Breast Reduction

Sometimes, overly large breasts can be inconvenient or even painful, depending on your body type. Women with oversized breasts often feel restricted in their activities due to discomfort. Others have difficulty finding clothing that fits them properly. In addition, oversized breasts can sometimes lead to skin irritation or pain in the back, shoulders, or neck. With a breast reduction, Dr. Andrew Cohen can remove excess volume and create a beautiful, more proportionate shape.

Breast reduction surgery is Dr. Cohen’s favorite operation, and he performs the procedure between 1 and 4 times weekly. He finds that breast reduction patients are among his happiest patients, as the procedure can be life-changing due to it relieving symptoms of neck and back pain as well as shoulder grooves. Having perfected the wise pattern inferior pedicle reduction with lift surgery, Dr. Cohen takes pride in helping patients improve their quality of life through this advanced procedure.

What Are the Benefits of Breast Reduction?

Breast reduction surgery (also referred to as mammoplasty) can be used to address both cosmetic and physical concerns. Women who choose breast reduction typically seek to accomplish one or more of the following:

  • Remove excess breast tissue
  • Elevate the position of the breast on the chest wall
  • Reshape the breast for a more proportionate look
  • Eliminate the pain and discomfort associated with oversized breasts
  • Improve range of physical activity

In many cases, breast reduction is combined with breast lift surgery to achieve greater rejuvenation of the breasts. After the breast reduction procedure, many women find the pain caused by oversized breasts is completely eliminated, feel more confident in social situations, and experience increased comfort while exercising (which can result in weight loss) and an improved overall quality of life.

Am I a Candidate for Breast Reduction Surgery?

While all women who choose to undergo breast reduction want to decrease the volume and size of their breasts, the personal reasons for this may vary greatly. Candidates for breast reduction typically experience limited physical activity due to the size of their breasts and may not be able to participate in certain sports or exercises. Women with overly large breasts also commonly live with chronic discomfort or pain located in the neck, shoulders, or back. Oftentimes, there are deep indentations on the shoulders caused by bra straps that do not comfortably fit. The skin beneath the breasts may also become irritated or a rash may develop.

From a cosmetic perspective, some candidates wish to reduce the size of their breasts to address sagging and elevate the breasts above the abdomen. Overly large breasts can also lead to difficulty finding clothes or swimsuits that fit properly. Finally, many potential candidates who seek out Dr. Cohen for breast reduction have reported receiving undesirable attention due to the size of their breasts. The best way to determine your candidacy for breast reduction is to schedule a consultation with a board-certified plastic surgeon who can perform a physical examination and thoroughly discuss your individual concerns.

What Is the Ideal Age for Breast Reduction Surgery?

The ideal age for a breast reduction will vary for each individual, but patients can be eligible for the procedure as early as their teenage years. Dr. Cohen has operated on patients as young as 14 to as old as 77 years. You are never too old for plastic surgery as long as you are healthy and have medical clearance.

If you are a teenager considering breast reduction, you will have to come in with your parent or guardian for the initial consultation. Dr. Cohen has performed surgery on 14- and 15-year old girls who had large breasts due to hypertrophy of the breast tissue or congenital breast asymmetry. If you are three years past your menarche, then you are a good candidate for the breast surgery. Studies have shown that waiting until three years after your first period is a good time to operate to ensure the breasts will not re-enlarge after the breast surgery.

What Does the Breast Reduction Consultation Involve?

Dr. Cohen will begin the breast reduction consultation by listening to your personal concerns and determining your candidacy for the procedure. The breast reduction procedure can be customized based upon the needs of the individual to achieve her expectations. Dr. Cohen will also review the risks and benefits of breast reduction surgery, allowing prospective patients to make an educated decision about their body and their health.

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What Can I Expect in My Breast Reduction Procedure?

Depending upon your unique needs and goals, Dr. Cohen will design a custom surgical plan using his refined wise pattern breast reduction technique. The procedure is performed under general anesthesia and typically takes two to four hours to complete.

What Is the Wise Pattern Incision Technique?

The wise pattern incision (also known as the anchor or inverted-T) avoids the problem of shape that some vertical incision breast reductions have. Removing the skin in the crease underneath the breast allows the breast to stay perky and round. When a pen is placed under the breast, it should not fall to the ground. The breast tissue should all be in a superior location after a breast reduction or lift. Dr. Cohen has perfected his breast reduction technique over 20-plus years and will tailor the surgery to you to help you achieve the shape, size, and symmetry that you desire.

Wise Pattern vs. Lollipop Incision

Dr. Cohen has found that the shape of the wise pattern lift is far superior to any other technique. This is debated in some plastic surgery circles who want to keep the incision smaller, such as the lollipop incision. When comparing the post-operative breast shape achieved using the lollipop technique versus the wise pattern approach, there is clearly an advantage to the wise pattern lift.

The advantage of the wise pattern technique is a pretty shape with a well-placed scar in the natural crease of the breast. The lollipop incision — even when done by experts — is a scar around the nipple and down to the crease, and sometimes an unsightly scar is bunched and goes too far inferior under the crease to the upper abdomen. The shape is compromised, in his opinion, and can be suboptimal as compared to the wise pattern lift.

The main downside of using the wise pattern incision is a larger scar underneath the breast crease, but it is better to have an improved shape and perkiness to the breast that will last long-term. The incision follows the natural curve of the breast, so it can be safely hidden in clothes or bathing suits.

Dr. Cohen has modified the traditional wise pattern lift by carefully making sure the lateral incision follows the natural curve of your breast so that it can be hidden. He calls this the “Cohen Curve Modification.”

Is Surgical Mesh Necessary for My Breast Reduction?

Dr. Cohen will frequently offer to use GalaFLEX mesh in his breast reduction, lift, or augmentation with lift patients. This is an internal scaffold that completely dissolves in about 18 months’ time. If a patient has poor quality skin and has a lot of stretch marks, the dissolvable mesh is used to help support the tissues. Once the mesh dissolves, your body creates collagen to help further support the tissues. For more information about the mesh, you can click here.

If you would like to avoid the use of surgical mesh, Dr. Cohen can place internal sutures of the breast parenchyma. For patients who elect not to do mesh, Dr. Cohen will still augment the lift and shape with internal sutures of the breast tissue to achieve a favorable outcome.

Is the Nipple Removed During Breast Reduction Surgery?

No. The nipple is left attached in an inferior pedicle. The goals are a sensate nipple with symmetry of your breasts, so we leave the nipple attached to its blood and nerve supply. It is rare that Dr. Cohen will remove a nipple and do what is called a “free nipple graft.” The free nipple graft is usually for female to male surgery, also known as top surgery.

Is Liposuction Necessary in the Breast Reduction Procedure?

Liposuction of the axilla or the pre-pectoral area of the breast helps to improve the overall shape. Dr. Cohen will use the power-assisted liposuction machine to allow less bruising and a more gentle approach to removing the fat cells.

Will I Have Drains After Breast Reduction Surgery?

Most of our breast reductions do not require drains but some do. It will depend on how much bleeding or oozing occurs during your surgery. Dr. Cohen usually makes that determination intraoperatively.

Outline of Typical Breast Reduction Procedure

  • Duration of Surgery: 2-4 hours, depending upon technique
  • Anesthesia Type: General anesthesia
  • Hospital Status: Outpatient
  • Post-Operative: Mild soreness, sensitivity, swelling, or bruising; temporary change in nipple sensation
  • Surgical Risks: Blood clots, infection, and in rare instances loss of nipple sensation are among the risks of breast reduction surgery; however, Dr. Cohen is highly experienced and employs techniques that can reduce the risk of these complications.
  • Duration of Recovery: One week before returning to work, two weeks before resuming normal exercise, and several months for scars to fade
  • Results: The results of breast reduction are considered permanent.

What Does Breast Reduction Recovery Entail?

After your breast reduction surgery, you may experience some degree of bruising, swelling, and discomfort. Dr. Cohen will use medication called TXA (tranexamic acid) to help minimize the bruising. This is a highly regarded medication used in all plastic surgeries as well as other surgical specialties to help minimize bleeding and bruising. It is given in the IV prior to the induction of anesthesia so you will not be aware of receiving it.

Our office will also provide Dr. Cohen’s Arnica Supreme, which is a homeopathic medication that contains arnica, bromelain, grape seed extract, and vitamin C. This helps with overall healing and your immune system as you recover.

Since Dr. Cohen uses all dissolvable sutures during breast reduction surgery, stitches will not need to be removed. Over the course of two weeks, they should gradually dissolve, but in some cases Dr. Cohen can remove the outside knot if the sutures become itchy or uncomfortable.

What Will My Breast Reduction Scars Look Like?

As with any surgical procedure, you will have scarring after your breast reduction procedure, but incisions will be made in the natural lines and folds of the breasts to help conceal them. Dr. Cohen has also refined the wise pattern lift technique by placing the lateral incision within the breast’s natural curve — known as the “Cohen Curve Modification — ensuring post-operative scarring is as inconspicuous as possible.

For those concerned about unsightly scars, the vast majority of patients can expect their breast reduction scars to flatten, soften, and fade in color over time. However, in some cases a scar can heal as a hypertrophic or keloid scar. A keloid scar is a raised scar that can occur depending on your skin type. If necessary, our team can inject the scar with the steroid kenalog up to three to five times post-operatively to help it flatten. If the keloid persists, then a small local procedure can be done to excise and revise the keloid scar. This occurs in less than 5 percent of cases in our hands.

Dr. Cohen and his team offer a comprehensive scar management plan. Silicone sheeting and cream is recommended after one to two weeks when the incisions are closed and intact. If scars are red at months 2-4, we offer laser treatments with the Cutera Laser Genesis to get the red (inflammatory cells) out of the scar. Microneedling with the SkinPen® can also help reduce the scar and improve its appearance if needed.

How Much Does a Breast Reduction Cost?

Every breast reduction procedure is customized for the patient, and as a result, the cost of the procedure will vary from case to case. The surgeon’s fee for a breast reduction is usually $12,000-17,000 depending on the size of the breasts and what needs to be done.  There is also a fee for the anesthesiologist and the surgical facility and pathology. These will all be discussed and explained to you prior to the surgery so there are no surprise fees after the surgery. Common factors that influence the overall price of the procedure include:

  • The surgical technique employed
  • The complexity of the procedure
  • Experience of the plastic surgeon
  • Geographic location of the practice

After your initial consultation, Dr. Cohen will be able to provide an accurate quote for the cost of your customized breast reduction.

For patients who may need further assistance, we offer a number of plastic surgery financing options. Through third-party companies such as CareCredit®, ALPHAEON™ Credit, and BLIS® Specialty Insurance, patients may qualify for low monthly payment plans with little or no interest. To learn more about these financing options for your breast reduction, please contact a member of our staff.

Will Insurance Cover My Breast Reduction Surgery?

Dr. Cohen is out of network with all insurance companies but will work with you to try and get your breast reduction procedure pre-authorized. You will receive a quote for the surgery, and we will see if your insurance company will authorize the surgery to help reimburse the costs.

Insurance providers may offer coverage for your breast reduction if you are having the procedure for medical reasons. Insurance companies typically require at least 500 grams of tissue to be removed from each side for the procedure to qualify for coverage.

You will receive a cosmetic quote for the surgery when you come in for the first visit so you will have a “good faith quote” if you wish to have a cash quote. We will then send a letter to your insurance for pre-authorization to see if it can be a covered procedure for you.

Additional Frequently Asked Questions About Breast Reduction

How Many Follow-Up Visits Will I Need After My Breast Reduction?

  • Dr. Cohen will see you for an initial consultation as well as a pre-op visit to once again go over the goals of surgery, sign consent forms, and review any pre-op lab work. We also see you post-op day one or two, one week post-op, one month post-op, three months post-op, six months post-op and one year. These follow-ups are necessary for pictures and scar management. 

What Is “Bottoming Out” After Breast Reduction Surgery?

  • Bottoming out is a rare post-op finding when the breast tissue falls below the inframammary crease. Dr. Cohen places special sutures in the pedicle itself, called the “Cohen Pedicle Support Sutures,” to help prevent this complication. These sutures shorten the pedicle to prevent the tissue from falling. Another method to avoid your breasts from bottoming out after surgery is to wear a good supportive bra 6 months to a year post-op. Both day and nighttime bra support is highly recommended.

When Can I Wear a Bra with Underwire After My Breast Reduction? 

  • Following breast reduction surgery, we recommend wearing support bras for 6 to 8 weeks, after which a wire bra should be fine. Wear a good supportive bra for six to 12 months post-op for best results, both during the day and night. Nighttime bras can help prevent stretching and bottoming out — we recommend the nightlift bra, which our staff can help you with.

Where Does Dr. Cohen Perform Breast Reductions?

  • Dr Cohen has a Quad A-certified operating room in his office in Encino, called the Cohen Outpatient Surgery Center, (COSC). This is where the majority of his surgeries are performed. The other three options are Providence Cedars-Sinai Tarzana Hospital in Tarzana, Cedars-Sinai Hospital in Los Angeles where he has been the Clinical Chief of Plastic Surgery for two terms in the past, or United Pacific Surgery Center in Tarzana.

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To learn more about how breast reduction surgery can help relieve pain and achieve your cosmetic goals, please contact our office to schedule your consultation.