When it comes to breast reduction surgery, I find that women contemplating this procedure don’t usually place the appearance of the final scar at the top of their list of concerns. This is quite the opposite for those considering a mastopexy (breast lift) where this is a major area of concern.
Why is this the case despite the fact that the incisions, usually anchor shaped, are often identical?
The reason is that women who are seeking breast reduction surgery are doing so because of the annoying and even debilitating effects that their massively enlarged breasts are having on them and their quality of life. Women seeking a mastopexy are doing so largely for aesthetic reasons.
Does this mean that the appearance of the scars is relatively unimportant?
Of course not!
I am just as diligent and meticulous in the repair of breast reduction incisions as I am with the mastopexy ones (as well as for all incisions for all procedures). These are closed using long acting deep sutures in a multilayered repair that avoids the unnecessary and displeasing rail-road track suture marks in the skin. Skin tapes are applied for additional wound support and security and may be used for a total of two to three weeks. At that point in time, my patients will usually begin applying a topical silicone gel to help the scars heal as ideally and inconspicuously as possible. This is usually continued for several months. For patients at higher risk for developing hypertrophic scars or keloids or showing early evidence of their manifestation, silicone gel sheets are used to aggressively deal with these issues.
Most breast reduction scars heal very well, usually as fine lines, and are quite acceptable. It is rare in my experience to see keloids develop in darker complected women.
Before breast reduction
After breast reduction
Before breast reduction
After breast reduction
If you would like more information on a breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Many patients who see me in consultation for a breast reduction have already conducted a fair amount of research on the internet about this procedure. One issue that they often have questions and concerns about is the need for and the usage of drains for this surgery. Some have read commentaries by previous breast reduction patients who emphasized the “significant” discomfort associated with these drains. Unfortunately, much of the information that people read is either incorrect, not accurate or doesn’t proportionately represent reality.
For many years, I customarily placed drains in all my breast reduction patients, the purpose of which was to help minimize the risk for accumulation of fluid (seroma) and blood (hematoma). This was the norm for the majority of plastic surgeons. The drains, which are “tubes” that exit through the lower skin incision and serve to drain fluid deep to the skin, were more of a nuisance rather than a source of significant discomfort or severe pain. Regardless, most patients were quite happy to have them removed.
Over the last several years, I have made their usage a rare exception and when they are placed, the decision is made during surgery based on a few factors. Fortunately, I have seen no increased incidence of these two complications with this approach – and my patients are happier that they have to deal with one less issue.
For more information on breast reduction surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
A very common question that many women have following breast reduction surgery is “When can I wear an underwire bra?” Some believe that they can never wear one again whereas others might have heard, were told or read recommendations for various periods of time and are confused about the correct answer.
So what is the real answer?
Believe it or not there is no right or wrong answer. There are no definitive, evidenced based studies in the medical literature which reveal that any specific period of time is better than any other or even if an underwire should be worn at all. As a result, each plastic surgeon may have his/her own protocol involving different amounts of time that seems to work for their patients.
What do I recommend for my patients?
A few days after breast reduction surgery, my patients are placed in a sports type bra for a few weeks. Thereafter, they are instructed to wear a comfortable but supportive bra on a regular basis to help maintain the shape of their breasts for a longer period of time especially against the undesirable and relentless forces of gravity. This can include an underwire bra but doesn’t have to necessarily be one.
Due to normal postoperative healing, the incision along the crease will be inflamed and even tender for a few months and it will be during this period of time that an underwire bra may not be very comfortable to wear. Generally, most patients wait at least 2 – 3 months before being able to wear an underwire bra without any discomfort. This time does vary between patients.
If you would like more information on breast reduction surgery or for any other plastic surgery procedure that I perform or to schedule your complimentary consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Breast reduction surgery can effectively reduce or eliminate symptoms associated with large breasts including neck, back and shoulder pain as well as discomfort associated with physical activities. Many of my patients over the years have shared with me their absolute delight that following their surgery they were finally able to play sports again and engage in other vigorous activities from which that they had been limited or avoided either because of discomfort or embarrassment.
Clearly the heavy weight, discomfort and often wildly kinetic movements of large breasts can be problematic on many levels. Macromastia (very large breasts) can significantly impact performance in a variety of sports and impair a woman’s competitiveness. For example, it is a rarity to see an elite runner such as in the 100 yard dash who has large breasts?
And you don’t find them in women who excel in the high jump event either!
An interesting and somewhat publicized case (that is, among her attentive and leering male fans) of an elite female sports figure who sought out and underwent a breast reduction in order to improve her comfort and performance is Romanian tennis star Simona Halep who was the junior champion at 18 years old at the French Open in 2008. Her 34DD breasts were helping her garner a sizable and rapidly growing male fan base but they were also causing her severe neck and back pain and affecting her on court performance.
Tennis star Simona Halep before breast reduction surgery
In 2009 she decided to undergo a breast reduction which decreased her cup size from a 34DD down to a 34C. Since then, she has increased her ranking 450 spots to number 57 in the world and attributes this ascendancy to her breast reduction surgery. Without the added breast weight, she notes that she is far more agile, faster and no longer experiences the neck and back pains. (She just competed in Wimbledon but lost to Serena Williams in 3 sets in the second round.)
Simona Halep after breast reduction surgery
Agility and speed after breast reduction surgery
On the down side but as expected, her male fan support took a little bit of a hit…!
For more information on breast reduction surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation, please feel free to call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Despite hearing and reading stories about the incredible happiness and satisfaction that women realize following breast reduction surgery (reduction mammoplasty), there are some patients that I see who are under the impression that the initial recovery is often quite uncomfortable. As a consequence, they have delayed pursuing the surgery which can markedly improve their quality of life.
So: Is breast reduction surgery painful?
You might guess that it would be uncomfortable given the nature of the incisions which are typically in an inverted “T” shape and extend along most or the entire crease at the bottom of the breast. They are, in fact, multiple times larger than the one used for a breast augmentation.
Fortunately, you will be quite happy and relieved to learn that most of my patients find the postoperative course following a reduction mammoplasty to be surprisingly quite benign. Some patients will take pain medication for a few days; others don’t even take any. Of course, there are some women who do require analgesics for a longer period of time.
Virtually all of my patients are up and walking around the day of surgery with some even going out to dinner that night though they are instructed not to drive at least that first day. Most do return to sedentary type jobs (not much lifting) by around 5 days postoperatively with the remainder usually by one week.
So if you have been interested in pursuing breast reduction surgery but feared that you would experience a lot of pain afterwards, now you know the real answer.
For more information on breast reduction surgery or for any other plastic surgery procedure that I perform or to schedule a consultation with me, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Dr. Turkeltaub Discusses Breast Reduction in Scottsdale AZ
In the most recent study from the American Society for Aesthetic Plastic Surgery (ASAPS), the top five most performed procedures for women in 2009 were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and breast reduction. Steven H. Turkeltaub, MD recently discussed the study’s findings as well as benefits that those patients seeking breast reduction surgery can generally expect at his Scottsdale plastic surgery practice.
Of the more than 10 million cosmetic enhancement procedures performed in 2009, the most recent statistics from the American Society for Aesthetic Plastic Surgery (ASAPS) show more than 113,000 women decided to undergo breast reduction surgery. At the Arizona Center for Aesthetic Plastic Surgery, Scottsdale plastic surgeon Dr. Steven Turkeltaub recently discussed the possible benefits associated with this procedure and answered some of the most common questions that his female patients have concerning a breast reduction.
Dr. Turkeltaub stated that the most common reasons many women pursue a breast reduction are for the neck, back, and shoulder pain associated with having very large breasts. He also noted that having overly large or asymmetrical breasts can have a significant and detrimental impact on a woman’s self-esteem and must not be disregarded. During each female patient’s consultation, Dr. Turkeltaub reviews the various reasons she is considering a breast reduction, and will discuss the procedure in detail, including risks, complications, and general expectations.
Whether Dr. Turkeltaub is performing nonsurgical procedures such as BOTOX ® injections or dermal fillers like Juvederm® and Restylane®, or a surgical procedure such as the tummy tuck, he states that he always discusses the various risks and benefits of each procedure as well as each patient’s own unique expectations and goals for their aesthetic enhancement. He notes that women considering a breast reduction tend to feel more comfortable knowing how common and effective the procedure is, as well as the extremely high satisfaction rate associated with the results. Dr. Turkeltaub adds that in over 23 years of practice, he has never had a patient express regret over their decision to undergo a breast reduction, with many actually stating they should have pursued the procedure years ago.
About Dr. Turkeltaub
Dr. Steven Turkeltaub earned his medical degree at the Boston University School of Medicine. He did his general surgery residency at the University of Miami/Jackson Memorial Hospital in Miami and the Northwestern Medical Center in Chicago. Dr. Turkeltaub then completed his plastic surgery residency at the University of Massachusetts Medical Center. He is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons and the Arizona Medical Association. Continuing education is extremely important to Dr. Turkeltaub and he attends several national symposiums and meetings each year to ensure he remains on the cutting-edge of the plastic surgery industry.
The Arizona Center for Aesthetic Plastic Surgery has two locations: the Scottsdale Office is located at 10290 N. 92nd St. Suite 207 in Scottsdale, AZ 85258; the Glendale Office is located 18275 N. 59th Ave. in Bldg. E Suite 126 in Glendale, AZ 85308. Both offices can be reached at (480) 451-3000 or found online at http://www.turkeltaub.com/ or the Plastic Surgery Arizona – Dr. Steven Turkeltaub Facebook page.
Over the years in my plastic surgery practice, I have seen countless women with massively large breasts who are seeking breast reductions. There are the usual large cup sizes: the “D”, “DD”, “DDD”, “DDDD” and the even more mammoth “E”, “F”, “FF”, “G” and “GG”. You surely know that these women would benefit from a reduction in their breast size.
On occasion, I have even seen women who have gargantuan breasts with cup sizes up to “J”, “K”, “L” and “M”. They uniformly have the classic symptoms associated with enlarged breasts including the neck, back and shoulder pain, grooving of the shoulders, and major limitation of tolerable physical activities. Many have rashes, areas of skin breakdown, require greater effort in breathing and can’t sleep lying down in bed and instead sleep in recliners.
Unbelievable as it may seem and having never seen this in my office, while surfing online, I came across an actual photo of a “T” cup.
If you would like information on breast reductions or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Though obesity has become an epidemic in this country, it is not a condition that most people aspire to become. The consequences of being massively overweight can exert a great toll emotionally, physically and physiologically. This can range from an increased risk of hypertension, diabetes, arthritis, infections, and cancer to poor self esteem, sexual dysfunction and disabling depression. Engaging in even the mildest of physical activities can be extremely difficult, embarrassing and exhausting.
Obesity, therefore, has few positives associated with it unless one uses a little creativity…
In a bizarre story, two women recently deployed their prodigious layers of fat and large pendulous breasts for evil purposes – to steal clothing from a store. They attempted to hide several pairs of boots, gloves and other items under their breasts and in body fat folds in a failed shoplifting attempt. The purported total value of the items sequestered was around $2600 – an amazing amount particularly since this occurred in a (discount) T.J Maxx store and not a Neiman-Marcus or Nordstrom.
I do see many people who have lost a significant amount of weight, often 100 pounds or more. Some have achieved their success by diligent dieting and exercise. Others pursue weight loss procedures such as lap banding or gastric bypass surgery. Nevertheless, what they are left with are massive amounts of excess skin that is circumferential and often hangs down in layers. This less than attractive sight is often not what they had expected to be left with following their successful weight loss.
Fortunately, there are a variety of plastic surgery procedures that can effectively address this post massive weight loss appearance problem and which I offer to my patients. They can be performed in a variety of combinations depending on each person’s particular needs and desires. Some of the more common of these surgical procedures include a tummy tuck, belt lipectomy (circumferential removal of skin from the abdomen and back), inner and outer thigh lifts, breast reduction, and arm lifts (brachioplasty).
These plastic surgery procedures not only can help patients obtain a much more attractive appearance and body contour but can also allow them to be much more active with little or no physical restrictions (as had been related to their weight or excess skin previously). My patients have indicated that they have had a marked improvement in self-esteem following surgery and a much more positive attitude and outlook.
If you would like to obtain information on plastic surgery procedures that can help address the excess skin that you have been left with following massive weight loss such as for a tummy tuck, belt lipectomy, breast reduction, or an arm lift, please call my office at 480-451-3000. We would also be happy to schedule a complimentary consultation for you if you desire.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Patients who have undergone breast reduction surgery have the highest rate of satisfaction of all major plastic surgery procedures. This even includes breast augmentations where 94% of women would make the same decision again. Furthermore, they are so happy and appreciative of the improvement or resolution of their symptoms that they frequently accept aesthetic results that women undergoing other procedures might take more note of.
The following patient of mine illustrates the dramatic improvements that can be obtained through pursuing a reduction mammoplasty. This 29 year old female was experiencing debilitating neck back and shoulder pains secondary to the massive size of her breasts for which she wore a 36G bra (photos A, C and E). Her activities including sports and working out were severely limited due to the pain and discomfort that she would experience as a consequence of her massively enlarged breasts. She already had deep grooves present in her shoulders from the weight of her breasts causing the bra straps to dig into the skin.
A.) frontal view - preoperatively
B.) after breast reduction surgery
C.) side view - preoperatively
D.) after breast reduction surgery
E.) oblique view - preoperatively
F.) after breast reduction surgery
This patient underwent an inferior pedicle technique for the breast reduction which involved anchor shaped incision. The nipple-areola complex was reduced in size and elevated to a proper position while still maintaining its blood supply. A total of 5 pounds of breast tissue was removed (photos B, D, and F).
As a result of the breast reduction, she has had complete alleviation of her neck, back and shoulder pains and is engaging in far more vigorous activities than she had for many years. To her delight, she now wears a “C” or “D” bra as opposed to the gargantuan “G” size which she wore prior to surgery, feels far more attractive and is no longer self conscious about her breasts. Another pleasant surprise is that the sensation of her nipples has been preserved.
If you would like more information on breast reduction surgery or any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Breast reduction surgery has been shown to be a very effective procedure for the alleviation of symptoms due to enlarged breasts. These symptoms can include neck, back and shoulder pains; headaches, fatigue, irritation, labored breathing and rashes. I have witnessed time and time again over my 23 years in practice here, the highly beneficial effects that a reduction mammoplasty has had for my patients. These positive outcomes have also been confirmed by several well controlled medical studies.
One important concern that many of my patients have who are planning to have children in the future and who also are also considering breast reduction surgery is whether or not they will be able to nurse. Fortunately, there is a relatively definitive answer for this question and which is also good news. Medical studies investigating this issue have been performed and have revealed that the most common techniques employed for breast reduction do not preclude the ability to breast feed. That is, if you would have otherwise been able to breast feed independent of any considerations for surgery, you should still retain this ability after breast reduction surgery.
The one major technique where this is clearly impossible is with the free nipple graft (FNG) approach where the nipples are totally detached intra-operatively and then replaced in the proper position later during the surgery as skin grafts. By the nature of this procedure, the milk ducts are necessarily divided.
If you would like additional information on a breast reduction or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
There is great news for women as well as men: women’s breasts have been getting noticeably and naturally larger over the past 50 years. This is an unmistakable finding which is unrelated to weight and height issues and is completely independent of breast implants.
Many theories have been advanced to explain this burgeoning of breast volume but there is no one definitive answer. Some feel that it is related to the improved general nutrition in experienced by women during this period of time including increased intake of fruits, vegetables and most importantly, proteins. Others ascribe this change to estrogen and other substances in our foods and environment including hormones injected into poultry and livestock and even from the BPA in plastic bottles. Birth control pills do facilitate an enlargement of the breasts but only in those who are taking them – so this doesn’t explain the global changes that have developed.
During this same period of time that the average size of women’s breasts has significantly enlarged, women have also increased the desired size that they ultimately want their breasts to be.
What are the results of all of this? More women than ever are desirous of a breast augmentation. Seemingly ironic, at the same time and as a result of other factors as well, more women than ever are undergoing breast reduction surgery. This may seem totally confusing and conflicting but it really does make sense. I have seen these trends in my practice over the last 23 years.
If you would like more information on breast augmentations, breast reductions or on any other plastic surgery procedure that I perform or to schedule a free cosmetic consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Among the many ideal goals in breast reduction surgery is to preserve the general appearance of the nipple and at least some sensation. These can be achieved much of the time with procedures that maintain the attachment of the nipple to the underlying tissues including ducts, nerves and blood vessels. However, for those women with exceptionally massive breasts, a procedure called a free nipple graft breast reduction may offer them the best opportunity to obtain more ideal results.
This technique facilitates the removal of an appropriate volume of breast tissue and with greater finesse while allowing for more ideal breast contouring with greater predictability of results, shape and durability. The scar pattern is the same as that of most other techniques. However, the biggest drawback to this approach is that the nipple-areola complexes are removed as “skin grafts” to be placed back on the breasts later in surgery at an ideal position. Their blood supply and nerve fibers are necessarily disrupted and their survival will depend on re-growth of the circulation. Because of this, most nipple-areola complexes will display some degradation of their normal anatomy.
What are some of these visual changes? Commonly, there is loss of some or all of the nipple projection and what may remain is a semblance of a nipple. The areola may also be thinner and not as domal shaped. Darker complected individuals also have a substantial risk of depigmentation of the areolas, either temporary or permanent. As with any skin grafting procedure, there is a risk for partial or total failure of the nipple-areola complex to heal and survive. This risk is higher particularly in smokers, diabetics and those with autoimmune disease.
The photo below demonstrates the appearance of a nipple-areola complex in one of my patients who underwent this free nipple graft breast reduction. She has maintained some nipple projection and has not lost pigmentation.
Breast reduction with free nipple graft
If you would like more information on a reduction mammoplasty or any other plastic surgery procedure that I perform or to schedule a free cosmetic consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Women who have naturally large breasts often experience a constellation of symptoms that can be quite uncomfortable and even deforming. Among the more common physical complaints are neck, back and shoulder pain, grooving of the shoulders, headaches, rashes, skin irritation, numbness of the hands, postural changes and arthritis of the vertebrae of the neck and lower back. Breast reductions are extremely successful in alleviating the pain and discomfort associated with massively enlarged breasts though some anatomical reminders persist.
It has been my observation that most women with significantly enlarged breasts will exhibit grooves of their shoulders caused by the weight of their breasts compressing their bra straps into their shoulders. The greater the weight and longer the duration before surgery is performed, the deeper these indentations may be. They are usually permanent as well.
The following photographs demonstrates the deep grooves of the shoulders that are one of the more common findings in women seeking breast reduction surgery. An interesting finding here is that the deeper indentation of the right shoulder is also associated with the much larger right breast.
Breast reduction patient with grooving of the shoulders. Note that the deeper indentation on the right is associated with the larger right breast.
Deep groove of right shoulder
Groove of left shoulder
For more information on breast reduction surgery or for any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Having to deal with the daily discomforts and issues of having large breasts – the neck, back and shoulder pains, rashes, fatigue, headaches, etc. – is frustrating and inconveniencing enough. Engaging in sports or activities such as softball, volleyball, jogging, tennis or even swimming, however, can be immensely challenging and painful. Many of my patients seeking breast reductions have confided that they often have to wear 2 or 3 sports bras in order to feel more comfortable when involved in these types of activities. Others told me that the discomfort and hassles were so bad that they just gave up completely attempting to play sports.
The good news is that breast reduction surgery not only can successfully alleviate most if not all the symptoms associated with large breasts but it can allow for the opportunity to be involved again in sports. By reducing one’s breasts to the desired size, their untoward collateral effects on a woman’s activities can be minimized. Wearing just one well fitting sports bra may be all that is needed.
Over the years, I have had many of my breast reduction patients tell me that they are thrilled that they can finally participate in sports and other vigorous activities again and do so without discomfort. Many also noted that it was easier for them either to successfully lose weight or at least control their weight.
In an earlier post, we noted that women pursue breast reduction surgery for either functional or aesthetic reasons. The vast majority of women that I see as well as those who seek out a breast reduction in general, are doing so in order to alleviate the symptoms associated with their considerably enlarged breasts. These symptoms can include neck, back and shoulder pains, headaches, rashes, and discomfort and limitations engaging in sports and exercising.
However, just because you have one or more of these issues does not mean that your enlarged breasts are a cause or even the only cause of your problems. The best way to ascertain whether a reduction mammoplasty would benefit you is to consult with a Plastic Surgeon certified by the American Board of Plastic Surgery such as myself. If your plastic surgeon determines that a breast reduction could help to alleviate or resolve some or all of your symptoms, then you would be a good candidate for the procedure.
Some women desire their breasts to be reduced in size (and lifted if indicated) solely for aesthetic reasons and not because they are experiencing any related symptoms. They simply want smaller and perkier breasts. A breast reduction can surely accomplish this though a plastic surgeon like myself can assist you in arriving at a prudent decision based on your concerns and goals.
If you have the appropriate functional or aesthetic reasons for pursuing a breast reduction as confirmed by a plastic surgeon and you are a relatively low surgical risk, then you would indeed be a good candidate for breast reduction surgery.
Just what is a “Mommy Makeover”? You probably have been hearing or seeing this expression used in advertisements recently and wondered what it is. Essentially a Mommy Makeover in Scottsdale is the correction by plastic surgery of the changes that occur as a result of having children in order to regain a more pre-pregnancy figure. Often, related cosmetic procedures can be performed concurrently to improve one’s overall appearance. Pregnancy permanently affects to variable extents women’s breasts, abdomen and body fat deposition and so these are the areas that are addressed.
Following pregnancy, many women lose some firmness, shape and volume of their breasts which may also become droopy and develop stretch marks. These changes can be further exacerbated by breast feeding with the duration and number of children affecting the outcome. A few women actually have a net increase in breast size though the shape and positioning usually suffer. Procedures that can effectively address these changes include a breast augmentation, breast lift with or without a breast enlargement and a breast reduction.
Permanent changes in the appearance of the abdomen following pregnancy are quite variable among women and are affected by a multitude of factors. The often is some residual degree of laxity of the skin and the underlying muscle layer along with changes in the distribution of fat. Cosmetic procedures that could improve the appearance of the abdomen include a mini tummy tuck, a standard tummy tuck (abdominoplasty) and liposuction. Liposuction can also be performed elsewhere including the hips, thighs, knees and even back.
The combination of the appropriate cosmetic procedures of the breast and abdomen with or without liposuction performed at one surgical setting constitutes the “Mommy Makeover”. Of course, other procedures such as eyelid surgery can be done at the same time if warranted and indicated. This rejuvenation of one’s body back to a more desirable shape can do wonders for your psyche, self-confidence and sense of attractiveness.
In a recent posting, I discussed the need to obtain mammograms for women beyond a certain age prior to undergoing a breast reduction. The reason for is to screen for any abnormalities that may need to be explored further prior to the reduction mammoplasty surgery. It was also noted that even with a “negative” mammogram, there is an incidence of occult breast cancer identified in the removed breast tissue of between 0.16% and 0.40%.
A retrospective study just published in the October 2009 issue of the Plastic and Reconstructive Surgery Journal evaluated the incidence of precancerous lesions present in the tissue removed in breast reductions. What they discovered was very interesting and clinically helpful in potentially identifying women who are at increased risks of developing invasive breast cancer. Atypical ductal or lobular hyperplasia (abnormal but not cancerous) was diagnosed in the specimens in 4.4% of the women and a non-invasive state of breast cancer (ductal and lobular carcinoma in-situ) was seen in an additional 1.8%.
Why is this important? Based on the pathological diagnosis, a woman’s risk for developing breast cancer in the future can be quantified and appropriate preemptive actions taken as warranted. Atypical ductal and lobular hyperplasia have a 4 – 5 time increased risk of developing invasive breast cancer whereas ductal and lobular carcinoma in situ have and 8 – 10 fold greater risk than the average woman. Ordinary fibrocystic disease has no elevated risk for the later development of breast cancer.
Those women with an elevated risk of developing breast cancer can then be referred to either an oncologist or breast cancer surgeon for further evaluation and possible treatment. This could include prophylactic mastectomies, radiation or even estrogen receptor modulator therapy such as taking tamoxifen.
Therefore, women who undergo breast reductions may now receive an additional benefit from a procedure that already has overwhelmingly positive satisfaction – reducing their risk of developing invasive breast cancer.
If you would like to obtain additional information on breast reduction, breast reconstruction or any cosmetic surgery procedure that I perform or to schedule a consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Dr. Steven H. Turkeltaub is the medical director of the Arizona Center for Aesthetic Plastic Surgery, a cosmetic surgery practice offering a variety of plastic surgery procedures that address aesthetic concerns of the breast, body, skin, and face. Dr. Turkeltaub offers several options for those considering plastic surgery in Phoenix and surrounding areas. In this article, Dr. Turkeltaub discusses how the economy has impacted his Plastic Surgery practice through Phoenix, Scottsdale and the surrounding areas in Arizona.
Prior to undergoing a breast reduction, it is the standard of care to have an up to date mammogram for women of at least a certain age (which can vary). The purpose of this is to screen for any abnormalities that may need to be addressed prior to surgery. If a suspicious mass or area is noted that raises concerns for possibly being of malignant potential, a biopsy can be performed prior to the planned procedure. If the results are benign, then one can proceed with the breast reduction. Conversely, if the biopsy results reveal breast cancer, then treatment of this would be to be undertaken rather than the originally proposed breast reduction.
Mammograms do not identify every single case of breast cancer. A small percentage of breast cancers that are early or very small can evade detection with this method of screening but can be identified pathologically. These “occult” cancers are the reason why the breast tissue removed in the performance of a breast reduction is always sent for pathological evaluation.
Scientific studies have been done to investigate the incidence of these occult cancers in women who have undergone a breast reduction. The percentage is very low, somewhere in the range of 0.16% to 0.40%. Despite having been diagnosed with breast cancer, these women are lucky in that their tumors were identified early on, offering them a very high cure rate with appropriate treatment. If they hadn’t been seeking a breast reduction, it is likely that many of these cancers might not have been identified until they were larger and with a less favorable prognosis.
The following patient of mine exemplifies this scenario. She presented for a breast reduction at age 39, wearing a size 34G bra, no family history of breast cancer and with a normal mammogram. A reduction mammoplasty was successfully performed and she had an otherwise unremarkable postoperative course. However, the pathology report of her removed breast tissue revealed early cancer.
After consulting with a general surgeon, she underwent bilateral mastectomies with immediate reconstruction. The following photos illustrate her preoperative appearance, immediately following her breast reduction and appearance after reconstruction.
Before Breast Reduction - Frontal view
Before Breast Reduction - Side view
Immediately following Breast Reduction - Frontal view
Immediately following Breast Reduction - Side view
After Breast Reconstruction - Frontal view in bra
After Breast Reconstruction - Frontal view
After Breast Reconstruction - Oblique view
After Breast Reconstruction - Oblique view in bra
Following Breast Reconstruction - Side view
Following Breast Reconstruction - Side view in bra
If you would like to obtain additional information on breast reduction, breast reconstruction or any other cosmetic surgery procedure that I perform or to schedule a consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Women seek to have the size of their breasts reduced for two reasons that can be interrelated: functional and aesthetic. Most commonly breast reductions are sought out because of the symptoms that are associated with markedly enlarged breasts such as neck, back and shoulder pains, headaches and rashes. Even with reductions where the intent is to alleviate symptoms, there is an aesthetic component as the result will be lifted, smaller and perkier breasts.
Most of the time that women seek a reduction solely for aesthetic reasons, it is where the breasts are a little larger than ideal but not massively enlarged where they would be associated with discomfort. For example a woman may feel self conscious and uncomfortable with all the attention and comments that she may garner with enlarged breasts. Even though she may not be experiencing physical symptoms related to the increased size, by undergoing a breast reduction her breasts will be less conspicuous.
Another example of an aesthetic reason for a breast reduction are breasts that are droopy (ptotic) and larger than she desires. A small reduction and a lift would be the treatment of choice.
There may be some confusion between what constitutes a breast reduction versus a breast lift or mastopexy and some of this relates to insurance company mandates for coverage. An intrinsic component of most breast reductions is a lift. By the same token, a mastopexy or breast lift can be performed with a small reduction in size. Both procedures often employ the exact same incisions. The difference essentially is in the amount of breast tissue removed though there is no exact amount that distinguishes one from the other. In the past, a reduction in size of less than 300 grams per side along with the lift was considered to be a mastopexy with a small reduction.
In essence, this is just semantics as no matter what it is called, the surgical outcome is smaller, lifted and rejuvenated breasts.
If you would like more information on breast reduction or mastopexy surgery or any other cosmetic surgery procedure, you can contact my office at 480-451-3000 or send us an e-mail.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
