Reconstructive Surgery

Breast Reduction

The Goals of Breast Reduction

What gives the breast it's shape?

Your Consultation

Insurance Pre-authorization

Dr. Rucker's Experience in Breast Reduction

Planning your Breast Reduction

The Procedure

The Recovery

Q&A

Closing

This procedure has been very helpful for women with large pendulous breasts who have experienced medical problems caused by the excess weight of the breasts.

These problems can include:

• Back and neck pain
• Skin irritation beneath the breast
• Skeletal deformities
• Bra strap irritation
• Breathing problems
• Occasional tingling sensation in the hands

Many physicians believe that this condition has a strong hereditary component with the maternal side contributing most to the frequency of the condition. Most patients present with a long history of upper or lower back problems requiring physical therapy or chiropractic care plus a psychological component presenting as diminished self-esteem and feelings of shame. In most cases alternative treatments such as weight loss, physical therapy, supportive bras and medications do not provide permanent relief of symptoms.

It is important to note that this surgery isnít just for women, either. Men who have conditions such as gynecomastia (where male breasts are enlarged abnormally) also seek the benefits of this procedure.

The Goals of Breast Reduction

The goals of breast reduction are to:

• Make your breasts look balanced when you are wearing a bra
• Regain your younger breast contour
• Reduce the size of the nipple areola complex to better fit the smaller breast size
• Reduce the overall breast size so as to reduce the associated symptoms and to make the breast size proportional to the rest of the body

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What gives the breast it's shape?

The breast consists of milk ducts and glands, surrounded by fatty tissue that provides its shape and soft feel. Situated beneath the breast is the pectoralis major muscle. The skin envelope surrounds the breast mound and the nipple areola complex is connected to the underlying system of milk ducts.

Your Consultation

Before undergoing breast reduction surgery, all patients will need a pre-operative consultation. At this time we review your medical history and perform an examination to ascertain if you are indeed a candidate for reduction mammoplasty. The relevant history and examination findings are then sent to your insurance carrier to determine coverage for the procedure. It is our experience that approximately 80% of our candidates for this procedure are approved by their insurance carrier. Also, during your initial consultation the procedure, the recovery and the expected outcome are discussed with each patient.

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Insurance Pre-authorization

All patients must undergo a pre-authorization evaluation prior to the breast reduction procedure. Our office will submit a letter for that purpose to your insurance carrier. Those patients that have demonstrated an attempt of conservation treatment for their symptoms have a higher chance of obtaining insurance coverage for breast reduction.

Below are listed the symptoms and the recommended conservative treatment for each of them. Most insurance carriers require a 3 to 6 month period of conservative treatment prior to approving the Breast Reduction procedure.

1. Upper/Lower Back Pain, Neck Strain, Chest Wall Heaviness:
   Chiropractic manipulation, Physical therapy, Heat treatments, Massage,
   Anti- inflammatory medication
2. Bra Strap Irritation (Shoulder Grooving):
   Shoulder padded bra straps
3. Rashes Beneath the Breasts:
   Ointments, drying powders
4. Tingling and/or Numbness of Hands:
   Hand splints, physical therapy, anti-inflammatory medications

It is also extremely helpful to have letters from the patient’s primary care doctor, physical therapist and chiropractor documenting their conservative treatment.

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Dr. Rucker's Experience in Breast Reduction

Dr. Rucker completed his Plastic Surgery Residency in 1984. Because of his desire to devote a major portion of his practice to Restorative Breast Surgery, he chose to attend a fellowship program in Breast Surgery in Atlanta, Georgia. Dr. Rucker became board certified in Plastic and Reconstructive Surgery in 1986 and attained the position of Fellow in the American College of Surgeons in 1989. During his 22 years of practice in west central Wisconsin, Dr. Rucker has performed approximately 1,000 breast reduction procedures.

Planning your Breast Reduction

Following your insurance companyís approval for your procedure, our office will contact you to discuss your upcoming surgery including potential dates and the appropriate preoperative testing that may be required. If requested, our office can direct you to another patient who has undergone this procedure to assist in answering any more questions that you may have. Our knowledgeable staff can also provide you with information regarding the type of anesthetic that will be used, where the surgery will take place and a more detailed outline of what to expect after your breast reduction.

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The Procedure

Breast reduction is performed under a general anesthetic in a local hospital. Care is taken to make the breasts symmetrical and to also preserve sensation to the nipple as well as hopefully, the ability to breast feed in the younger patient. Both of these goals are addressed by leaving the nipple areola attached to a pedicle of breast tissue. Through this pedicle run the nerves and vessels that help preserve sensation and a good blood supply to the nipple areola complex (see fig 1). All incisions are closed under limited tension, resulting in a smaller breast and areola and a more lifted breast contour (see Fig.2). All of the tissue that is removed undergoes a pathologic examination in order to rule out the possibility of any underlying breast disease.

During Dr. Ruckerís 22 years as a surgeon he has performed approximately 1,000 breast reduction procedures. In order to gauge the improvement of symptoms, we conducted a survey. Of approximately 100 breast reduction patients, 95 % stated that their symptoms and quality of life had significantly improved following reduction mammoplasty.

The Recovery

You will be in the hospital over night following your surgery. Most patients rate their pain level following surgery as a 5 on a scale of 1 to 10. The first morning following your procedure, you will be evaluated prior to discharge home. Typically, 98% of our patients are discharged on the first post-operative day. There will be drains beneath each breast and they are usually removed prior to your discharge. All patients are given detailed written postoperative instructions and prescriptions for an antibiotic and pain control.

Light activity is tolerated well in the first week. Most patients are never so incapacitated that they can not take care of their own basic needs. You will return to see the doctor one week after your procedure. All of your dressings are removed; your postoperative recovery and activity levels are again discussed as well as an anticipated date for your return to work. Light employment is tolerated after two weeks with heavy lifting and regular activity in 3 to 5 weeks. You are also given detailed instructions for care of your suture lines so as to help prevent excessive scarring. Your final consultation usually occurs 5 months after your procedure.

See cases illustrated in the photo gallery.

 

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Q&A

Am I a candidate for breast reduction?

This is a question that can only be answered after a full consultation with your plastic or reconstructive surgeon. Determining factors are your age, health and the presence of symptoms which have not responded to conservative methods.

Does insurance cover breast reduction procedures?

Yes. In most cases breast reduction is covered if there is a well documented history of the above noted symptoms. A letter is sent to the prospective insurance carrier along with the patientís history, height, weight and breast size. Also attached is an estimate of the amount of breast tissue to be removed to reduce the breast to a more proportional size. It usually takes 4 to 6 weeks to receive a response and approximately 80% of our patients are approved.

How much experience do you (Dr. Rucker) have with this procedure?

Besides the usual training in general surgery and plastic and reconstructive surgery, I elected to do additional reconstructive breast reconstruction training in Atlanta, Georgia. Since 1984, I have performed approximately 1,000 breast reduction procedures.

What results are realistic for me?

The breast will be made as symmetrical as possible. Immediately following the procedure, the breast may feel and look tight, but with time, the skin softens and the breasts take on a more natural appearance.

How will my reduced breast feel to the touch?

Most patients relate to us that they have approximately 90 to 95% feeling remaining after breast reduction. In some cases there may be areas of the breast which demonstrate less feeling than other areas.

What possible complications should I know about?

As with any surgical procedure, there are risks of bleeding, infection and scarring. A more detailed list of other potential risks will be discussed with you during your initial consultation.

How long will I be in the hospital following breast reduction?

Patients have usually gone home 24 hrs after their procedure in 95% of our cases.

When can I return to physical activities?

Most strenuous exercise can be started within 4-8 weeks.

Can I talk with other women who have had the same surgery?

Yes. You can contact our office and we will be happy to connect you with someone whoís had the same type of surgery.

What happens if I gain or loose weight?

Weight gain or loss may enlarge or reduce the size of the breast by 10 to 20%.

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Closing

Dr. Rucker and his staff hope that this information will be of help to you if you are considering breast reduction (Mammoplasty) surgery. The staff has gained a considerable amount of experience and knowledge in helping over 1,000 patients during the preoperative, operative and postoperative periods of reconstructive breast surgeries. Please feel free to contact Dr. Ruckerís office with any concerns or questions that you might have.

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Risks

There is a potential for complications in any operative procedure. The most common being infection, scarring and sensation changes. During your consultation a detailed discussion of these potential risks will be given to you.