- Your Consultation
- Insurance Coverage
- Short-Scar Breast Reduction
- Post-Operative Instructions
- Potential Complications
- Schedule a Consultation
A short-scar breast reduction is a great procedure for you if you have big, heavy breasts that give you pain in your shoulders and back, restrict your activities, and make you look like a grandmother — and you are thus willing to trade them for lighter, smaller breasts that still look very feminine but cause far less back pain. However, your breasts will have scars on them for the rest of your life. Dr. Lori Cherup never performs this procedure on patients who do not have significant symptoms and who do not feel that this tradeoff is absolutely worth it.
Short- Scar Breast Reduction Consultation
To begin your short-scar breast reduction consultation, Dr. Cherup needs an accurate history of how long you have suffered from neck, shoulder and back pain, rashes in your breast folds, shortness of breath, numbness in your fingers, inability to exercise to your fullest, and weight gain due to inability to exercise. Without these symptoms, the surgery is considered cosmetic and not reimbursable by insurance. Any past history of breast masses, breast cancer in your family, and breast biopsies will be discussed. If you are over 25 years old, a mammogram will be necessary before the surgery to document that your breasts are mammographically normal. You will be shown photos of other patients who resemble your body type who had the surgery, and your approval of the final size and scars will be sought by Dr. Cherup. Photos of your breasts will be necessary for documentation, and may need to be sent to the insurance company.
Authorization of the Surgery by Insurance Companies
In some states, such as California, breast reduction surgery is not paid for by health insurance companies at all. In Pennsylvania, it is much harder to get approved than it was 10 years ago. Insurance companies adhere to the “Schnur Chart,” which correlates your height and weight with the weight of the breast tissue to be removed. If your breasts are not really that large compared to your body size, and you have factors that reduce your ability to heal – such as previous biopsies or smoking – Dr. Cherup may not be able to remove enough tissue from each side to satisfy the insurance requirements. In all, Dr. Cherup is able to get 90% of breast reductions approved by insurance.
The Short Scar Surgery
Previous breast reduction methods produced long scars from the armpit to the breast bone. A newer technique developed by a surgeon in Canada is utilized by Dr. Cherup. This procedure leaves a 6-cm scar in the fold; it is well hidden by the breast tissue. This breast reduction technique takes Dr. Cherup approximately two hours and is always done under general anesthesia. The surgery involves removing skin only from the bottom third of the breast. Then, breast tissue is removed from inside the breast — from the bottom, the lateral side, and the lateral top of the breast. The nipple-areola complex is never detached from the breast parenchyma. The breast tissue is rotated back up onto the chest and anchored to it with sutures to keep it there. All of the incisions and skin flaps are wrapped back around the higher breast tissue and closed. All sutures are under the skin — there are no hatch marks on the skin. Two drains exit underneath your armpits to drain the fluid for the next two days. You go home with dressings, in a surgical bra, after you recover in our Radiance Surgery Center recovery area.
Post-Op Healing After Breast Reduction
During the two days in your home, you will not move your upper body very much. Sleep on your back propped up. Your family will be taught how to manage your drains and record the drainage. Dr. Cherup will see you on the second postop day. The drains will be removed, and instructions given about changing your dressings, washing your bra, and showering once a day.
Here are some issues in post-op healing that are common concerns:
Sutures – All of the sutures in Dr. Cherup’s technique are placed under the skin. The ends of the sutures are brought out at different points at the ends of the incisions and left long. They are clear sutures. These sutures will be trimmed at two weeks and that is all that is involved in “removing the sutures.”
Dressings – Dr. Cherup will give you a sheet that describes the once-a-day dressing changes you will perform after she sees you on the second postop day. It describes cleaning the skin with peroxide, then alcohol, and then applying bacitracin ointment. 4X4 cohesive gauze is layered on and secured with paper tape. Your bra will keep most of the dressings on.
Buying new bras – Dr. Cherup will supply with you a surgical sports bra that you will wear for at least two weeks after the surgery. Some patients have to wear it longer if they have problem areas on their suture lines that require more healing. At about three or four weeks after surgery, Dr. Cherup will measure you and recommend the new bra size that you will wear. Your breasts will change very little after four weeks. You are welcome to buy any kind of bra you want, including an underwire.
Activities – In the first two weeks after the surgery, you should not raise your arms above the shoulder level for any prolonged period of time. Minimize hairstyling, and certainly do not reach way up in the top of a cupboard. All these activities will pull your incisions apart. After two weeks, when most of the sutures are out, you can perform most activities of daily living. You certainly would not want to participate in sports such as tennis, racquetball, or very aggressive swimming. Most exercise routines that require your lower body, as well as stretching, are fine. Do not participate in yoga for at least six weeks after the surgery.
Back to work – People who have a sedentary job can go back to work on postop day four or five. Just remember that you cannot take narcotics if you are going to be commuting. People who have more physical jobs that may require them to carry heavy items (e.g., waitress or sales representative) probably need to take at least 10 days off of work.
Later Sequelae (Effects) of Breast Reduction Surgery:
Widened scars – Breast reduction scars encircle the areola, drop vertically from the areola to the crease beneath the breast, and then run for a short distance horizontally in the crease. The overall shape of the scars resembles an “anchor.” Any of these scars may thicken and spread and remain red for many months, mostly because there was a fair amount of tension on the skin during the healing. Surgeon Dr. Lori Cherup will suture them all meticulously, using the best plastic surgical techniques available. How they eventually look depends largely on your own unique skin qualities and healing characteristics. Some patients have fine white scars, and some patients have wider purplish-to-red scars. Even the purple scars eventually fade to white, but sometimes it may take over a year. If you had an area that lost a patch of skin due to poor blood supply, that area will eventually heal with a flatter, thicker scar. Occasionally, you and Dr. Cherup may decide to revise some of the scars, usually not for at least six to nine months after the surgery. Dr. Cherup has scar preparations that she can prescribe for you and silicone sheathing that may help to improve the scars.
Decreased sensation – Although some breast reduction patients experience areas of partial numbness on the skin, permanent loss of sensation is rare. It is also not common to experience permanent loss of sensation to the nipple. Many patients tell Dr. Cherup that they have more sensation to their nipple areola complex after the surgery. Erection of the nipple is usually present after surgery. If there is reduced sensation, it may take up to two years to improve.
Asymmetry – Few women have perfectly symmetrical breasts. After surgery you may still have some mild asymmetry. Dr. Cherup works very hard during the surgery to get the volume, size, and scar length symmetrical. Sometimes with healing, tissues relax and stretch at different rates, and there may be residual mild asymmetry. Occasionally, patients require small revisions after a year. Dr. Cherup can perform that surgery at Radiance Surgery Center.
Areolae that are not perfectly round – Dr. Cherup again works very hard during the surgery to make sure that the areola that we keep from your native areola has a round shape. Again, sometimes due to relaxation of the muscles in the skin, or due to stretching of scars, the areola is not perfectly round. If this is a significant problem aesthetically, Dr. Cherup may offer a revision. Sometimes, we cannot get an insurance company to pay for aesthetic details such as this.
Breast feeding – Dr. Cherup’s current breast reduction technique allows for some breast feeding in that the nipple is sensate and there are plenty of breast glands connected to the nipple. However, it would be foolish to think that milk production is the same as it would have been prior to the reduction. There is some risk that the breast feeding may not be possible at all. If this issue affects your decisions or future plans, discuss it with Dr. Cherup before the surgery is performed.
Hardness inside the breast – Postoperative scarring within the breast tissue may cause areas of hardness. These areas are actually fat that has scarred due to poor blood supply. Sometimes when these are discovered later by another physician, there is a concern about cancer. Mammography or even biopsies are occasionally indicated. Dr. Cherup cannot remember when these areas of hardness have ever become a true medical problem for a patient of hers.
Infection – Infection is an unusual complication. Frequently, patients with very large breasts will experience some separation along the suture line, especially down at the bottom near the fold, where all the suture lines meet together. Although the skin may separate and become contaminated with bacteria, a true infection is rare. Very rarely a patient will experience a deeper infection in the breast that needs to be drained surgically. Dr. Cherup will treat it appropriately with antibiotics, and all separations along incision lines will eventually heal with good wound care and time.
Schedule a Breast Reduction Consultation
For more information about breast reduction, or to schedule an informative consultation, please contact Dr. Cherup at (412) 220-8181 or (877) 441-0639.