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” 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
Many of my breast reduction consultations ask me the following question before I even discuss the procedure: “Dr. Turkeltaub, will my breasts also be lifted when I have a breast reduction?” After making what I think is a humorous comment about that it would depend on their insurance plan, I let them know that this is an intrinsic part of the procedure.
A breast reduction, also called a reduction mammoplasty, involves a significant reduction in the size of the breast, lifting the tissue up to a more appropriate level, making the breast less wide, reducing the diameter of the nipple-areola complex and elevating it to an ideal vertical height. Most of the time this is accomplished through an anchor shaped/ inverted “T” shaped incision. The result is a smaller, lighter, higher, perkier and more rejuvenated appearance.
Just what the Doctor ordered and what my patients want!
Before Breast Reduction
After Breast Reduction
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Breast reduction surgery is an extremely effective and rewarding procedure that many women undergo for the treatment of large, significantly uncomfortable breasts. It entails the removal of an appropriate amount of breast tissue and skin with recontouring in order to alleviate the symptoms. Research studies have shed light on another benefit: a lowered risk of developing breast cancer for some women. It would seem logical that with less breast tissue available to degenerate into cancer, the risk should be decreased. That is indeed what has been determined. Evidence from several studies performed to examine this possible relationship reveal a risk reduction ranging from 28% to 50%. This effect, however, was only noted to occur in women who were over 40 years old when the surgery was performed. No discernable benefit was seen in those women less than 40 years of age.
This well substantiated finding is just another potential benefit from undergoing a breast reduction. For those women who have an inherently high risk of developing breast cancer, a more appropriate procedure that removes virtually all the breast tissue should be considered such as a subcutaneous or total mastectomy.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona
Substantially reducing the size of the breasts with surgery is considered by most plastic surgeons and patients to be reconstructive in nature and not cosmetic. Unfortunately, many insurance companies do not quite see it that way and can make it difficult to obtain authorization for a breast reduction (reduction mammoplasty). The trend by more insurance companies over the last several years has been to exclude this surgery as a potential covered benefit. In order to determine whether you may be eligible for coverage, you will need to contact your insurance company and provide them with your specific policy number.
Even if benefits are available, there is no guarantee that you will be approved for the breast reduction. Most insurance companies require documentation of your symptoms related to your enlarged breasts (mammary hypertrophy or gigantomastia) as well as supportive photos. These issues can include neck, back and shoulder pains, grooving of the shoulders from the bra straps, postural changes, headaches, rashes and skin breakdown, and even numbness of the arms. Some companies have established very stringent criteria that can include height and weight numbers, body mass index (BMI), evidence of a prolonged course of physical therapy that did not alleviate symptoms, and several letters from various medical personnel including your primary care physician. Most also require that the anticipated weight of breast tissue to be removed per side exceeds a specific amount.
In the worse cases scenario, if your policy does not provide benefits for a breast reduction or you have been refused authorization for surgery, the procedure can still be performed though you would be responsible for the attendant costs. The results from the surgery are so effective and rewarding, that many of my patients who cannot get insurance coverage will pay to have the procedure done in order to obtain relief from their symptoms.
At the Arizona Center for Aesthetic Plastic Surgery, we offer several ways for you to keep costs down and make the surgery more affordable. Package pricing is available that can save you thousands of dollars off typical hospital costs. We also accept various credit cards and offer financing from several companies that will allow you to make more affordable payments spread out over time. You can call our office at 480-451-3000 for further information and assistance regarding breast reduction, insurance questions, financing, and scheduling your consultation.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona
Wherever you turn nowadays, it seems that big breasts are where it is at. Magazine articles, advertisements in all media including even on billboards, and marketing materials intentionally display alluring, voluptuous women. Television and movie actresses, anchorwoman and even hostesses at many finer restaurants are well endowed in clearly disproportionate numbers. Breast augmentation usually ranks as the number one plastic surgery procedure among women. Why then would a woman choose to reduce the size of her breasts? Could this apparent lack of judgment be caused by drinking too much bottled water or is it the result of a never before recognized side effect of global warming?
The real answer to this is that naturally large breasts can be very big problem. Their sizable weight can be associated with neck, back and shoulder pains, skin irritation and rashes, unpleasant odors, numbness in the extremities, fatigue, and even impairment of breathing. Some women are forced to sleep propped up in bed or in a recliner as their breasts are so massively enlarged (gigantomastia) and heavy that breathing is a chore. With time, many women develop arthritis of the neck, deforming postural changes and deep, painful grooving of the shoulders from the bra straps relentlessly digging into their skin. Exercising can be extremely difficult, painful and even embarrassing so many forego it. I have had patients tell me that they need to wear two or three sports bras just to attempt to feel more comfortable. Many give up on vigorous activities and as a consequence, gain weight. Some of that increased weight goes to their breasts and so it becomes a vicious cycle. An extremely high proportion of women with large breasts, therefore, are well above their ideal body weight which can also lead to other health issues. Finally, many find themselves being gawked at or the target of unwanted comments or ridicule.
Clearly for these women, large breasts are not a blessing but a curse. This is why many seek to have their breasts made smaller through an effective breast reduction procedure (reduction mammoplasty). By reducing the size and weight, recontouring and lifting them, most if not all their symptoms can be alleviated. They can start exercising again, engage in sports that they had to avoid previously, and can address weight issues more effectively. Self-image and confidence improve significantly.
In over 20 years of practice and performing a large number of breast reductions, I find that women who have undergone this procedure are among the happiest and most satisfied of any of my patients along with those who have had a breast augmentation.
Breast Reduction – before
Breast Reduction – after
Breast Reduction – before
Breast Reduction – after
To learn more about breast reduction, breast augmentation or other cosmetic surgery procedures, please contact Dr. Turkeltaub at 480-451-3000.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona
