Breast Reduction Surgery Tips

Breast reduction surgery is one of the most common procedures performed by US plastic surgeons and has been shown to be effective in reducing the symptoms and improving the quality of life for women with heavy, pendulous breasts. In fact, The American Society of Plastic Surgeons reported more than 103,000 breast reduction procedures in 2013.

If you have neck and back pain, painful shoulder grooving from bra straps, headaches, difficulty purchasing clothing, and difficulty participating in sporting activities, you may be an excellent candidate for what is called a "medically necessary" breast reduction procedure. Most insurance companies cover this procedure. However, each carrier uses different criteria to determine whether breast reduction surgery will be covered at all.

If you are considering breast reduction surgery, first read your insurance policy. If your insurer does not provide coverage for a breast reduction, you may not even be covered for a consultation with a plastic surgeon to discuss your options. Most insurance companies will look at a woman's reported symptoms, the duration of her symptoms and how these symptoms may have affected her quality of life. It is important for you to discuss your concerns with your primary care physician and to have your symptoms documented in your medical record. Letters from your primary care physician, chiropractor and/or physical therapist can be invaluable "evidence" in building your case for prior authorization for a breast reduction. This documentation, when included in a packet with a letter and pictures from your plastic surgeon, will help you obtain authorization from your insurer prior to scheduling surgery. This is a necessary step, as an insurance carrier may refuse to cover the costs associated with surgery if the procedure is not authorized beforehand.

It is common for insurance companies to require that a certain amount of breast tissue be removed from each breast in order for your breast reduction to be considered medically necessary. The breast tissue weight to be removed (for insurance approval) is determined based on your height and weight, but often this weight requirement is in conflict with a woman's aesthetic goals. Insurance companies are not concerned with the way you look, despite the well-known fact that physical appearance can have an impact on quality of life. Despite medical literature proving that breast reduction surgery improves a woman's quality of life regardless of the weight of tissue removed (Spector & Karp, 2007), a recent report by Koltz, Frey and Langstein (2013) revealed that 86 percent of surveyed insurance providers still use a chart based on the 1991 Schnur Sliding Scale that compares a woman's motivation for breast reduction and her weight.

The Schnur scale recommendations are derived from a survey that asked plastic surgeons their perceptions of whether their patients' motivations for a breast reduction were reconstructive or cosmetic (Schnur et al., 1991). A survey (even one among surgeons) should not be taken as scientific proof. Years later, Schnur himself even challenged insurance carriers' misuse of the scale and indicated that the scale should no longer be used as criteria for insurance coverage (Schnur, 1999).

Each person responds differently to physical symptoms and breast reduction is not a term that should be defined by a number, but rather needs to be considered within the context of the individual woman seeking a better quality of life. If you disagree with your insurance carrier's decision, you are entitled to an appeal.

Being a good candidate for a surgical procedure also means you have a thorough understanding of the condition that is being treated and of the intended procedure. Breast reduction is one of the most patient pleasing procedures we perform. If you feel that large breasts are interfering with your daily functioning, ask to visit with at least one plastic surgeon certified by the American Board of Plastic Surgery to learn about your options for breast reduction. Your family, your personal physician and your experienced plastic surgeon can help you make the decisions that are right for you.

Breast Asymmetry Tips

Breast asymmetry is a very common concern among women, adolescents and adults alike. No one is born with perfectly symmetric breasts and mild to moderate differences in breast shape, size (1-2 cup size difference) and position in the developing adolescent are to be expected. Moreover, breast asymmetries that persist beyond puberty affect more than half of all women! In fact, one study of 100 women who wanted breast augmentation with implants found that 88 percent had natural asymmetries (Rohrich, Hartley & Brown, 2006). At a time when our body and mind are changing rapidly, when is breast asymmetry a cause for concern? In this article we look at how breast asymmetry may impact a young woman and we review the pros and cons of surgical intervention with an emphasis on newer techniques (i.e. breast reconstruction with autologous fat transfer).

No one really knows what causes breasts to develop differently from one another, but possible contributors include hormonal changes or traumatic injuries. Your breast tissue changes according to your menstrual cycle. For instance, your breasts may feel fuller and more sensitive when you're ovulating; and, in fact, they do get bigger because of water retention and additional blood flow. This is also when they're most likely to be the same size. During menstruation, breasts shrink again.

Breasts are glands positioned on the chest wall. The breast tissue undergoes lobular proliferation in females at puberty, when the breast buds develop into adult size breasts. Surgery or trauma to the chest wall in early childhood may affect development of the "breast bud" and result in breast asymmetry later in life. In a small percentage of the population, an underlying medical or skeletal condition may cause asymmetrical breasts. Poland syndrome, tuberous breast deformity and juvenile hypertrophy are rare findings, which can result in unilateral or bilateral differences in breast growth and shape.

A recent study published in the December issue of the Plastic and Reconstructive Surgery Journal highlights the psychological impact of breast asymmetry on adolescents. The study findings suggest that patients with breast asymmetry have poorer emotional well-being and lower self-esteem than their female peers (Nuzzi, Cerrato, Webb et al., 2014). This is not a surprising revelation given that high rates of breast dissatisfaction have been reported within the adolescent female population, especially during early adolescence when there is greater variance among peers. Psychological issues are important in this group of young women, and these issues include social embarrassment, low self-esteem, depression and isolation from peers. Problems that occur relate to sexual relationships and cultural beliefs. The majority of these patients are young, healthy individuals, and the psychological and social impact of these conditions is significant. Physicians and parents should be aware that seemingly small differences to an examiner's eyes might have a considerable impact on the sometimes "fragile" psyche of an adolescent.

Surgical options for correction exist. These include improving breast symmetry by combining different techniques using implants, autologous fat transfer, liposuction, breast reduction and/or tissue flaps. Correction of breast asymmetry often involves multiple surgical procedures. Surgery in a young adult with a long life expectancy means that with further life changes (pregnancy, aging, weight gain and/or weight loss) the long-term outcome from surgery is not always satisfactory with loss of sensation, scar issues and further asymmetry being common complications. The best policy is early intervention with education, support and counseling. The key steps in successful management are diagnosis, appropriate referral, counseling, optimal timing of surgery and avoiding unnecessary surgery in a developing young adult. In the rare instance that the asymmetry causes such distress that your doctor recommends surgery, please consult with an experienced plastic surgeon about your options for surgery. Advances in science and technology, have implemented newer surgical procedures with improved outcomes.

Newer techniques such as autologous fat transfer, offer a less invasive way to correct breast asymmetry with more natural appearing results. Fat grafting is natural, flexible and versatile. It allows the plastic surgeon to gradually sculpt and reconstruct the breast to a natural looking shape and feel. Like other reconstructive techniques, fat grafting is a staged procedure with results achieved over time. Fat is harvested from the abdomen, flanks and thighs and then is injected into the breasts through small incisions. This is an outpatient procedure, with each stage carried out every 3 to 6 months. The number of stages required for completion varies on an individual basis. The results are long-lasting and the patient also receives the added benefit of liposuction at the donor sites.

Breast Implants Tips

If you have never had kids, and you've thought about getting breast implants, it is likely that you have put some thought into whether or not you should wait until after you've had kids. Unfortunately, when it comes to this issue, there is no right or wrong answer, it is ultimately up to you. Most women like to ask their doctor about this, but most doctors will tell you the same thing, 'the choice is yours'.

Although the choice is yours, there are pros and cons to both. If you are a young woman in your late teens or early twenties thinking about getting breast implants, then you might have also put some thought into this. While some young woman are positive they want kids, others are not. If you want breast implants now, but are not planning on having kids for another ten years, then getting breast implants now may be the best choice for you. Most young women that really want implants now at young age, are not willing to wait that many years to have the breasts they've always wanted.

Secondly, you may also not want to wait until after you have kids to get your breast implants because at the end of the day, you may change your mind in a few years and never have kids. Some women say they want kids in the future, but plans change, so why wait until later to get your breast implants?

Now for the women highly considering waiting until after having kids, I know you've probably heard all the rumors. One of the most common rumors about having getting implants before pregnancy is not being able to breastfeed. Although the thought of this may sound scary, it is not particularly true. Most women that get implants before getting pregnant are still able to breastfeed after. During a breast augmentation, most plastic surgeons try to avoid damaging any nerves or tissues around the nipple and areola. Therefore, it is very rare for women to not be able to breastfeed after getting breast implants. Again, if you do not want to risk this possibility, then it may be best for you to wait until after having kids.