The breast reduction is among the most common operations in the field of cosmetic plastic surgery. In severe cases (if the removed tissue exceeds 500g) the procedure is medically indicated and therefore the health insurance usually covers the costs.
There are well over 100 different surgical procedures, which vary radically in the incision and in the type of tissue removal. Most surgeons are proficient in 4-5 different techniques in relation to the anatomical conditions of the breast. For those seeking advice, it is usually impossible to co-decide the method of choice. To better understand the advantages and disadvantages of each method, I would like to mention the most important parameters that play a role in a reduction surgery:
- Characteristics of the blood supply of nipple and areola
- Shapeing of the breast
- Durability of the procedure/building an inner bra
- Preservation of the sensitivity/excitability of the nipples
In discussion with your surgeon, you should consider which of these aspects are particularly important.
When using scar-saving techniques, the inner side of the submammary fold remains untouched, therefore maintaining a neckline is possible. Unfortunately, these methods can rarely be used with very large breasts. Furthermore, there are techniques that preserve the sensitivity of the nipple better than others, but have the disadvantage of poorer formability of the breast.
The last 20 years were spent developing methods that are characterized by the formation of an inner bra to improve the durability of the results. Hereby the weight of the breast is redistributed from the skin to the inner bra to counteract the sagging of the breasts. I intensively concerned myself with this topic considerably and amended a long-proven method (B-technology) so that the formation of an inner bra is possible.
For most patients, scarring is of course important, but I would like to point out that an attractive breast shape, from an aesthetic point of view, is much more important than shorter scars.
When planning a breast reduction, the following points should be noted:
- The surgery should usually be carried out after completion of family planning. A pregnancy after a breast reduction is possible, but it must be expected that the established breast shape will deteriorated due to the strong size change again.
- Weight fluctuations of more than 5kg may worsen the outcome as well, so you should, at the time of operation, have a body weight with which you feel comfortable and can maintain.
For those concerned, a successful reduction of the breast is a huge improvement in quality of life. In addition to relieving back pain, bra strap marks and significant posture problems, this procedure often removes the emotional discomfort and self-consciousness often associated with having large pendulous breasts.
1. At what age and until what age can a breast reduction be performed?
A breast reduction should not be carried out prior to 18 years of age. Growth in size and breast growth should be completed. If the family planning is not yet complete, a method should be used which takes into account the sensitivity of the nipples and the ability to breastfeed. There is no upper limit if you are medically and psychologically sound.
2. What methods of breast reduction surgery are available?
There are well over 100 different surgical procedures, which differ radically in the incision and in the type of tissue removal. Please discuss with your surgeon the pros and cons of the methods used.
3. How do the various methods of breast reduction differ?
They differ in the course of scarring, method of tissue removal, characteristic of blodd supply of nipple and areola, the preservation of the sensitivity/excitability of the nipples, the shaping of the breast and not least in the durability of the surgical result. Depending on which of these aspects are particularly important for the patient, different techniques are selected.
4. What possible types of scarring are there?
Scarring can progress like an inverted T (Anchor), looking down and out from the areola, run vertically down or be confined to the areola. The anchor-shaped incision is the most effective proceudre and permits best shaping of the breast. Scar-saving techniques can be used, if not much tissue must be removed or if the necessary lift of the areola is not very long (<10 cm).
5. During a breast reduction, can a large areola also be reduced?
A reduction of the areola is in the context of a breast reduction possible and is routinely carried out if necessary at no extra cost.
6. Can a breast reduction be carried out under local anesthesia?
A breast reduction is a comprehensive intervention, which should be carried out under general anesthesia.
7. Will I lose the ability to breastfeed with a breast reduction?
Generally not, however, in rare cases, the ability to breastfeed may be affected. Only when using non-contemporary methods (free mammary transplant) is the ability to breastfeed completely lost.
8. Will I lose the sensitivity of the nipples with a breast reduction?
There are ways that jeopardize the sensitivity of the nipples less than others, but have several disadvantages. If sensitivity is particularly important, you should tell your doctor.
9. What complications can occur?
The most common medical complication is bleeding, followed by infection and impaired wound healing (necrosis of the skin and/or the areola). When performed correctly, they are very rare. Other complications can include asymmetry in size and shape, distorted areolas and widened scars. Aesthetic complications can almost always be corrected. For serious medical complications (necrosis, etc.), this is unfortunately not always possible.
10. How long after the procedure can I expect to be fit again?
In general, normal activity can be resumed after 10-14 days.
11. What are the long-term results after breast reduction?
In the vast majority of breast reductions, long-term results are generally very good. Keep weight fluctuations and pregnancies limited to increase the possibility. A reduced breast usually keeps its size. The situation is somewhat different with the durability of the result. How long the result lasts and as from the time it starts to drop and/or bottoms out again, depends on the weight of the breast (gravitiy) and the individual properties of the tissue (loose or tight connective tissue) and the method used.
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Preparation for surgery (blood test, chest X-ray, mammography, surgical release by an internist)
Blood lab, mammography and X-ray are no additional cost if you are insured in Austria and the procedure is considered medically necessary. The same applies to the OP-release by an internist or general practitioner, who are under contract with the usual social security institutions in Austria. In our medical center, there is an internist that the insurance considers a physician of choice. In this case, the insurance will cover about 50% of the cost.
Hospitalization – in-patient (overnight)
EUR 1.350 – 3.500, – depending on the duration of the surgery, number of nights, room type (suite, single, triple) and hospital
The operation is performed under general anesthesia therefore an anesthesiologist is needed for surgery. The cost of the anesthesiologist may vary depending on the duration of the operation. The cost is between EUR 400-1.000. The average cost is around EUR 600-800.
Depending on the duration of the surgery and the accompanying supplementary measures, the surgical fee is between EUR 2.500 to 7.000. The average cost is around EUR 3.500-4.500.
After a breast reduction, the affected breast should have little or no movement and perfect support. Depending on the make and design, a support bra costs between EUR 60-180, –
Visits and Check-ups
Visits and check-ups are included in the surgical fee.
A breast reduction is performed in principle in an ISO-certified operating room of a hospital.
For a period of 14 days before the operation, anticoagulants (aspirin, Marcoumar, vitamin E, etc.) should be avoided as this can delay blood clotting. Also alcohol and sleeping pills should be avoided as far as possible, because they reduce the coagulating ability of the blood and thus increase the risk of bleeding. The consumption of cigarettes should be reduced to a minimum. Nicotine has a vasoconstrictive effect, which can lead to impaired wound healing.
The operation is performed under general anesthesia. Therefore, prior to surgery, you need the following tests:
- Lung X-ray and ECG
- Complete blood count, blood type, HIV testing and hepatitis A, B, C
- Surgical release by a general practitioner or internist
Please note that the results may not be over 10 days old at the time of surgery. Please bring the X-ray and all the findings for surgery.
For the smooth processing of admission, please arrive at the hospital at least 2 ½ hours BEFORE the surgery and be six hours sober at the time of surgery. After completing the admission formalities you will be placed in your room. At your request, you will receive an infusion which reduces your thirst.
With a breast reduction, a hospital stay of one to three nights is to be expected.
- OP-date plan
- OP-date set (take a vacation, compensatory time or sick leave, arrange for child care if necessary, etc.)
- 2 weeks before the surgery, complete the necessary preoperative exams (blood lab, mammography, X-ray, ECG, surgical release)
- A preoperative interview will take place the day before the surgery. It will assess the findings, discuss final details and sign the consent form. An instruction sheet will be given to you by the assistant to complete and bring to the hospital. Planing of the 1st Follow -up Visit.
- Arrive at the hospital 2.5 hours before surgery to complete admission formalities. If requested, an assistant can accompany you to help shorten the time before the surgery.
- Discharge from the hospital usually one to three days after the surgery. Please do not drive yourself. Take a taxi or let yourself be picked up.
- At home, relaxation and recovery should be in order. Avoid strenuous activities.
- 1st Follow-up Visit (about 5-7 days after surgery): Change of bandages to a support bra
- 2nd Follow-up Visit (approximately 10 days after surgery): Removing the stitches.
- 3rd Follow-up Visit (approximately 20 days after surgery)
- 4th Follow-up Visit (approximately 30 days after surgery)
- Further follow-up visits will take place two to six months after
- Final follow-up control after one year