Tissue Removal with Reduction Mammoplasty

Prior to performing a breast reduction it is important to estimate how much tissue is going to be removed from each breast for a couple of reasons.  One is to satisfy insurance requirements for prior authorization to ensure coverage before surgery; the other is to satisfy what the patient is trying to achieve.

Insurance Requirements

First, most insurance companies require a certain minimum amount of tissue to be removed from each breast in order to qualify the procedure as medically necessary.  Traditionally, this has been almost an arbitrary number (like one pound per side) without taking into account the body habitus of the patient.  More recently, many insurance companies set the number in proportion to a patient’s BMI (body mass index); higher amounts for bigger patients, smaller weights for smaller ones.

Patient Desires

Second, it is helpful for the surgeon to have a goal weight of resected tissue in mind prior to surgery; not only to help accomplish an end result that is satisfying for the patient, but also to create better symmetry in cases where the breasts are significantly different in size to begin with.  Some women, especially those with larger frames, would like to still have large breasts after their reduction so that they are proportional to the rest of their body.  Others who are fed up with back, neck and shoulder strap pain are interested in being as small as possible. 

Dr. McMahan’s Formula

Several formulas have been developed in the past to help surgeons estimate the amount of tissue to be removed during a reduction mammaplasty.  Dr. McMahan’s formula, published in Plastic and Reconstructive Surgery in March 2012, is the most accurate technique to date and is based on two simple breast measurements taken at the time of consultation. 

In the Operating Room

During surgery, the tissue is weighed as it is removed to let the surgeon know how close he/she is getting to the goal weight and to help with symmetry.  The tissue is weighed again after it is sent to the lab for pathological analysis as each side is sent separately.  This is important even is cases of cosmetic breast reductions to make sure that there is no abnormal breast tissue present.

The final determination, however, as to how much tissue is removed during surgery is simply how large the breasts look on the operating room table.  As they say, the proof is in the pudding.  If the goal weight has been removed but the breasts still look too big for what the patient is hoping for, more breast tissue is removed.

Going Too Small

Sometimes, patients who have a breast reduction will become very motivated with their diet and exercise programs after surgery and lose a considerable amount of weight.  In the situation where they also lose more tissue in their breasts to the point where they wind up being smaller than they want to be, it is possible to perform a breast augmentation in the future.

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