Bizymoms, April 29, 2010 – Interview on Breast Reduction

An Interview on Breast Reduction With Jeffrey H. Donaldson, MD , A Qualified Plastic Surgeon For Moms In Columbus

1. Will breast reduction affect pregnancy or breastfeeding?

Breast reduction will not affect pregnancy, but it may dramatically decrease the ability to breastfeed. I usually counsel patients to wait for surgery until after they are finished having children, but there are times when the symptoms of large breasts are so severe that patients cannot wait. In this situation, I use a central mound technique to preserve as much functional milk-producing tissue and ducts beneath the nipple as possible.

2. Is there anything I should do to prepare myself for breast reduction surgery?

Prepare to be extremely happy with your results! Most of my patients have one complaint: they wish they had done the surgery years ago. They feel immediate relief from their aches, pains and rashes. They can buy normal bra sizes and play sports without the extra weight on their chests. One of my breast reduction patients is a concert pianist, and she can finally reach the farthest keys now without struggling past her bosom! To be fair, you should also prepare for the potential risks of assymetry, changes in nipple sensation, wound healing issues and lengthy scars.

3. Will I be able to return home the same day as my breast reduction surgery?

Yes: this is same-day, outpatient surgery in my practice. I minimize discomfort by using general anesthesia during the procedure (patients are fully asleep), as well as a generous amount of local anesthesia (numbing medicine) to ease the transition as patients wake up. Before they go home, patients begin taking oral pain medicine so that there is never a lapse in comfort. I usually schedule a follow-up visit the next day to check healing.

4. Who is NOT a candidate for breast reduction surgery?

Patients with active infections, abnormal breast masses, pregnancy, extreme obesity, tobacco abuse and compromised immune systems are not candidates. In order to be considered for insurance coverage of a breast reduction, patients must be able to document a strong history of symptoms and failure of conservative therapy. This might include back/neck/shoulder pain, rashes and activity limitations despite weight loss, supportive devices, prescription medications, physical therapy or massage. In the absence of severe functional problems, breast reduction surgery is considered cosmetic and patients pay out-of-pocket for the operation.

5. When is the best time of your life to have the surgery?

It is best to wait until adulthood, when your breasts are finished growing. Ideally you would wait until after you are finished having children since pregnancy and breastfeeding affect the size and shape of the breast.

6. How much breast tissue can be removed/what size can my breasts be reduced by?

There is no limit to the amount of breast tissue that can be removed, although the average is one to two pounds per side. I take most of the tissue away from the outer breast that crowds into the armpit, and from the lower breast that causes sagging beneath the breast fold. I preserve fullness in the upper and inner breast because most women want a higher, youthful shape with cleavage despite a decrease in several cup sizes.

7. How do I decide on what size I want to be/ What size will my breasts be after surgery?

I have very specific conversations with my patients to understand their goals regarding shape and size. Typical answers range from “take as much as you possibly can” to “just a little bit,” but most women want to stay within proportion to the rest of their body. The exact size cannot be established in most cases, so communication between surgeon and patient is essential when relying upon intra-operative judgment. It is difficult to predict cup sizes in advance because everyone heals differently, bra manufacturers are not standardized, and some patients like a tighter fit than others.