The most important aspect of a breast reduction, like many cosmetic procedures, is the planning. Just prior to surgery (or the day before as I prefer), the patient is marked in a standing position to select the proper position of the nipple and areola as well as placement of the skin removal incisions.
The surgery is performed as an outpatient under anesthesia. During the procedure, excess skin and breast tissue is removed, the nipple and areola are elevated as is done in a breast lift and, very often, the size of the areola is reduced. Early in the procedure, a pedicle of breast tissue is developed which is attached to the nipple and areola as well as the chest wall. An effort to maintain sensitivity and viability to the nipple area, this pedicle of breast tissue is designed to contain substantial blood supply and encompass the proper nerve pathways. In younger patients who may wish to breastfeed in the future, a significant amount of breast tissue and milk ducts are also maintained.
While the breast tissue is removed, its weight is monitored for symmetry and to help determine final breast size. The weight removed is also important to document, as a minimum amount is generally required for coverage by most insurance carriers. This tissue weight is estimated at the consultation visit and is provided to the insurance company in the preauthorization letter.
After the excess tissue is removed and a careful check for bleeding is performed, the incisions are closed and dressings are applied. I prefer all internal absorbable stitches with no external sutures so that they leave no other marks in the skin. Sometimes drains are placed to collect any blood and serum that can build up in the void where the breast tissue had been. When used, these drains are removed in just a few days.
The tissue that is removed is sent to the pathology lab for microscopic examination to look for any evidence of breast cancer or pre-cancerous changes. The results are received a few days after surgery. In the event that such cancerous tissue was found by the pathologist, you would be referred to a general surgeon to determine what would need to be done to further treat the cancer. The risk of finding breast cancer in the tissue removed during a breast reduction is about one percent.
It is not uncommon for patients who are undergoing breast reduction surgery to have another cosmetic procedure performed at the setting to reduce costs and to decrease recovery time. Liposuction and tummy tucks are the two most common procedures to be done at the same time as a breast reduction. Combining procedures can result in significant cost savings as surgery, anesthesia and facility costs can all be reduced.