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Breast Reduction

Breast Reduction

Miami breast reduction surgeon, Dr. Sam Gershenbaum combines modern technology with vast experience to offer the best breast reduction surgery in Florida. His two year plastic surgery residency at the University of Medicine and Health Sciences, Des Moines Iowa afforded Dr. Gershenbaum with a massive 60 breast reduction cases to perfect his skills. And now, after 30 years in practice, patients from all over seek out Dr. Gershenbaum for his exceptional results.

For many women, the size, shape, and contour of their breasts do not fit their self-image. Women with unusually large, sagging, or uneven breasts are dissatisfied with their physical appearance. Some experience pain and discomfort due to the weight of their breasts and the pressure of bra straps on their shoulders and neck. Excessively large breasts can affect posture, limit physical activity and exercise, and make it difficult to find properly fitting clothes. Ungainly stares and rude comments may further promote a feeling of self-consciousness, limiting confidence and adding psychological strain to the physical symptoms.

At our Brickell Riverfront Surgery Center in Miami, Florida, we routinely perform breast reduction or reduction mammaplasty to reduce and lift overly large and sagging breasts to a more comfortable size and shape. Breast reduction surgery improves body contour, reduces pain, and increases comfort in daily activities and exercise. Breast reduction is generally performed on women who have fully developed breasts, but occasionally, it is necessary in teenage girls who suffer from the physical and psychological symptoms of overly large or asymmetric breasts. Patient satisfaction with breast reduction is exceedingly high, and a great majority of women who have had this procedure wish they had had the procedure earlier.

An ideal breast reduction candidate is uncomfortable with their large and/or asymmetric breasts. Patients must also be free of medical conditions such as heart disease, hypertension, diabetes, skin/connective tissue disorders, etc. If pregnancy is planned for the “near” future, it is best to wait until well after breast-feeding is complete.

Breast Reduction Consultation

The initial consultation is extremely important to review the patient’s medical history, goals, and expectations, as well as build mutual trust and rapport. During the initial consultation with Miami breast reduction surgeon Dr. Sam Gershenbaum, you will review numerous before and after photos from previous breast reduction procedures. The procedure is explained in complete detail, and treatment variations are discussed to meet your particular needs. Dr. Gershenbaum also uses this consultation to get to know his patients, developing a level of patient-surgeon trust that he feels is necessary for a comfortable surgical process. A complete evaluation reviewing expectations and physical examination is needed to determine the best choice of procedure(s) for each individual patient. Careful discussion as to the requested final breast cup size is important to best meet those expectations. Once agreed upon between the patient and Dr. Gershenbaum, this plan, along with incision/scar placement will be discussed in detail. All breast reduction patients are also offered the option to use an absorbable mesh to add additional long term breast support and shape. One of the issues with breast reductions and lifts is the skin and soft tissues ability to maintain the elevation and shape of the breast over time. Much of this will depend on the size and weight of the breast, along with the variable thickness and quality of the dermis. Also, gravity is a constant force that will weaken breast tissue’s structural integrity and elasticity over time. GalaFLEX is a synthetic mesh, much like absorbable suture material, that slowly dissolves in the body over 12 to 18 months into water and carbon dioxide. GalaFLEX absorbable mesh acts like an internal bra that supports the internal breast tissues and is secured to an elevated position on the chest wall. As the mesh dissolves, it is replaced by the body’s natural collagen and elastin fibers to create a scaffold that is two to four times stronger than would be if no mesh were used. This new tissue scaffold support can provide more lasting long term shape and support. It certainly does add cost to the surgery, but Dr. Gershenbaum uses this absorbable mesh routinely and highly recommends it if possible.

Prospective patients are encouraged to speak with previous patients about their experience, surgery and results. Dr. Gershenbaum and his staff are always available for questions. Following the initial consultation and after appropriate time for reflection and decision making, an appointment is scheduled for routine preparation and informed consent. Additional questions and concerns may also be addressed. Routine blood analysis and medical clearance is required prior to any surgery. Depending on one’s age and history, and previous studies, a breast cancer screening procedure may be recommended prior to surgery.

Types Of Breast Reduction Surgery Procedures

There are currently several techniques for breast reduction in Miami, Florida. Each of the following breast reduction techniques is aimed to remove excess breast tissue, elevate and add contour to the breasts and reposition the nipple.

“Keyhole” pattern or “Anchor” scar breast reduction

The most common and standard breast reduction technique uses a “keyhole” pattern or “anchor” shaped incision. The incisions/scars for this procedure extend in three areas.

  1. Entirely around the areola (the pigmented area around the nipple)
  2. From the areola in a vertical direction down to the fold or crease under the breast
  3. Horizontally along the fold or crease under the breast extending for a variable length

Generally, the larger the breast and the greater amount of the reduction and lifting, the longer will be the horizontal portion of the scar. Skin and breast tissue are removed and sculpted from the inner and outer quadrants of the breast and from the area above the nipple. The nipple and areola are preserved on a pedicle or mound of breast tissue that carry the blood supply and also serves to add volume and shape to the breast. The remaining breast tissue and nipple are relocated in this keyhole pattern and the incisions closed. Dr. Gershenbaum always spends the extra time to confirm all the markings and measurements using a “tailor-tack” technique before making any incisions. A “tailor-tack” technique sews and joins all the tissue/skin together, making final adjustments as needed, to preview the result before the incisions are made. It takes longer, but produces the most reliable results. Dr. Gershenbaum also does not use clips or staples to close the skin. All incisions are closed with sutures below the surface of the skin to avoid cross-hatching and suture marks to optimize the chances for the finest scars. This traditional “keyhole” or “anchor” scar breast reduction typically preserves nerve connection to the nipple and keeps most of the milk ducts intact. Hence, there is reduced potential for loss of nipple sensation and an increased likelihood of being able to breastfeed in the future.

A circumareolar – vertical or “lollipop” breast reduction

A circumareolar – vertical or “lollipop” breast reduction technique is a type of minimal scar breast reduction aimed at reducing scars. It is also known as a short-scar breast reduction or vertical incision breast reduction. This procedure is best suited to women who require a more moderate amount of breast tissue removal, and perhaps a degree of lift. This technique will consist of removal of excess breast tissue either by excision and/or liposuction and will result in incisions/scars only around the areola (the pigmented area around the nipple) and vertically down to the crease under the breast.

Scarless breast reduction

There is also a scarless breast reduction technique, which is another modality in selected individuals to reduce breast size with no visible scars. This liposuction only breast reduction technique is meant for patients who are not willing to accept the scars associated with the more standard breast reduction techniques, but are willing to accept a less dramatic change in size and shape. This procedure will work well on breasts with larger amounts of fat and will not be an option for those who have more significant dense breast tissue as seen on mammogram or MRI. This liposuction only procedure will result in a conservatively smaller breast and an overall elevation of the breast and nipple. However, the overall shape will remain about the same. In other words, as the breast volume and weight is reduced, the whole breast and nipple-areolar complex will rise, but the position of the nipple on the breast will not change.

Breast reduction with “Auto Augmentation”

Dr. Gershenbaum often combines his standard breast reduction with “Auto Augmentation”, a technique to help maintain fullness in the upper portion of the breast. One of the problems extremely common with most breast reduction surgeries is a flatness or lack of fullness in the upper area of the breast. This deficiency in the upper breast area occurs gradually over several months as the repositioned breast tissues settles and succumbs to gravity. This can be referred to as “bottoming out” of the breast. Some surgeons routinely place breast implants during breast reduction to maintain upper fullness. Placing breast implants during a breast reduction add cost and additional risk and potential complications to the surgery. This is also likely committing the patient to future surgery to replace the implants over the years ahead. Miami breast reduction expert, Dr. Sam Gershenbaum prefers to perform “Auto Augmentation” to enhance the upper part of the breast during the breast reduction procedure. “Auto Augmentation” is a procedure where space is created in the upper part of the breast and a portion of the internal breast tissue, which would normally be discarded, is left connected to the chest wall and blood supply is moved up and secured to the chest wall in this elevated position. This acts to keep fullness in the upper breasts as one’s own natural tissue breast implants. This procedure can be combined additionally with the support of GalaFLEX mesh, as described above, to further add support, fullness and longevity to the breast reduction procedure.

Breast Reduction, The Operation

This breast reduction surgical procedure is performed in our state-of-the-art facility Brickell
Riverfront Surgery Center in Miami, Florida. The procedure is performed under general anesthesia. Depending on which technique is used, the actual surgical procedure may take anywhere from two to six hours. While standing, lines of incisions, new nipple/areola location and remainder of the surgical plan is outlined on the breasts. After speaking with the anesthesiologist the patient is brought to the operating room. After asleep, local anesthesia combined with a medication that shrinks blood vessels and capillaries to reduce bleeding are instilled into the incisional areas and areas to be worked on. Depending on the patient’s exam and agreed upon plan, the chosen technique to reduce, shape and elevate the breasts is next performed. If liposuction is to be performed, it is done first prior to any skin incisions. The amount of fat removed is recorded, so as to remove the same amount for the opposite breast, plus or minus to account for any asymmetry. If performing the standard “anchor” scar technique, or the “lollipop” scar technique, after the incisions are made and the appropriate amount of breast tissue removed, the first breast is closed in a tailor-tack technique. This is a temporary closure to fine tune the exact amount of skin and insure appropriate measurements to optimize the final results. The amount of breast tissue removed is weighed so as to best match the reduction on the opposite side. Next, the opposite side surgery is completed in the same fashion and closed in this tailor-tack technique so as to best match the first side. Any adjustments to maximize symmetry are next performed to insure measurements, size, and shape are as close as possible. Lastly, final skin excisions are performed prior to skin closure. Again, Dr. Gershenbaum closes the deep tissues and skin in multiple layers placing all dissolvable sutures below the skin surface to avoid cross hatching and suture marks. Understand that many doctors simply mark the breasts, cut and remove the tissues and close in the name of time. Dr. Gershenbaum goes through these multiple painstaking steps, which do take substantially longer, to produce the finest results for his patients. Any ancillary procedures, such as correction of inverted nipples, etc may lastly be completed. Steri strips and a light dressings are placed over all incisions and a support bra is applied. The patient, after awake, is transferred to the recovery area, where they will generally spend one hour in preparation for discharge.

Breast Reduction, The Recovery Period

Following breast reduction surgery, patients generally report mild to moderate discomfort, which is easily controlled with medication. Patients are always thrilled to see the dramatic change in size and shape during their post op visit the next day. Varying degrees of swelling, bruising, and firmness subside over several weeks to months. The periareolar-vertical breast reduction techniques often result in varying degrees of “pleats” or folds around the incisions, which will resolve over weeks to months. Patients can generally return to work after several days to one week. Light exercise may begin after four to six weeks. A support bra is generally worn for three months following the surgery and is encouraged as much as possible thereafter to maintain the contour. Recovery and healing will vary from patient to patient and depend on the extent of the surgery.

It must also be remembered that complete healing takes time and patience, taking up to one year or longer before realizing the final results of breast reduction surgery. It can take this amount of time for scars to soften, lighten and fade and for the breast tissue to soften, relax and remodel itself. The breasts will get slightly smaller and descend to a certain extent as swelling subsides and the effects of gravity and tissue relaxation act on the newly tightened skin envelope. Most patients find this beneficial in that the breasts look more natural over time. The ability to breast-feed after breast reduction is generally preserved, but cannot be guaranteed.

What Is The Cost Of A Breast Reduction In Miami ?

The cost for a breast reduction in Miami will vary depending on several factors including the practice, the surgeon, the surgery center and the anesthesia provider whether physician or nurse anesthetist.  Please check out the article on my website under patient education, What’s In A Surgical Fee to help better understand why prices vary. In general the full cost of a breast reduction in Miami, Florida will range from $8000 to $14,000. If GalaFLEX mesh is used, it will add an additional $3500-$4500. For more information on breast augmentation, or to schedule your appointment, click here to our Contact Form, or simply call 305-933-1838…….. Because YOU deserve the best!

Breast Reduction, Complications and Risks

As with most cosmetic surgical procedures, complications following breast reduction are unlikely when the procedure is performed by a skilled and competent surgeon. Complications include, but are not limited to, anesthesia risks, bleeding, infection, tissue loss, delayed wound healing with obvious wide and/or raised scars, numbness, altered nipple sensation, asymmetry in breasts and/or areolas, enlarged areolas, and need for revisional surgery. Also, rare but possible are blood clots or emboli (blood clots which dislodge and travel in the blood stream to distant sites) which can be fatal.

At Dr. G’s Brickell Riverfront Surgery Center, Venodyne® calf compression devices are used for every breast reduction surgery (as well as other surgeries). Venodynes are pressure cuffs that fit over each lower leg from the ankle to the knee circulating every one to two minutes to reduce the pooling of blood in the lower extremities and further reduce the possibility of blood clots or emboli. Also, smokers must stop smoking well in advance of surgery. Smoking seriously decreases blood circulation in the skin, which increases the risks of complications and poor healing.

Rest assured that we at the Brickell Riverfront Surgery Center, in conjunction with Dr. Gershenbaum, will do everything we can to make your procedure(s) and experience truly rewarding. In the unlikely event of a complication or a result that is less than desirable, we will do all within our power to work towards a result that you can be proud of.

Breast Reduction Frequently Asked Questions

What Is The Youngest Age You Can Get A Breast Reduction?

While there are no specific age restrictions for breast reduction surgery, most plastic surgeons prefer to wait until maturity and breasts are fully developed. This age of maturity can vary from late teens on forward. In some cases, females in their younger teens can struggle with juvenile breast hypertrophy who experience early abnormal enlargement of their breasts. In other cases, females in their young teens can develop hypertrophy/enlargement only on one side with marked asymmetry causing insecurity, embarrassment with potential psychological consequences. In these cases, when the parent and primary care doctor recommend surgery, a breast reduction can be performed in earlier teen years. It should be understood that a breast reduction performed on breasts that have not yet fully developed, may require a second breast reduction in the future.

Can You Breastfeed after Breast Reduction?

The short answer is generally yes, but possibly no. Part of the answer lies with what type of breast reduction surgery is to be done, or was done. There are different techniques in breast reduction surgery. One procedure with very large breasts entails removing the nipple areolar complex and replacing it on the reduced size breast mound as a skin graft. This would not likely support breast feeding. Women whom wish to breastfeed after breast reduction should ask if the nipple is being removed and replaced, or simply moved during the procedure. It has been shown that breast reduction techniques that preserve a full intact column of breast tissue connecting the nipple to the chest wall have a much higher chance of retained nipple sensation and successful breast feeding. This is exactly the way that Dr. Gershenbaum performs this procedure. Dr. Gershenbaum reports that of his patients who wished to breast feed after breast reduction, they have been successfully able. It is important to understand, that depending on the patient and the extent of surgery, some mother may not have an adequate milk supply to fully nourish their baby without additional supplementation.

Should I Have A Breast Reduction Before Kids Or Wait To Have A Beast Reduction After Kids?

It is a personal decision with no right or wrong answer. If breast feeding is important and desired, and having children is planned in the near future, it would be recommended to wait until after child bearing and breast feeding is complete. The answer can depend also on the extent of the breast size and how much it is interfering with neck and back pain and how much it is impacting ones daily life. For these reasons, one may choose to have breast reduction surgery sooner, rather than later.

Should I Lose Weight Before A Breast Reduction?

There are different answers to this question, depending on the circumstances. All surgeons will agree that being dramatically overweight or obese, with a body mass index (BMI) over 30-35, will increase the risks of complications. These complications can range from anesthesia risks, to risks of infection and complications of wound healing. Hence, with a BMI over 30-35, the recommendations are for weight loss prior to breast reduction.

If there is a plan and desire to change life styles and eating habits and lose a significant amount of weight, or weight loss through bariatric surgery, this should be done prior to breast reduction surgery. Studies have shown that losing a significant amount of weight after breast reduction surgery may likely result in volume loss and changes in the breasts causing dissatisfaction with the results. This is supported by studies outlined by the American Society of Plastic Surgeons (ASPS).

For those not wanting or planning any significant changes in weight, Dr Gershenbaum recommends staying at ones comfortable set weight. If someone loses a significant amount of weight before breast reduction surgery, and then gains it back after the surgery, their breasts may end up larger than they planned on.

Does Breast Reduction Reduce The chances of Breast Cancer?

Studies from several places around the world have reported that breast reduction surgery can lower the risk of breast cancer, especially for women over 40. Studies from Austria and Denmark have reported that breast reduction can reduce the risk of breast cancer from 30 to 50 percent. Another study reported that women who have undergone breast reduction surgery had a lower risk of breast cancer as compared to the general population. The consensus appears to conclude that the risk profile is proportional to the amount of breast tissue removed. Hence, the greater the amount of tissue removed in the reduction, the lower the risk of developing breast cancer.  Breast reduction will reduce the area in which cancer cells can develop. Breast reduction, however, cannot prevent breast cancer as varying amounts of breast tissue still remain. All women, regardless of surgery, should follow the recommended guidelines for routine breast cancer screening.

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