BREAST REDUCTION By Joshua Zuckerman, MD, FACS in New York City

If you suffer from the deleterious effects of overly large breasts, you may be a good candidate for this operation. Dr. Zuckerman can help you alleviate a number of related concerns including:

• • Disproportinate amount of breast ptosis (sag) or droop
• • Back and/or shoulder pain
• • Anxiety, discomfort, self-consciousness
• • Breast weight leading to bra-strap indentations or rubbing

During a breast reduction, Dr. Zuckerman removes breast tissue to decrease the size of the breasts. This physically removes weight from the breast, helping to alleviate chronic pain. There exists no single formula for the ideal breast size, and Dr. Zuckerman’s patients vary in the amounts of breast tissue they desire removed. He will customize the procedure to your preoperative anatomy and surgical goals and has various methods of achieving a mutual consensus as to the postoperative size you desire. While bra sizes are not standardized, it can help to have an idea of what size “bra cup” you would like to be after surgery. Ultimately, the procedure requires trust in your surgeon to achieve your desired aesthetic outcome and to account for future settling of the breasts, as gravity will continue to act on them over time.

Breast Reduction versus Lift

Similar to breast lift surgery (mastopexy), Dr. Zuckerman’s breast reduction surgery will raise the breast mound, and with his experience and surgical skill, you will be left with a higher, round, natural-looking breast. Unlike a breast reduction, breast tissue is generally not removed during a breast lift. However, the difference between breast lift surgery and breast reduction surgery is often more of a spectrum than a definitive line, because many patients need some breast tissue removed. If you are unsure which procedure might be a better fit for you, please contact us to schedule an initial cosmetic surgery consultation with Dr. Zuckerman where he will address any and all questions you may have.

Good candidates for this operation are those with fully developed breasts. Please discuss any medical conditions you may have with Dr. Zuckerman at your initial consultation as this may affect your candidacy for the procedure. In addition, if you plan to breastfeed in the future, please let Dr. Zuckerman know, so he can discuss your options with you. If you are a candidate for having health insurance cover the cost of your procedure, Dr. Zuckerman’s staff can assist you with the insurance approval process.

Dr. Zuckerman uses two different techniques to perform breast reductions depending on the reduction desired. The Circumvertical, or vertical / “Lollipop”, or the Anchor / Wise Pattern. To minimize scarring, Dr. Zuckerman uses the vertical pattern unless the reduction required is large.

Dr. Zuckerman’s breast reduction surgery proceeds as follows:

• Before surgery: Dr. Zuckerman will mark your breasts with preoperative surgical markings that will guide his incisions intraoperatively. For this procedure, tissue is removed from certain areas within these markings, and the closing incisions and ultimate scars are more minimal than the initial markings.
• Initial incisions: Dr. Zuckerman begins surgery by making initial incisions along the marking pattern.
• Remove tissue & skin: Dr. Zuckerman removes excess fat, breast tissue, and extra skin.
• Liposuction (not all cases): He may perform small volume liposuction of the armpit area, or “bra rolls”, to help ensure a natural-looking, round result.
• Areola Reduction: For most breast reduction patients, Dr. Zuckerman also repositions and improves the appearance of the areola, the more darkly pigmented skin around the nipple. By trimming tissue from the areola, Dr. Zuckerman’s breast reduction can also reduce the size of the nipple.
• Closing: Dr. Zuckerman closes the incisions into one of the two patterns at left.

There are two techniques, or incision patterns, that Dr. Zuckerman uses in his breast reductions as seen at left. The decision of which incision to use depends on the amount of breast tissue to be removed.

• Circumvertical: This technique is also known as a “”Lollipop”” and involves a periareolar incision, around the areola, plus a vertical incision from aerola to the inframammary fold.
• Wise Pattern: This technique is also known as the anchor incision and combines the Circumvertical incision with an additional incision hidden in the crease of the inframammary fold underneath the breast.

Dr. Zuckerman most commonly uses the Circumvertical incision pattern, also known as a vertical breast reduction. Because the ultimate scarring is about 50% less with the vertical breast reduction, Dr. Zuckerman strives to use it whenever possible and estimates that 75% of his breast reductions allow him to do so. However, for large reductions, he will recommend the anchor pattern to acheive the best result.

Dr. Zuckerman performs breast reductions under general anesthesia with a board-certified anesthesiologist present, and depending on the surgical technique used and amount of breast tissue removed, the procedure typically lasts approximately two to four hours. You may undergo breast reduction surgery on an out-patient basis at Dr. Zuckerman’s state-of-the-art, fully equipped operating room located inside his office in midtown Manhattan. This operatory facility has been certified by the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF), certifying it as a facility that offers an equally high standard of care as a hospital. The privacy, discretion, and convenience of Dr. Zuckerman’s private in-office operating room facility is an exclusive benefit of Zuckerman Plastic Surgery that many patients appreciate. Should you desire, you may also undergo surgery with Dr. Zuckerman at Manhattan Eye, Ear & Throat Hospital, a major hospital in Manhattan in the Northwell system where all types of breast, body, and face cosmetic surgery procedures are performed. Dr. Zuckerman is on staff in the department of plastic surgery for Northwell system hospitals in Manhattan among others.

After surgery, Dr. Zuckerman’s plastic surgery team will fit you with a specialty surgical bra to bind your breasts. This device provides significantly more support than a normal bra and minimizes stress on the newly closed incisions on your breasts, thereby helping ease and expedite the healing process. You’ll wear this bra for several days after surgery, but Dr. Zuckerman will provide customized postoperative care instructions dependingon the extent of your procedure. If necessary, Dr. Zuckerman may place surgical drains to drain any excess fluid, but this is not common. He removes stitches after one week for most patients, and for approximately one month after surgery, Dr. Zuckerman recommends a post-surgical bra be worn.

On the day of surgery, Dr. Zuckerman also applies a long-acting local anesthetic called EXPAREL® for all his patients undergoing this procedure. Whereas most traditional pain medicines last up to a maximum of twelve hours, EXPAREL® gradually releases medication to a particular region for up to three days. This approach is a significant departure from previous techniques and minimizes postoperative pain and discomfort. Patients can expect some bruising and swelling after breast reduction surgery, and Dr. Zuckerman typically prescribes medication to manage any discomfort after the effectiveness of EXPAREL® has waned. However, some patients require little or no narcotic pain medication due to the efficacy of EXPAREL.

Dr. Zuckerman advises most patients that they may resume their normal activities after two weeks, but patients should not perform strenuous tasks or heavy lifting for up to four weeks. In general, activities that stress the breasts should be avoided during this period.

Frontal view of one of Dr. Zuckerman’s breast reduction surgery results. Images taken before surgery and three weeks after.

Frontal view of one of Dr. Zuckerman’s breast reduction surgery results. Images taken before surgery and one month after surgery.

More Before & Afters

Dr. Zuckerman publishes many of his previous breast reduction results with patient consent. The before and after image gallery has pairs of high resolution images from three to four angles for each patient. Many prospective patients enjoy finding a similar case to their own that Dr. Zuckerman has performed in the past. Take a look through the gallery by clicking on the button below.

BEFORE AND AFTER IMAGE GALLERY

Breast reduction surgery is overwhelmingly safe when performed by a board-certified plastic surgeon. Dr. Zuckerman is an expert in cosmetic breast surgery, and he will work to ensure your safety, comfort, and minimize the risk of complications. Breast reduction surgery is a very common procedure and is extraordinarily safe, but all surgery carries some risk, albeit low, of complication. Below are a few:

• Wound breakdown
• Alterations in nipple or breast sensation
• Hypertrophic, raised, scarring
• Bleeding or hematoma formation
• Infection of the incision sites
• Remaining breast asymmetry
• Fat necrosis

According to a study in the Aesthetic Surgery Journal, the most common reasons that patients sought reoperation were related poor technique on the part of the original surgeon:

• Surgeon removed too much breast tissue.
• Surgeon created asymmetry between the sizes of the breasts.
• Surgeon poorly reshaped the nipple-areola complex.

Below are the answers to some questions Dr. Zuckerman most frequently receives from prospective patients. If you don’t see your question below, feel free to contact Dr. Zuckerman’s office, and a member of his staff will be glad to reach out to you.

Can I combine a breast reduction with a breast augmentation?

This is a relatively uncommon combination, because most patients undergoing a breast reduction suffer from the effects of overly large breasts. They desire breast tissue to be removed. If you are considering a breast augmentation, you may be a better candidate for a breast lift (mastopexy). Dr. Zuckerman can perform a combined breast lift and breast augmentation called an augmentation mastopexy (or aug/pexy) for short.

Will insurance pay for a breast reduction?

The answer to this question varies based on your insurance, but it is not a firm “No”. If a patient can document health issues related to having overly large breasts, for example shoulder and back pain, it may be possible to receive partial or full health insurance compensation for this procedure. Please contact the Zuckerman Plastic Surgery office for more information. Our staff can help you both determine if you qualify and help you through the process.

Are you ready for your breast reduction consultation with Dr. Zuckerman? He will perform a thorough evaluation of your desired outcome and needs based on your anatomy and medical history. Dr. Zuckerman will also address any questions or concerns you may have about the surgery and discuss with you the details of his approach: incision location(s), procedure length and techniques, likely operative outcome, etc. Contact his office by clicking the button below or by calling 212-231-9897. Dr. Zuckerman also offers consultations via Skype and a process for out-of-town patients to visit New York City to have surgery with him.

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