as expected. Rarely, a second smaller operation is done for improvement.

10. WOUND DIHESCENCE or separation of incisions occurs rarely and will delay the healing process.

11. SCARS: Every operation creates some type of scar. Incisions are planned to hide and minimize visible scarring. However, scars are not predictable and infrequently patients will develop scars that are widened, thickened, raised, more red or generally more visible than anticipated (hypertrophic or keloid). Normally, scars go through a maturation process which take months. This includes an expected period of thickness redness and firmness, during the first 4-6 months. (More information on scars is available upon request).

12. LOSS OF NIPPLE SENSATION: Numbness in the nipple area may be permanent and sometimes even erotic sensation (sensation related to sexual stimulation) is lost.

13. INTERFERENCE WITH NURSING: With current techniques, we try to leave the mild ducts completely intact, and although we have had patients successfully nurse their babies post-operatively, this is not predictable. Large breasts are often deficient in glandular tissue, and nursing may not be successful even though the duct system has been preserved. Milk cysts have been reported in post-reduction mammaplasty patients who have nursed an infant.

14. RECURRENT HYPERTROPHY: Young women with excessive growth during adolescence may have continued growth after a breast reduction requiring additional surgery as they get older. In other patients, breasts can change significantly with pregnancy requiring other operations.

15. BLOOD CLOTS IN THE LEGS OR LUNGS: (thrombosis and pulmonary embolisms) : Some people (particularly older people) tend to form blood clots in their lungs after abdominal surgery ,especially if their hips are in a flexed position. These blood clots can break off and go to the lungs. It is possible for such an event to be fatal. It is important for the patient to get up out of bed and begin walking as early as possible after surgery to avoid this problem. Elastic stockings may also be used to help prevent this problem.

16. ATELECTASIS AND PNEUMONIA: Following a general anesthetic, there is a tendency for the air sacs in the lungs to stick together. It is very important for patients to take deep breaths and to cough vigorously at frequent intervals after surgery to inflate the air sacs. Once in a while, some air sacs will stay collapsed, causing patients to have a fever. The area in the lung that is affected can often be seen as a shadow on a chest x-ray, and is called "atelectasis". Patients must then make every effort to breathe deeply, to cough frequently and to expand the air sacs, otherwise, pneumonia can result and hospitalization will be prolonged.

17. PHOTOGRAPHY: Photographing, filming, or videotaping of the treatment or procedure for educational or diagnostic use is a standard and required part of patient care.

18. NO GUARANTEE: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.

19. COMPLICATIONS AND ADDITIONAL SURGERY: Any of these problems noted above may require additional surgery, hospitalization, and time away from work. If this occurs, there will be additional costs for surgical fees, supplies, anesthesia, etc., depending upon the required operation. Complications of cosmetic surgery generally will not be covered by medical insurance.

20. For cosmetic mastopexy procedures, if additional surgery is required , these costs are the responsibilty of the patient.

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