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Breast Reduction

Conveniently located to serve Washington DC, Arlington, Bethesda

What is a breast reduction?

A breast reduction surgery is a procedure that lifts your breast and reduces the size.  This relieves symptoms of neck and back pain, bra strap grooving and rashes under your breasts. This also improves the appearance of your breasts by lifting them. It is one of the most common procedures in plastic surgery due to the high satisfaction rate.

Who is a good candidate?

Anyone who has neck, upper back pain, bra strap grooving and shoulder pain or rashes from heavy breasts may benefit from surgery. Heavy breasts can cause pain and limitations in your activities.  Patients who just want smaller, more perky breasts would also benefit from a reduction.

How is the procedure performed?

In the preoperative area, you will be marked in a standing position.  Once surgery begins, we first resize your areola with a “cookie cutter” device to create a perfect circle.  An area of breast tissue that carries the nerve and blood supply to the nipple is deepithelialized to allow the skin to ultimately be buried. The extra tissue and extra skin are removed ,and after shaping the breast, the incisions are closed in layers with dissolvable suture.  Both sides are compared and adjustments are made to maximize symmetry.  The incisions are then dressed and a surgical bra is placed.  The use of drains is not required in most cases.

Recovery

Breast reduction recovery is fairly easy, with most patients  back to work in about a week and back to the gym in 3 weeks.  Showering is restarted at 72 hours after surgery and baths/swimming are allowed at 4 weeks post procedure.  Scar therapy starts soon after surgery and a surgical bra or a sports bra is worn for a month (no underwire).  We recommend waiting 6 weeks to buy new bras/swimsuits to allow swelling to resolve.  Although you won’t need to wear a bra once you’re healed, we do recommend it to maximize the longevity of your results. You will generally notice decreased neck and back pain and better posture within a few days to weeks after surgery.

Will insurance cover my procedure?

Breast reduction can often be covered by insurance.  Each insurance company has its own criteria, however most policies and insurances cover the surgery if you have symptoms and enough tissue to remove . 

When you come in for your consultation, we will calculate your body surface area (using your height and weight) and use this to determine if your insurance will cover this surgery based on their criteria – using the Schnur Scale.  After discussing your goals and performing an exam, we will let you know if we think insurance will cover the surgery. If you don’t have enough tissue to remove in order to meet the gram requirements, we will give you a self pay quote for surgery. This could be either because you don’t have enough breast tissue to remove to meet insurance requirements or removing that much tissue would make you smaller than your aesthetic goals.  

Some patients are borderline insurance candidates and we will give you the option of going through insurance or will give you a quote for the self-pay rate. We will submit prior authorization for surgery, however some insurances don’t perform prior approvals and will review the operative records after surgery to determine if it’s a covered benefit. 

(United Healthcare does have many policies where breast reduction is not a covered service when performed in non-breast cancer patients – if you call UHC you can ask them whether it is a policy exclusion when performed for neck and back pain)

Risks

  1. Bleeding – all surgical procedures come with a small risk of bleeding, in some cases, this may need to be drained
  2. Infection – infection is uncommon in mastopexy, but if it does happen, antibiotics may be needed
  3. Nipple sensation changes –but you could have an increase or decrease in nipple sensation or even loss of sensation
  4. Nipple loss – extremely rare and would require reconstruction
  5. Poor scarring – breast reduction incisions do create scars. In most patients these are thin and well tolerated, however in some genetically predisposed patients, these can be wider or even keloids.  Usually scar therapy works well, however in a very small percentage of cases, revisional surgery may be needed
  6. Wound healing issues – breast lifts use tension to lift the breast, in a small percentage of cases, this may cause some slow healing, this occurs most frequently at the trifurcation (the area where the vertical and horizontal incisions meet)
  7. Asymmetry – virtually everyone has some minor differences between their breasts prior to surgery, during surgery we attempt to correct any preexisting asymmetries, however very mild asymmetries may remain due to surgical technical limitations.
  8. Need for revision – in some cases a touch up may be needed for optimal aesthetics
  9. Changes in breastfeeding – breast reduction removes breast tissue and although possible in some patients, there is a significant risk of not being able to breastfeed after surgery
  10. Breasts that are too large or too small – we make every attempt to get you the size that you want, however cup sizes vary according to bra manufactures, so we cannot guarantee a certain size.  Technically we have to leave a certain amount of tissue behind to carry blood supply and nerve supply to the nipple, which may limit how small you can be.  Insurance companies also have requirements about how much tissue has to be removed during surgery, to meet these criteria, we may have to excise a certain amount of breast tissue that could leave you smaller than your goals – we will discuss this at your initial consultation if it pertains to you.  You would also have the option of not using insurance which would remove any restrictions on surgery. 
  11. Breasts that regrow – this is very uncommon and almost exclusively happens in patients who have the surgery at a young age prior to development being complete – 16-19 years old
  12. Changes on mammograms – every breast procedure creates some changes on mammogram, in most cases the radiologist identifies this as post surgical changes, but in some cases a needle biopsy may be needed
  13. Fat necrosis/hardness – Sometimes there are areas of the breast that don’t get adequate blood supply after surgery, this can lead to hardness of the tissue. This can usually be left alone, but if it bothers a patient, excision of the area may be needed.

Your Breast Reduction will be performed in Dr. Praful Ramineni‘s surgery center located in Washington, DC.

This has been an amazing experience from the consultation to post-surgery!!! I honestly can’t even express how happy & grateful I am with the results. Everyone….Dr. Ramineni and his whole team are impeccable, to say the least. A very thoughtful, professional, kind, and knowledgable team. I will 100% always refer anyone I know to this amazing team…Dr. Ramineni had a challenge when I came to see him with my issue but he 1000% went above & beyond to achieve perfection with my results. I can’t thank this team enough!! I genuinely want to thank you so much!

- Sally T.

Dr. Ramineni was recommended to me by my plastic surgeon as a masterful surgeon who could figure out why I was having complications. He diagnosed the problem correctly and fixed it. I am grateful for his openness, his honesty, and skill.

- Saiyyaed A.

Life-altering surgeon. He helped make my dreams come true with the most flawless surgery I’d been waiting my whole life to get. Healing and recovery has been almost disturbingly easy and pain-free. I could not recommend enough. Everyone there is so sweet as well!

- Katie C.

Before & After

Breast Reduction Before & After

Dr. Praful Ramineni

Plastic SurgeON IN WASHINGTON D.C.

Dr. Ramineni is the founder of District Plastic Surgery. He is board certified and has over 15 years of experience in plastic and reconstructive surgery. He started his career as one of the busiest surgeons at Medstar Washington Hospital Center with a focus on complex reconstructive surgery including cancer and trauma reconstruction, microsurgery and aesthetic surgery.

Dr. Praful Ramineni
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