Bulletin Board for Patient's Questions and Answers
Breast Reduction (Reduction Mammoplasty)

Explore what others have to say about breast reduction (reduction mammoplasty) with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

• Why did you choose to have the surgery?
• How did you choose your doctor?
• How much did it cost?
• Was the final cost the same as what you were told before the surgery?
• How was the recovery?
• Were there any complications? How were they resolved?
• How do you feel about the results?

• Did it have any effect on your life
  • emotionally
  • socially
  • sexually
  • professionally
• How did others react to your surgery?
• Did you learn any lessons?
• What would you advise others?

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Important Information About Breast Reduction - Introduction and site map

• What is the problem with large breasts?
• Large Breasts come in different sizes and shapes
• Should I have breast reduction surgery?
• The Consultation - What are the Risks of a Breast Reduction operation?
• Details of the Breast Reduction Operation
• Breast Reduction with the Wet Technique
• What Happens After Breast Reduction Surgery?
• Should My Insurance Cover Breast Reduction Surgery
• What about breast feeding after Reduction Mammoplasty?
• What are the risks of Breast Cancer after Breast Reduction?
• Patient Questions and Answers about Breast Reduction Chat and Forum 1 - 2 - 3 - 4

Inverted Nipple Surgery

Mastopexy Breast Lift Without Reduction

Cost and Prices for Breast Reduction

Patient Photographs Before and After Breast Reduction Surgery

• Breast Reduction 22 year old female with asymmetrical breasts - central pedicle short anchor incision
• Breast Reduction 19 year old female - central pedicle short anchor incision
• Breast Reduction 37 year old female - central pedicle short anchor technique
• Breast Reduction 34 year old female - superior pedicle short anchor scar (wet technique) More pictures - Evolution of early healing more early breast reduction pictures
• Breast Reduction 56 year old female - short scar Regnault type B with liposuction (wet technique) More photographs - Breast reduction healing progression more pictures of tissue evolution
• Breast Reduction 16 year old adolescent female - short scar tumescent technique - Additional images - Minimal bruising 6 days after breast reduction surgery
• Secondary Breast Reduction 40 year old female - for a patient asking for smaller breasts
• One Sided Breast Reduction and Bilateral Breast Lift 37 year old female Pictures Short Scar Tumescent Technique for Uneven Breasts - Photos Recovery and Healing after Breast Reduction and Lift - Early After Uneven Breast Reduction and Lift Photographs

PlasticWeb

• Breast Reduction on the Web
• Tumescent and wet technique breast reduction - medical literature
• Advantages of Reduction Mammaplasty - research

Find Books written for the public about Breasts and Breast Surgery

Breast Lift Surgery Introduction to the problem - Larger deformity operations

Short scar breast lift options - Drawings

Breast lift without breast implant - patient photographs

• Photograph during surgery and preoperative markings
• Early results - tissue redraping
• Tissue evolution photographs with dynamic movie of result

Mastopexy short scar - patient pictures before and after surgery

• Breasts how they move after mastopexy breast lift - patient photos
• Scar and tissue changes after breast lift - patient pictures
• Limited bruising breast lift with dilute local anesthetic techniques

Inverted Nipple Surgery

Gynecomastia - Breast Reduction and Chest Sculpture in Men

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Subj: Re:Breast reduction-
Mike,

Thanks for your reply. I'll call that number you posted. I had to LOL when I read "massive" in your note - you're right on target with that characterization.<G> I know what you mean about the buoyancy and yes, there is a difference.

Thanks again,
B

Subj: Re:Breast reduction
Sorry to hear about your scamming the insurance company to get what, for you, was cosmetic surgery. I hope we don't have the same insurance company because I don't want to pay for anymore of your backaches.

Subj: Re:Breast reduction
I also agree with G, A. Just had a breast reduction and went from an overflowing DD to a C. I, too, wish I had done it years ago. I feel I am finally in proportion, look better and feel better! When I remember the physical and mental pain I went through for 25 years, I know I made the right decision!

Subj: Re:Breast reduction
I had breast reduction surgery on May 16. It is now September 28, and I am still facing more surgery. The nipple on my right breast did not 'take', and had to be removed two weeks after the original surgery. I lived with a gaping hole (larger than a 50-cent piece) in my breast from Memorial Day until two weeks ago (September 12) when it had finally shrunk enough to allow surgery to close it up. I will have to have further surgery to 'create' a new nipple and will have to have tattooing to make it the right color. I also had to have follow-up surgery on a small portion of the left breast to remove necrotic (solidified, dead) fat. While it was a horrendous experience to have to deal with a hole in my body that gave me a little more of an 'insight' than I ever wanted to have, I can't say I regret having the surgery. My breasts are really 'taking shape'. They are beginning to look like real breasts instead of the water balloons I had before. Also, insurance covered the original operation and the surgeon has been most caring and attentive. He also has absorbed any charges not covered by insurance. Would I have had the surgery if I had known ahead of time I would have gone through all this? I don't know. It probably sounds worse than it has actually been. There was no pain or discomfort, other than the psychological discomfort of having a gaping hole in my body. Certainly there has been an improvement in my physical well-being in terms of reduced back, neck, and shoulder pain and greater freedom of movement and exercise. I also feel that I look better. If I had to offer advice to anyone considering this surgery, I guess it would be, 'Be certain that the risks and complications are spelled out for you ahead of time and that you would be able to deal with them if they occur'. From what I understand, I am the exception to the rule - most women sail through this surgery with no problems whatsoever. Good luck and God bless.

Subj: Re:Happy results
I am one week into my recovery, and I just wanted to post that my reduction went very well, and I am extremely happy with the results. Frankly, it was NOT as painful as I through it would be during this first week (the percocette has been very useful for that) and even though I am still moving slowly, I am confident that all will be smooth sailing. If anyone is considering reduction surgery I would be happy to e-mail you a fuller report of my experiences.
C...feeling quite PERKY in more ways than one.

Subj: Re:Happy results
C,
I would love to hear as many details as you are comfortable with. I am planning on having surgery as soon as the surgeon will see me. I had to loose a total of 25 pounds before my HMO would consider paying for it. I have 5 more pounds to go until the surgeon will talk to me about it. I have gotten considerably healthier as a result. I work out at the gym for 1 hour 4-6 times a week. Of course I can't jog or run but I get enough work done to help me loose the pounds. I am on meds to cut down on back pain and look forward to getting off them. It was such an insult and all having them tell me I was too fat. Oh well.
Thanks
K

Subj: breast reduction
I'm hoping someone out there can give a referral for a good surgeon in the state of Ohio who specializes in breast reduction. I'm 25 and 46DD. I've wanted this surgery for a very long time. Also, can't it be deemed medical so that my insurance will cover it? Back and neck pains are intense!! Any info appreciated.

Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Many insurance companies pay for breast reduction. The trend is however becoming more and more restrictive such that many patients fall outside criteria that will fit almost nobody. A consultation with a competent plastic surgeon will help you understand the issues about this operation, if you are a candidate, and how your insurance may or may help you.

The American Society of Plastic Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

Subj: Re:Breast reduction
If you have breast reduction surgery, just PLEASE research those surgeons who have done the most of that procedure. You'll probably benefit in the long run if you have surgery by someone highly skilled & sensitive to your preferences.

Subj: Breast Reduction
I am interested in getting a breast reduction surgery but I am scared. I am 22 years old 5'1 and I weigh close to 160. I wear a size 38 D and I cant even find a nice bathing suit to fit me. Please give me some information about this surgery my screen name is x

Subj: Breast Reduction
It seems like all we hear about are women with small breasts bemoaning their fortune. I just want to make sure the others are heard too. I was a 34 DDD, and looked really out of proportion with my small frame. I had back problems, neck problems, those lovely little strap marks on my shoulders, and skin problems under my breasts, not to mention the emotional problems that come with growing up as the "largest" girl in a small town. I finally decided to see a plastic surgeon, and it has changed my life. Not completely, of course, but it's such a relief. And the best part was that the doctor decided that breast reduction was medically necessary, so my insurance paid 80% of the costs. Without that I couldn't have afforded surgery. You do have some scarring after the surgery, and, at least in my case, the cost of replacing my underwear, but I'd do it again in a heartbeat. I can now jog without hurting; I can run up or down stairs; I can wear clothes that I always wanted to; and I no longer feel that people are talking to my chest instead of me.

If anyone has any questions about breast reduction surgery, for a patient (not a doctor), please feel free to E-mail me at x. I'd love to see everyone be as happy with themselves as I am now.

Subj: Re: breast reduction

Hello.I am nineteen and a 38D if not larger. I'm only 5'1 and 129 lbs. so I look quite disproportionate. I gave up trying to keep up. I am scheduled to have a breast reduction on April 16th, and although I have NO qualms with the pros and cons of the surgery my elders are questioning if such a small personal change is worth the risks of major surgery (obviously they have never tried aerobics with the pain I have) However, I am trying to research breast reduction benefits medically speaking and I was interested in breast cancer and large breasts. Are women with large breasts more prone to breast cancer, especially if my great grandmother died from it? any information would be greatly appreciated.
thank you,

K

Dr. Bermant responds
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

To my knowledge, larger breasts have no greater incidence of cancer than smaller breasts. Larger breasts are more difficult to examine and I have been taught that breast reduction surgery can make breast examination easier by reducing the amount of tissue. Breast reduction surgery does not seem to increase nor decrease the chance of breast cancer from what I have read.

My patients who have breast reduction surgery for uncomfortably large breasts have been among the happiest of my patients. Most say they do not know why they waited so long to have surgery. Good luck on your surgery.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737.

Michael Bermant, MD

From Plastic Surgery New release:

Subj: Patients Seeking Breast Reduction Surgery Face New Hurdles With Managed Care

ARLINGTON HEIGHTS, Ill., March 4 /PRNewswire/ -- "I had a patient who obviously needed a breast reduction but instead was told by her HMO to go to an orthopedist for her back pain. The orthopedist called me and said, 'This is ridiculous,' and I said, 'I know, but what can I do?'" As plastic surgeon Robert W. Bernard, MD, tells his story, his tone is somewhere between outrage and resignation. Asked what impact managed care is having on some of his patients, he and many other plastic surgeons plunge immediately into the murky waters that, for purposes of insurance coverage, are blurring the distinction between reconstructive and cosmetic surgery.

Even the numbers are ambiguous. According to a survey by the American Association of Health Plans, to which most managed care organizations (MCOs) in this country belong, 11.8% of HMO enrollees were covered for "cosmetic" surgery at the end of 1994 (by just 7.5% of HMOs). But neither the survey nor the AAHP is clear on just what cosmetic means in the context of these statistics. What is clear is that a growing number of insurance companies are denying coverage for procedures like breast reduction -- which certainly have an aesthetic component but traditionally have been considered reconstructive plastic surgery.

"After six months of physical therapy," continues Dr. Bernard, chief of plastic surgery at Northern Westchester Hospital in Mt. Kisco, NY, "which the insurance company was happy to pay for, we wrote to them again and documented the fact that this had, of course, in no way helped. And they denied the surgery anyway."

Breast reduction is not the only procedure that has shifted from reconstructive to cosmetic status in the sea change called managed care. Certain nasal procedures, surgery to correct protruding ears and abdominal reconstruction for morbid obesity all are being "rationed out of managed care coverage," in the words of Neal Reisman, MD, a plastic surgeon and attorney in Houston.

Plastic surgeon Marie Christensen, MD, has spent her whole practice life-- 16 years -- in the advanced managed care market of Minnesota, where she is a member of a 350-person multispecialty group practice. She cites her concern about secondary work for "things that seem like they should unquestionably be covered -- like scar revisions for cleft lips." So far, she says, she has been able to argue such cases successfully, but "I don't know how long that's going to last. It's the same argument that we've had about breast reconstruction after mastectomy including balancing procedures on the opposite breast. Many carriers, both standard third party and managed care, will say this is cosmetic,' but it's more of a problem with managed care systems."

Barry Scheur, president of Scheur Management Group, a national managed care consulting group based in Boston, insists that the system is totally market-driven. But plastic surgeons are not impressed with this kind of reasoning. Their concern is patient welfare. "I think we have to keep pressuring to be sure that physicians don't get coerced into a position where they are, in fact, working for the managed care system and not the patient -- that's the most dangerous aspect of managed care," says Dr. Christensen.

She is troubled by trends like managed care systems refusing to cover the complications of uncovered procedures. "Plastic surgeons can, and must, fight to protect the patient's right to choose purely cosmetic procedures without penalty. What if a patient has a wound infection or some other complication associated with a cosmetic operation?" The policy, she says, seems unfair. After all, "a patient doesn't get benefits withheld because he breaks a leg skiing or fails to take his insulin or does something else the plan thinks is unnecessary."

As a strategy for dealing with managed care, plastic surgeons are now arming themselves with proof that their services are valuable. Bruce L. Cunningham, MD, chair of the Scientific Research Committee of the American Society for Aesthetic Plastic Surgery (ASAPS), says that "we are very close to validating a global, generalized instrument for measuring outcomes for all kinds of plastic surgery." This instrument will look at quality of life, patient satisfaction and the impact of the change in appearance on emotional and social well-being.

Joyce Bogetti of Tuckahoe, NY, has no doubt about the outcome of the breast reduction surgery she had just over a year ago. "It certainly made a positive change in my appearance and the way I feel about myself," she says. "But it also gave me relief from back pain and other discomfort that having very large breasts creates. People who have never experienced it don't realize how physically difficult it can be just to do simple things -- like exercising or playing sports -- when you're carrying around all that extra weight. For an insurance company to say that this kind of surgery is unnecessary for someone who has the same kind of problem I did is really unthinkable."

Subj: Re: Breast reduction Scars

Dear Doctor:

About 20-25 years ago, I had a breast reduction operation. Although I am very happy with the size of my breasts and the operation in general, I have always been rather unhappy about the scars- they are rather thick and the stitch marks can still be seen in places. The scar that runs down the center of the breast is from residual nipple tissue (don't ask me how they did that!) and is naturally, darker than the rest of my scars, but much less raised than the ones underneath. The scars around my nipples are practically nonexistent and if it weren't for the different tissue of the scar running down the center of my breast, this one would be too (they are much flatter and smoother) However, the scars that are underneath are the main problem- they are ropy in nature and I'm wondering if going in for a breast lift and having the scars redone would make sense- What can be done in a case like this? The color has faded, but the texture is still raised and bothers me a great deal. (Also, I'm wondering why some of the scars are much less obvious than others, and why they can't all be less obvious?) I would greatly appreciate your response.

Thank you....

PS I am in New York City. Any physician" recommendations that you can make would be appreciated.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The chest especially the region between the breasts tends to scar more so than other areas of the body. Each individual also has their own tendency to scar. Some scars can be improved with reconstructive surgery. The risks usually are that the thick scars might recur. We have some relatively new tools that we use on patients developing such scars (while the scars are still red). This helps some patients.

I would need to evaluate you to determine any recommendations. We do see patients from far away and the reconstructive surgery and operating room costs are much less than New York (I know since I just moved my practice here from upstate NY).

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: Breast Surgery

To whom this may concern:

I am considering breast surgery due to uneven breast. I think that I would have one breast reduced. I am wondering what kind of surgery would best suit my needs? And what is the normal cost for a surgery such as this? Please give me any information you have on this abnormality and it's corrective surgery.
Sincerely,...

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Consultation by computer mail/bulletin board is not safe nor appropriate. There is too much information missing. My typical evaluation takes 30-60 minutes face to face. Depending on the problem, the evaluation may take much more time. You really should see a board certified surgeon for an examination. Then you would have an idea what options are available to you.

It depends on if the problem is one of how the breast hang, or if the size is really different. Skin envelope reduction is a possibility for the first problem. Breast asymmetry for size differential is frequently managed by reducing the larger breast. Surgical costs depend on the complexity of the operation and could range from several hundred to several thousands of dollars.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Member of the American Society
of Plastic Surgeons, Inc.

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