Breast Reduction in Los Angeles

The simple most important factor is recognizing that you would rather be smaller and perkier with scars than how you are now without scars.

A breast reduction can reduce neck, back, shoulder, and breast pain. It can reduce rashes that can occur under pendulous breasts; it can alleviate grooving from bra straps; it can make a woman feel more proportionate and wear a greater variety of clothing and lingerie. But the most significant differences are issues such as improved self-esteem, not feeling that people are staring at their breasts, an increased ability to exercise and play sports, and overall feeling lighter and more spry.

A breast reduction includes a breast lift. Skin is removed and tightened – that takes care of the lift. Tissue is removed on the inside, and that takes care of the reduction.

NO. NEVER. Everyone thinks that this will happen, and it does not. Skin around the nipple is removed and tightened, but the nipple always remains attached to the breast. Purely out of historical interest, there was an operation years ago for extremely massive breasts that involved removal of the nipple, but that is not done today.

A standard breast reduction involves significant scarring on the breast. It can remove skin and lift the breast, as well as removing any amount of breast volume on the inside. A ‘scarless’ breast reduction is nothing more than liposuction of the breast. One or two very small incisions are made underneath the breast and fat is removed. But there is no removal of skin or lift.

The standard reduction is best for most of our breast reduction patients because it allows for correction of droopiness and the greatest volume of tissue removal. But if the skin is relatively good, if the breast is not very droopy, and if the breast has a significant fatty component, then a scarless reduction can be a good choice. With the removal of weight in the breast, the breast may rebound upwards a bit, but it does not actually lift the breast per se. With a regular reduction, Dr. Teitelbaum can remove as much skin and tissue as a patient wants. But with the scarless he does not remove any skin, and the amount of volume removed is limited by the amount of the breast volume that is fat (because the glandular, milk-making part of the breast is too firm and dense to be removed by liposuction.)

You and your surgeon will discuss how much smaller you want to be. But understand that the actual footprint of the breast on the chest – where the breast starts towards the center and where it ends to the side – can be changed little in most situations. Given that, there is an ideal breast volume that will create the most aesthetic breast. In an attempt to go too small, the breast can look wide and flat; if it is left too big for the width, the breast will of course still look too big. This is the subject for an extensive conversation at the time of your consultation. With a scarless breast reduction, only fat tissue can be removed, and so this limits the amount that can be removed. Our Los Angeles patients are usually satisfied with the volume removed, but at other times they wish that more could be removed. Even so, most of these patients are still satisfied that for whatever lack of reduction they had, they still didn’t have to have any scars. They can still have a regular reduction to remove more, but it is rare for a scarless reduction patient to ask for this to be done.

Reduction patients never look fake like a breast augmentation patient might. In other words, an excessively perky and round breast isn’t possible, even if that were to be your goal. The shape is almost always significantly better than before the reduction. Other than the scars, the breasts will look and feel totally natural – because they are.

The tissue that is removed is gone. Remaining breast tissue can fluctuate with hormones, fat in the breast can fluctuate with weight, and droopiness can start to increase just due to gravity. But by and large most of the result of a breast reduction is permanent, though like all breasts, they will of course change over time.

They can increase in size, but they are unlikely to get as large as they were unless you gain a significant amount of weight.

You will have what is called an "anchor" scar, which is a scar that goes around the nipple, straight down to the bottom, and across the underneath part of the breast. This affords the greatest shaping in all three dimensions. The so-called "vertical" lift only has a scar around the nipple and straight down to the bottom of the breast. Many surgeons do not consider the shape of these breasts to be as attractive, which makes sense because there is one less direction of control the surgeon has. And though there is less total length of scar, inch by inch the quality of the scar is less because this technique requires ‘bunching’ of skin, which often makes a wider scar. The vertical frequently requires some scar revision, often including the placement of a horizontal scar at the bottom at a later date, so in most cases it does not make sense. Patients always ask about the "donut" lift, also known as the "circumareolar" or "Benelli" scar. This is very limited in how much tissue can be removed and in how much the breast is reshaped. The breasts often end up looking under-projected, and therefore this procedure has not really caught on in the USA.

There are usually two scars, each about ¼" long located in the crease under your breast. For all intents and purposes, these scars are invisible.

Loss of sensation is a risk of breast reduction. Many women with large breasts have lost sensation from the stretching of their nerves, and for them this is not an issue. But many others have a lot of sensation, and the risk of losing that sensation is important to them. It is very hard to measure and quantify changes in breast sensation. While most patients do not experience a reduction in feeling, the bottom line is that you have to decide for yourself that you would rather be smaller even if it meant you lost sensation.

Today’s techniques for breast reduction do not cut the milk ducts. Studies show that 2/3 of women getting a breast reduction are able to breast feed afterwards. Of course, not all of the 1/3 who couldn’t would have been able to breast feed without the reduction, as many women with breasts large enough to need reductions have stretched out ducts and flattened nipples that babies may not be able to latch on to.

If a patient has symptoms of neck, back, shoulder, and breast pain, or has a history of rashes under the breasts, most insurers will pay for a reduction. As time goes on, they are getting more and more strict. They also usually require removal of 500g (a bit more than a pound) in order to pay for it, which doesn’t make any sense because that could be a lot on a short woman and a small amount on a taller woman. But even if the insurance company agrees to pay, you will still have significant financial responsibility unless you choose an "in network" plastic surgeon.

Please note: We are not contracted with any insurance companies and we do NOT preauthorize or bill insurance. We will provide you with an operative note to submit to your provider.

We will give you detailed instructions after you have scheduled your surgery. We will provide you with the bra you will need to wear after surgery. Just wear a comfortable sweatshirt top you can zip on and off.

You are well enough to go home; you do not need to go to an aftercare facility. But some patients go if they do not have a friend to watch them the night of surgery, or if there is just too much commotion going on at home for them to be able to relax.

Most patients use the word sore more than painful. They feel achy, they feel pressure, but the pain is never sharp or severe. The pain builds gradually, so if you feel yourself getting uncomfortable, take a pain pill and you will feel better.

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

The bottom line is that the fate of your scar is mostly determined by your own genetics and by the surgery itself. It is not clear the extent to which putting things on scars will influence their final appearance. However, most patients want to do something. There has never been a direct comparison between the various products. Patient feedback has been the most positive from three sorts of things: Scar Guard, which is a liquid containing steroid, Vitamin E, and silicone that you brush on like nail polish; Silicone gel strips (such as Neosporin scar strips); and silicone ointment (such as Scar Fade.) You can get these from our Los Angeles office or the pharmacy, and you can start putting them on once the glue or the steri-strip is off, following the instructions on the packaging.

It is normal when operating on two sides of the body for them to swell differently, but by and large they serve as a control for the other. So if one is much larger or more painful, let us know right away. If the incisions get red, tender, inflamed, let us know. Sometimes there can be a little separation along the incision or a "spitting" suture, and you should come in so we can help you treat this.