When we imagine breast surgery, we picture images of women indulging in the larger breasts they’ve always coveted – or getting relief from too-large breasts via reduction. But, there are a whole lot of other reasons, medical and otherwise, a woman may decide to opt for breast surgery.
Tuberous breasts Tuberous breasts, a congenital abnormality where breasts fail to develop normally and fully, is fairly common, says board-certified plastic surgeon Dr. Tracy Pfeifer I see about 1-2 patients per month who have some variant of this condition. Maybe the fold is too high with a short areola to fold distance - this is quite common. It can be a major asymmetry of size and shape that requires both an implant and a mastopexy. Patients who have shape and size asymmetry are more likely to be aware that they have tuberous breast, but the majority of patients have no idea they have a congenital condition,” says Dr. Pfeifer. Patients may think they have abnormal looking breasts and often their families have discouraged them from seeking help. “The goal with tuberous breast is to increase the size, improve the symmetry, correct any ptosis and improve the overall shape of the breast. This is a huge confidence booster for these patients,” explains Dr. Pfeifer.
Inverted nipple Inverted nipple is also a frequent reason for a visit to Dr. Pfeifer’s practice. “The patients who come in are well-aware that they have inverted nipple and have read about it ahead of their consultation. They know that there are grades of inversion and have an idea of the basics about how to correct it. One of the main concerns for women is breastfeeding. Patients often ask about loss of nipple sensation. They are very self-conscious about their breasts and are very careful to wear certain types of clothing and bras so no one can see that their nipple is inverted. The goal is to correct the inversion without transecting any ducts if possible. However, if the inversion is severe, ducts will need to be transected to correct the condition. In this situation, the patient would not be able to breastfeed because the inversion is so severe,” says Dr. Pfeifer.
Uneven breasts “I would say that very few people come in saying their breasts are uneven after breastfeeding. They may have asymmetry, but what the patient usually notices is the sagging and reduced size. This of course is very common, and we see several patients each week in this situation,” says Dr. Pfeifer. Patients want to restore the fullness of the breast and eliminate the sagging. “Our goal as surgeons is to enhance the fullness with an implant if necessary, lift and shape the sagging breast tissue, remove the excess skin and reposition the nipple areola complex on the breast mound. Mastopexy is often associated with recurrent sagging so we try to reduce the chances of this. My personal approach is to use a textured breast implant with Galaflex mesh as an internal bra and subglandular pocket if possible,” explains Dr. Pfeifer. “Both the patient and I want a fine quality scar, so I use Quill sutures and paper tape postoperatively. It is very important that post-op the patient wears a bra that fits properly. Most patients wear bras with a band size that is too big and then the cups cannot support the breasts as they should,” Dr. Pfeifer says.
Size issues When it comes to breast surgery, many of us immediately think of desiring larger or smaller cups. “I see more women who want larger breasts as opposed to reductions, but the trend now is moving more towards restoring lost fullness. Patients, who are born with smaller breasts want a natural looking enhancement with tasteful results,” explains Dr. Pfeifer.
Surgery and shaping Particularly with uneven breasts, there’s a lot of direction that size and shape can go. “Of course we are assuming that the shape is right and does not need correction. I ask the patient which breast they prefer, the larger or the smaller. If they prefer the smaller, then the larger side is lifted and/or reduced. If they prefer the larger side, it can get tricky. It can be difficult to put an implant on the smaller side and have it match the larger side. Often the large side has a lot of ptosis and needs a lift. Also because the large side has more breast tissue, it will always look different from the smaller side with the implant. Usually I will reduce the larger side and then put the same size implants on both sides. This is complicated but gives the most control over the symmetry of the final result,” says Dr. Pfeifer.
Recovery time For different breast surgical procedures, you can expect different downtime and recovery time. “Correction of inverted nipple can be performed under local anesthesia and the patient can return to work the next day. I use a bulky dressing and advise them to wear a loose-fitting top that camouflages the dressing,” says Dr. Pfeifer. In general the other surgeries have similar recovery times, says Dr. Pfeifer, but the hardest is under-the-muscle augmentation. “Implants under the muscle have more pain because the muscle goes into spasm, so we prevent this with muscle relaxants. I also put long-acting anesthetic in the pocket to help. Implants on top of the muscle have much less discomfort because of very little muscle spasm,” explains Dr. Pfeifer. “All other surgeries including augmentation, reduction, and lift may require general anesthesia and my patients take off one full week from work. No heavy lifting or exercising for at least 2 weeks,” she says.
“Because of the general anesthesia and the inflammation associated with the healing process, patients will feel a little tired for about three weeks and will need a full three months to feel 100% in terms of energy level.” Dr. Pfeifer cautions her patients against doing many activities when initially returning to work. With proper medication the patient should be a 2 on a pain scale of 1-10 with 1 being the least discomfort. Breast reduction and lift patients have more of soreness (basically a skin operating with minimal if any muscle spasm) as opposed to pain and it is easily managed with minimal medication. Larger breasts can be generally seen as an aesthetic reason for surgery and not medically necessary, despite the fact that some women seeking a reduction are doing so for medical purposes. Because of this, some breast reduction surgeries are covered by insurance, while others are not. “Breast reductions are often covered by insurance carriers in my practice. Whether or not it is covered will depend on the health insurance policy the patient has. We need to show that it is medically necessary. Usually this means getting a neurologist or chiropractor to agree that the patient’s symptoms of pain will be improved by the reduction. The insurance carrier usually requires a certain weight of breast tissue to be removed, often 400 to 500 grams per breast,” explains Dr. Pfeifer.
Some policies will cover the removal of ruptured silicone implants, but not cover an inverted nipple or a breast lift. “If the patient is having a revision of an implant reconstruction for aesthetic reasons, the revision will be covered because of the history of breast cancer, including if the surgery is on the non-cancer side. For example, the non-cancer side may need revision or surgery for symmetry,” says Dr. Pfeifer. Breast surgery, like any other surgery carries risks, so whatever reasons for undergoing breast surgery, you should always seek a board-certified plastic surgeon.