10 Questions To Ask Before Getting A Breast Reduction

Deciding to go under the knife or needle for any reason is, needless to say, a big decision. What’s the best way to make a big decision? Arm yourself with as much information as possible. In this series, Ask AEDIT, we break down the best questions to ask before choosing to undergo aesthetic treatments and procedures with expert insight from the providers that perform them.

Breast reduction is one of a handful of procedures that can have both a medically necessary and cosmetic component to it. Whether you’re interested in undergoing the surgery to alleviate pain and improve quality of life or are aesthetically unhappy with the shape and size of the chest, there are certain things you need to know about the procedure. From the impact it can have on breastfeeding to insurance coverage, these are some frequently asked (and important) breast reduction questions answered by two top plastic surgeons.

1. What should I consider when choosing a breast reduction surgeon?

Choosing the right surgeon for a breast reduction (or any procedure for that matter) isn’t about any one thing. Instead, it’s important to find a provider that is well qualified and also someone you feel comfortable with. In addition to researching board certification and speciality, “it is imperative that you can speak to the surgeon openly and freely,” says Payman Danielpour, MD, a board certified plastic and reconstructive surgeon in Beverly Hills. That includes being able to “express your desires openly without feeling that you are uncomfortable or that the surgeon is dominating the experience,” he adds.

But it’s not just about bedside manner. Understanding a prospective surgeon’s technique and aesthetic is also key. Ask to see before and after photos of patients who have a similar breast size and skin color as you, explains Umbareen Mahmood, MD, a board certified plastic and reconstructive surgeon in NYC, “as poor scarring is a potential concern” (more on that later).

2. Does insurance cover breast reduction?

In short: It depends. “This is highly variable and depends on a number of factors,” Dr. Mahmood shares. As it turns out, insurance companies can be quite prescriptive and even seek to dictate the specifics of the surgery. “Even if the insurance company gives a precertification for the procedure, they then determine how many grams of tissue the surgeon must remove for the surgery to be covered, which often may leave patients with breasts that are far smaller than they desire,” she continues.

There is no doubt overly large breasts can cause medical concerns (think: neck and back pain, rashes in the breast folds, interference with daily activities, etc.), but a breast reduction procedure is also aesthetic and needs to be treated as such. “I often tell patients, while breast reductions are certainly a medical issue, they are also an aesthetic procedure and should result in breasts that look beautiful to the patient,” Dr. Mahmood says.

3. What are the risks associated with breast reduction surgery?

The primary risks associated with breast reductions are hematoma (blood clot), decreased nipple sensation, and wound healing issues. In rare cases, “the blood supply to the nipple can get damaged, causing loss of the nipple,” Dr. Mahmood explains. There is also the possibility of asymmetrical results, although “asymmetry between the breasts is not considered a risk since it is an inherent element when operating on two of the same body part — but it is still an important point to discuss with patients,” she adds.

4. If I plan to have children, should I wait to have a breast reduction until after?

Ideally, yes. But in both doctors’ experience, patients as young as 18 often decide to proceed with breast reductions to eliminate neck, back, and shoulder pain. “I see many patients in their late teens and twenties who may be years away from thinking about a family but are in agonizing physical pain as well as emotional and psychological distress due to their overly large breasts,” Dr. Mahmood explains. “While I certainly counsel all patients on the inherent risk of decreased ability to breastfeed, in instances like these, a patients quality of life and well-being must be considered.”

If you can wait, Dr. Mahmood advises waiting until after you have breastfed (if that is something you want to do, of course!). “Breastfeeding potential after a breast reduction is based on the amount of milk ducts and milk producing glands that remain after the surgery,” Dr. Mahmood says. “Reduction techniques that keep the nipple attached have a much higher chance of maintaining breastfeeding potential, as well as those that preserve more of the glandular tissue from the nipple to the chest wall.”

The ability to breastfeed after a breast reduction is not something doctors can determine for sure one way or another — every body is different. “The longer the period from the operation, the higher the likelihood that lactation will be successful,” Dr. Danielpour says.

5. What is the breast reduction recovery process like?

The good news is that a breast reduction is not the hardest postoperative process. For six weeks afterwards, patients are advised to wear a surgical or sports bra and cannot exercise (no heavy lifting, swimming, or vigorous physical activity). “Most of my breast reduction patients do well with Tylenol alone and no narcotic pain meds,” Dr. Danielpour says.

6. What kind of scarring is expected after a breast reduction?

“In the immediate postoperative period, the scars are very visible, red, and raised,” Dr. Danielpour says. They do, however, flatten and lighten over the course of several months. It can take up to a year to see how scars have fully healed, and, most of the time, he says it’s quite minimal. “Most patients, even those with known tendencies to form hypertrophic scars, heal well after a breast reduction, likely because there is no tension on the tissue — unlike with a medial thigh lift or brachioplasty,” Dr. Mahmood says. “The post-surgical bra takes pressure off the incisions, and I advise patients to use scar cream at three to four weeks post-op and use sunblock when outdoors or on the beach.” If, ultimately, the scarring bothers you, it can be reduced with lasers and other treatments.

7. If I am overweight, do I need to lose weight before a breast reduction?

“As with all elective plastic surgery procedures, patients are advised to be at an appropriate weight before surgery,” Dr. Mahmood says, noting that “studies have shown that the risk of infection and wound breakdown is elevated for those at a higher BMI.” Needless to say, surgeons want to mitigate risk for patients.

It’s also important to maintain a good diet and exercise regimen after surgery, she adds, adding that “most are excited about finally being able to do, as they are finally unencumbered by large breasts.” An active lifestyle is important to avoid having breast volume increase again in the future, she explains.

8. If my weight fluctuates after a breast reduction, will it impact the results?

Though this isn’t common, it can happen. “It is generally unlikely that breast growth will occur after a breast reduction, particularly because skin, fat, and breast tissue are removed,” Dr. Mahmood explains. When it does occur, it is usually the result of hormonal changes (think: pregnancy, menopause), weight gain, or medication.

9. How is the size of my post-reduction breasts determined?

Determining the right size requires an open and honest dialogue between patient and provider. Dr. Danielpour says it is important to balance the patient’s goals with what will work best for their body. “The size should match the individual’s frame and also be small enough that it will help, if it is meant to reduce neck, shoulder, and back pain,” he says.

A pro tip? Don’t fixate on a particular size. “It is well known that there is wide variability in bra sizing — different companies and brands have their own sizing rules — so there is no consistency in determining what a patient's size is pre-op,” Dr. Mahmood says. “Furthermore, most patients are wearing incorrect or poor fitting bras, and they often state themselves that their bra size is an inaccurate representation of their current breast volume”

As she explains, there is no correlation between the amount of breast tissue removed and the resulting bra size because patients have different baselines, different overall breast measurements, and varying tissue composition. To combat this, Dr. Mahmood asks patients to generally tell her what their “ideal size” is, as women tend to have a rough idea of what cup sizes look like. “Based on that, I perform the surgery and tailor the amount of tissue I remove to what will help them achieve that size,” she says.

10. Can I speak to former patients and/or see before and after photos?

Absolutely! “It can be challenging to speak directly to former patients based on HIPAA regulations, as well as patients not wanting their personal information shared,” Dr. Mahmood shares. “But patient testimonials and before and after photographs are certainly invaluable to helping patients determine which surgeon is the right fit for them and what their results might look like.” So, don’t be afraid to ask for the assets you need to make the best decision for yourself.