Breast Reduction – San Diego
Breast reduction is a highly satisfying operation for patients with heavy, pendulous breasts. Many women have associated symptoms like neck pain, back pain, shoulder grooves from bra straps, rashes under the breasts, difficulty finding appropriate bras and other apparel, and social embarrassment. The improvement in many of these symptoms and in self-esteem is often nearly immediate. Many of the considerations we discuss on our breast lift page also apply to reduction; the actual techniques are extremely similar, as are the potential incision patterns. The amount of tissue removed during each procedure varies greatly, however.
Breast reduction is meant to achieve the following objectives:
- Raising and repositioning the nipple
- Restoring breast tissue to a higher, less descended location on the chest wall
- Significantly reducing the volume — and hence the weight – of the breast
- Tightening and removing sagging, loose breast skin by placing an incision around the nipple, as well as vertical and possibly horizontal ones depending on the amount of skin excess and how low the breasts hang
In some cases, the breasts are so massive that the procedure actually requires removing and reattaching the nipples as skin grafts in order to support the blood supply to the nipple (free nipple graft). In Dr. Sayed’s nearly 15 years of practicing plastic surgery, after hundreds of breast reductions, he has only needed to employ this technique in a couple of patients. In general, Dr. Sayed is known for an approach that preserves the right volume in the right places to maintain good central cleavage even after significant reductions. Dr. Sayed is experienced performing this procedure on patients of varying ethnicity.
Patients seeking breast reduction in Southern California or South Florida have a number of options available. Dr. Sayed can simulate a variety of methods using Crisalix® software and can educate you with drawing tools and before and after photos.
View real patient before & after results in our photo gallery.
Breast Reduction 101
Breast reduction planning includes deciding on the pedicle — the area of breast tissue that will be preserved in continuity with the nipple — so that incisions can be designed appropriately. There is a small risk of impaired blood supply to the nipple which in rare cases can cause loss of nipple tissue, and may require revision surgery or reconstruction (this is uncommon but is a known risk of the surgery that plastic surgeons take into account in designing the surgical plan).
During the procedure, Dr. Sayed removes excess weight from the breast in different quadrants, depending on your anatomy. Dr. Sayed will reposition the nipple by moving it with a column or mound of breast tissue that stays attached to the nipple. In order to reposition the nipple, the surgeon must place an incision around the whole nipple-areola complex. In order to gain access for removal of significant tissue, an incision is placed vertically from the bottom of the areola to the fold under the breast. Many patients also require a horizontal incision in the crease in order to shorten the length between the crease and the nipple.
Contact us today!
If you’re in the San Diego or Newport Beach areas and have any questions about breast reduction or wish to schedule a consultation with Dr. Sayed, please contact our office.
Breast Reduction FAQ’s
Some of our selection criteria to include you as a candidate include:
- Excess breast weight/volume
- Associated symptoms like neck pain, shoulder pain, back pain, shoulder bra strap grooves, rashes in the folds under the breasts, desire for smaller breasts, social embarrassment, or other troublesome issues
- General good health, meaning you do not have major uncorrected cardiovascular, respiratory, kidney or other major organ conditions
- No masses on breast examination – if you have a significant family history of breast cancer or are over 30 we will request a preoperative mammogram if you have not had one within a year
- Nonsmoker or willing to commit to NO NICOTINE IN ANY FORM for at least 3 weeks preop and for the duration of your recovery
- Available support system of friends, family, caregivers or others who can help you to keep your appointments, complete your preop and postop tasks, and emotionally bolster you through this exciting journey
- Reasonable expectations of how much breast enhancement is possible with specific techniques
Most procedures are about two and a half to three hours in duration, depending on the incision approach, size of the breasts, degree of asymmetry, and other considerations.
Most reductions are performed on an outpatient basis in a AAAASF-certified operating room, ensuring the facility is up to high standards of accreditation. Patients usually spend up to a couple hours in the postoperative suite before being discharged in the care of a companion, family member or friend. Dr. Sayed gives a 24 hour phone number to all patients who can reach him for urgent questions, and we also issue access to a patient engagement application that allows the patient or companion/caregiver to send SMS messages, photos, video and other content to our team in a secure, private digital format. This keeps us mutually informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.
Early postop recovery findings can include bruising and swelling, mild discomfort, reddish discoloration in the lower part of the breasts, numbness or diminished sensation in nipples, and some mental adjustment to the process of healing which most patients undergo. Most patients are advised to take a few days out of social circulation and we’d prefer that you not drive yourself in the first 10 days or as long as you are taking any prescription pain medication. Most sutures are dissolvable but there may be a few that need to be removed at around 14 to 21 days postop.
We ask that you abstain from exercise for 2 weeks and then return to light fitness routines after that. You will be asked to wear a surgical bra and avoid underwires for a few weeks, and it will be easiest for you if you wear tops that button down in the front in the first 10 days or so. Dr. Sayed and his team provide close postop care in the office and with our remote engagement tools. You will be asked to take some supplement medications to aid in your recovery, which may include medications for pain, bruising, swelling, and dietary optimization.
The durability of results depends on a few factors. These include the weight of the patient, size of the breasts, childbearing and breastfeeding status, general health, and other issues. If treatment is performed prior to childbearing, things may change considerably. Use of proper breast support with well-fitted bras can help maintain the shape and position. A certain amount of normal “bottoming out” can happen with breast reductions, but this usually maintains a reasonable natural position to the breast that is still pleasing. The most significant consideration is probably weight — larger breasts are simply more common in patients who are overweight, so it is not unusual for some breast enlargement to occur if a patient gains weight. Dr. Sayed has worked with medical weight loss experts in his practice and can help direct you to healthy ways to keep weight off.
- Have a reasonable expectation of what surgery can accomplish
- Look at before and after photos and understand what kinds of techniques you are interested in
- Don’t smoke or take nicotine in any form for at least 3 weeks and ideally longer before (and after) surgery
- Stay well rested and well hydrated and eat a nutritious diet balanced with plenty of protein
- If your diet is lacking in vitamins, take vitamin C and zinc supplementation but ask Dr. Sayed about other supplements. We have a list of ingredients we ask you to avoid in the immediate preop phase to optimize healing and minimize bleeding risk
- Designate a caretaker who can help you through the first 5 to 7 days after
- Identify whether any female relatives in your immediate family have any history of breast cancer
- Obtain the necessary paperwork from your insurance if you want to try to be reimbursed for some of the fees. Dr. Sayed does not perform breast reduction through insurance at this time but his staff can help provide you with billing codes and other information if you want to file a claim
We don’t like to publish pricing as it is subject to market changes and dependent on the types of procedures you consider. Review our Pricing page to build a “wishlist” and get estimated pricing on breast reduction or a combination of procedures. We also have a fee schedule available in the office after your consultation. Feel free to contact our San Diego office for a pre-consultation and we are happy to provide more information.
Breast reduction may be covered by insurance in certain circumstances, depending on the patient’s medical symptoms, insurance policy, height, weight, breast size, and other factors. The body surface area, which requires knowing the height and weight, is used to help calculate the amount of breast tissue the surgeon needs to remove to meet the insurance company’s criteria for payment of the services rendered. The surgeon has to estimate preoperatively the right amount to remove and calculate it against a sliding scale used by most insurers. Insurance companies also require documentation of symptoms associated with the heavy breasts in order to approve the procedure.
- Neck and back pain not attributable to other causes (like slipped discs)
- Shoulder grooves from the bra straps
- Difficulty finding properly fitting bras
- Rashes under the breasts
- Psychological embarrassment
- Failure of improvement of symptoms with physical therapy, supportive bras, and other treatment methods for several months to over a year
Usually the surgeon’s office will need to submit photos as well as documentation to your insurance company ahead of time to obtain authorization for the surgery, including the estimate of the breast weight to be removed. If approval is denied, an appeal can be filed but there is no guarantee of successful approval on appeal. Medicare beneficiaries considering a reduction may be asked to sign a waiver to self-pay for the procedure if Medicare denies coverage, as Medicare does not have a pre-authorization pathway like third-party insurance companies do.
Most patients are able to breastfeed after their surgery, but some techniques may put the breast milk ducts at more risk than others. The tissue left attached to the nipple for its blood supply – the “pedicle” – can be designed in many ways. Some approaches preserve most of the connections of the breast gland to the nipple without undercutting it, but others divide more of the central and lower breast tissue away from the nipple. Dr. Sayed can illustrate for you on a drawing tool how the surgical decision may impact breastfeeding. However, there is plenty of good surgical data out there that indicates that most patients can breastfeed after properly performed breast reduction regardless of which pedicle is used.