Joseph A. Mele MD
Plastic Surgery


Breast Reduction Types

Breast Reduction Surgery (Reduction Mammaplasty)

Inverted-T, Keyhole or Anchor Breast Reduction

This is the most frequently performed breast reduction surgery in the United States. It is similar to the breast lift of the same name; however, unlike a lift, breast tissue is removed. Removing breast tissue allows for a reduction in size and weight, resulting in a reduction of symptoms. While individual results vary, often relief is felt immediately, in the recovery room, directly after surgery. An Inverted-T breast reduction can be used for any size breast, no matter how large. I advise all my breast reduction patients that breast feeding may not be possible after breast reduction surgery. The inverted-T technique preserves a wide inferior base, providing the greatest chance of preserving lactation for women who can't wait until after childbirth.

Vertical Breast Reduction

A vertical breast reduction is similar to an inverted-T breast reduction. It lacks the horizontal inframammary fold (IMF) incision, so less reduction of the inferior breast skin is possible. For long pendulous breasts, an inverted-T approach may provide a more predictable cosmetic result.

Horizontal Breast Reduction

A horizontal breast reduction is similar to an inverted-T breast reduction. It lacks the vertical incision, which runs from the lower pole of the areola to the IMF. It is best for the very ptotic (saggy) narrow breast. The nipple needs to be very low (before surgery) in order to eliminate the vertical scar.

Periareolar Breast Reduction

For breast that are starting relatively smaller, with excellent skin tone, sometimes both the vertical and horizontal scars can be eliminated. A periareolar lift is limited in the amount of lift it can provide, but in carefully selected patients, it can provide adequate lift with minimal scars. Since the incision is periareolar, the amount of lifting is limited, similar to a periareolar breast lift.

Liposuction ("No Scar" Breast Reduction)

The ultimate breast reduction would have no scars. For women with excellent skin tone and nipples near the optimal position, liposuction may be an option. Liposuction does not lift the breast so, liposuction for breast reduction works best with perky breasts. Liposuction can provide about one cup size reduction. The amount of reduction is limited by the amount of fat in the breast. Larger reductions can lead to a deflated appearing breast.

Are My Nipples Removed?

The nipple and areola are not usually removed from the breast when Breast Reduction is performed. The exception to this is the free nipple graft. For extremely large reductions, when there are problems with areolar circulation, and in cases where limiting surgery time is important, sometimes a free nipple graft is utilized. It is much like a skin graft, so it allows for the widest possible range of nipple placement. The down side is loss of nipple sensation. I rarely recommend free nipple grafts for my female breast reduction patients.

Free nipple grafts are more frequently used for gynecomastia reduction of very large male breasts. Since no extra breast tissue needs to be preserved beneath the nipple graft, the result is a flatter, more masculine chest.

Breast Reduction Insurance Coverage

Sometimes insurance will cover Breast Reduction Surgery that is done to relieve physical symptoms like shoulder rutting, neck and back pain, pain in the breasts, chronic rashes, or a history of recurrent infections under the breasts. Some health plans have completely stopped covering breast reduction surgery. Please check with your insurance company to see what is covered and what is necessary for approval. If you have an HMO plan, you will need to see an HMO doctor. Document your symptoms and what you are doing do treat them. A letter from other doctors you have seen about your symptoms, physical therapists, chiropractors, and a list of medications including the dose and frequency can help when seeking prior authorization for Reduction Mammoplasty.

Breast Reduction Recovery and Follow-up

Breast Reduction is an outpatient procedure. If you are healthy, you can go home the same day. If you have high blood pressure, or other medical problems, you may advised to stay overnight. Post-operative discomfort is most often described as pressure, and is usually well controlled with rest, ice and medications as needed. Follow-up visits are initially weekly, and decrease in frequency as you heal. Specific instruction will be provided tailored to your recovery, including scar reduction therapy.

Schedule Your Breast Reduction Consultation Today

If you are considering Reduction Mammoplasty, the best first step is an in-person consultation with an experienced, Board Certified Plastic Surgeon. Call our office today (925) 943-6353 to schedule your personal Breast Reduction Consultation today.