Best Breast Reduction Oakland California (CA) Surgeon

Reduction mammoplasty is a surgical procedure to reduce, lift and reshape a breast. It may also reduce the size of the areola (the dark skin surrounding the nipple). Most women request a breast reduction to alleviate back pain, neck pain, shoulder pressure, strap pain, rashes or skin tags, as well as to improve the appearance of their breast. 85% of patients are more than satisfied with the results of reduction mammoplasty. The procedure is performed under general anesthesia. The operation takes about 3-4 hours, and usually requires an overnight stay.

There are numerous techniques used to reduce the breast. Recent popularity has been given to minimal scar techniques which involve an oval incision from which the breast tissue is removed and the wound is then closed as a circle, using a subcutaneous purse-string suture technique, or as a circle with a vertical line akin to the shape of a lollipop. The design of the pedicle of breast tissue to remain may be one of 4: superior, lateral, medial and inferior/central based. The superior base provides the best breast projection but has the disadvantage of often loosing sensation and is best performed for small breast reductions.

Breast Liposuction is a recent attractive alternative for patients who seek no visible scars. This procedure is limited by the degree of laxity to the skin prior to liposuction. If there is significant laxity to the skin, then the degree of ptosis (drooping) may be worsened by the procedure. Secondly, the real possibility of difficulty reading a mammogram as a result of post-liposuction scarring must be weighed carefully, acknowledging that one in 8 woman in the United States will develop breast cancer over a lifetime.

Keyhole, Anchor, or Wise pattern incision is the traditional and currently the most favored technique in the US for reduction mammoplasty. Two incisions are made each angled downwards and outwards from the base of the circular incision around the areola. The base of the 2 these incisions then are angled to the inframmary crease. Skin within this pattern is removed except for the nipple and areola, which remains attached to the underlying breast tissue. The pedicle can be based on a dermal blood supply and again looses sensation or it can be an inferiorly or inferior and centrally based pedicle. I prefer the latter since it provides the best opportunity to preserve blood and nerve supply. During this procedure, the pedicle of the breast tissue is 8cm in width is left attached to the chest wall, the entire vertical height. The overlying skin flaps are then closed over the breast pedicle to form one vertical line after the fat and extra tissue on either side of the pedicle has been removed. One drain is then placed on the side of each breast, which is removed during the first clinic visit after surgery. The incisions are then closed with an absorbable suture and the surface glued in order to prevent scar widening and excessive scarring.

Free Nipple Graft Breast Reduction In some cases, the nipple and areola are transferred as a skin graft to their new position. This is performed when the breast is very pendulous and the nipple must be lifted greater than 12 -15cms. The inferior/central pedicle technique would be unreliable in preserving blood supply in such cases. The disadvantage of this technique is that sensation is completely lost and in darker skinned patients there may be a partial loss of pigment for up to 2 years and possibly longer.

Breast Reduction Surgery, Male Breast Reduction, Mammoplasty Reduction, Breast Lift, Reduction Surgery and More

Insurance Criteria for Breast Reduction

Criteria for breast reduction to be a covered benefit is individual to specific to each insurance company. Aetna, I believe was the first to use ‘evidence based medicine’ to help determine who should qualify for a covered benefit. The paper used to help determine their criteria written by Dr. Schnur, in 1991 (Schnur PL, Hoehn JG, Ilstrup DM, et al. Reduction mammoplasty: Cosmetic or reconstructive procedure? Ann Plastic Surg. 1991;27(3):232-237). Many other insurance companies, for example Blue Cross and HealthNet, have used the same paper as a basis for determining similar insurance eligibility.

By way of example, Aetna’s criteria includes:
a. patients must be at least 18 yrs old,
b. referred by another physician who supports surgery,
c. at least 1 yrs duration of at least 2 of the following: back/neck/shoulder/strap pain and or grooving, painful x-ray documented kyphosis or headaches,
d. at least 3 months without success of such measures as supportive special bra, non steroidal medication, physical therapy,
e. if aged 40 and above, a mammogram within 1 year of the planned surgery,
f. a Polaroid photograph anterior and lateral of the breasts to be sent with the written request for surgery and
g. the patient’s full understanding that the amount of breast tissue to be removed will follow a calculation called the ‘Schnur Scale’, based on determining the body surface area: Body surface area in meters squared: BSA (m2 ) = ([height (in) x weight (lb)]/3131)1/2 Simply stated, this means that a 140 pound 5 foot 3 inch woman would require at least 324 g/breast and simply put, any woman over 180 pounds would require at least 1kg/breast to be removed at the time of surgery.

Click on the following link to watch a Breast Reduction patient education video -
Breast Reduction

Moulton-Barrett is an Oakland California (CA) Breast Augmentation Surgeon office. Our main offerings include: liposuction doctors and tummy tuck cosmetic surgeries.