November 30th, 2013 Miguel A. Delgado Jr, MD
This is a 23-year-old resident of San Francisco and seen in the Marin County Office for a breast reduction. She is 5 feet 2 inches, 167 pounds. She underwent an inverted T breast reduction at the Marin Cosmetic Surgery Center. She went from a size DDD to a C cup in size. The photographs are approximately nine months after surgery. Note the nicely fading incisions.
San Francisco, California-The American Society of Plastic Surgeons (ASPS) is the largest plastic surgery specialty organization in the world, representing more than 94% of all Board Certified Plastic Surgeons in the United States.
“Plastic and Reconstructive Surgery” is the medical journal of ASPS where a recent study was reported on the health benefits (both physical and mental) for breast reduction patients. This study was done to justify the necessity of breast reduction surgery to the insurance companies. For purposes of evaluation, “Breast Q”, which is a well validated questionnaire, was used in this study.
The study included 49 patients that were preparing to undergo breast reduction surgery. Of the 49 women, there were 78% who completed the questionnaire either before or after their reduction mammoplasty surgery. Satisfaction with surgery and quality of life issues were evaluated in four areas; appearance, psychosocial, sexual and physical well-being. Not surprisingly, the study showed significant improvement in all four areas. Based on a scale of 100, the improvement for each area was reported as follows:
1. Satisfaction with breast appearance went from 20 to 80 after surgery
2. Psychosocial well-being was 41 and increased to 84
3. Sexual well-being went from 40 to 78
4. Physical well-being was 43 and increased to 81, noting great relief of pain in the breast, back, neck and shoulders.
Appearance of the breasts showed the greatest satisfaction with the overall outcome of the surgery. Women stated they slept better and had greater ability to exercise, in addition to the reduction of pain.
Medical insurance companies notoriously have many conditions the patients must meet in order to get coverage for surgery. For example, many insurers require that the patient has documented proof that they have tried; physical therapy, good support bras, analgesics, and most require the need of a minimum of 500 grams of breast tissue to be removed.
The study also determined that for many, improvements occurred for women that had small reductions, which disputes the insurance coverage guidelines for a mandatory amount to be removed. Researchers plan to continue with additional studies with more patients and a longer term follow up.
Presently, the only way to know if your insurance will cover reduction mammoplasty surgery is to call them. Have your I.D. number available. Don’t be surprised if the answer is “that depends”, at this point it is recommended that you see a Board Certified Plastic Surgeon that specializes in breast surgery, to help you with the ins and outs of obtaining approval for surgery.
The Affordable Care Act, also known as “Obama Care” is probably going to continue to change as it moves forward, with Congress arguing over each detail. It is impossible to know how the Affordable Care Act will affect breast reduction surgery approvals in the future.
In addition to breast reduction, many patients are now choosing to have some areas of fat reduced by CoolSculpting which is now available to Dr. Delgado’s patients. CoolSculpting is a non-surgical treatment that can reduce stubborn pockets of fat that resist reduction by diet and exercise. For a consultation call today at (415) 898-4161 or email.
October 21st, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-There are several reasons that women look for alternatives to breast reduction other than surgery.
Some women are fearful of surgery, some are fearful of anesthesia, while others are concerned about the time that they would need to take out of their busy schedules for recovery. The financial expense for women who do not have coverage by medical insurance can be prohibitive. Then there are women who worry about what their breasts may look like after a reduction mammoplasty surgery.
For all of these reasons and more, women look for ways of reducing their large breasts that does not involve surgery.
The breast is composed of fat and breast tissue, the ratio varies greatly among women. For those with a greater degree of fat, weight loss can make a big difference. If the woman does not have good skin elasticity, the breast may end up looking deflated and droopy after significant weight loss.
There have been a great number of inquiries asking if exercise can make a difference in breast reduction and possibly help to lift the breasts. As mentioned the breast is made up of fat and breast tissue, not muscles. Exercise may strengthen the underlying pectoralis muscles, but the breast is supported by a network of suspensory ligaments which are not affected by exercise. Due to gravity and the loss of integrity of the connective tissue support over time, the weight of the breasts will diminish the ligament support to the chest wall, and the breasts will droop.
Men with gynecomastia (male breasts) hope to reduce their man boobs through exercise. They find the same thing that women do, it doesn’t work. In some cases, the development of the pectoralis muscle may even make the breast more prominent by pushing the breast out further beyond the muscle.
The breast gland sits on top of the muscle and is not affected by how strong the underlying pectoral muscle is and strengthening the pectoral muscle will not alleviate back and neck pain. Weight loss and exercise are helpful for tone but not tightening. Exercise could help strengthen the back muscles which could help support the extra weight of the breasts on the chest.
In the search for alternative methods of breast reduction, women may find expensive pills, creams and lotions advertised on the internet. Some state they are granted “GRASE” status by the FDA, which means the herbal ingredients are safe, not that the product works, if it worked, no one would have surgery.
Getting the right support bra from a specialty store is not a permanent solution, but with good support some of the heaviness and back pain may be alleviated.
Many women have gotten good results from a less invasive procedure, liposuction, but not all women are candidates. The best candidate for liposuction breast reduction is the woman who has minimal to moderate breast enlargement, a larger fat to breast tissue ratio, with minimal sagging; usually it is the younger woman with normal skin elasticity. Liposuction can significantly reduce the breast size for this patient with less pain, a shorter surgery and faster recovery. However, when the fat is removed the skin may not contract fully, and the breast may sag. In addition, the breast will not be lifted as in a traditional breast reduction. With all this being said, breast reduction surgery remains one of the most patient pleasing surgical procedures.
September 25th, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-For the severely obese patient, the question is sometimes posed; “is it a good idea to have breast reduction surgery before or after bariatric surgery?” The result of a study on this very question was published in Plastic and Reconstructive Surgery, which is the official journal for the American Society of Plastic Surgeons.
Obese women find it almost impossible to exercise when they have large pendulous breasts. Many hope that by having a breast reduction mammoplasty that they will be able to exercise and lose weight on their own and avoid bariatric surgery.
This is a 35-year-old resident of Mill Valley, California who presented to the Novato office in Marin County for evaluation of a tummy tuck (abdominoplasty). She had a large weight loss due to diet and exercise. She underwent a full tummy tuck, breast reduction and liposuction of her flanks. Her surgery was performed at Marin Cosmetic Surgery Center in Marin County, California.
Bariatric surgery is a catch-all phrase for weight reduction surgery for obese patients. There are two main ways that this is done. The first would be Malabsorption such as gastric bypass surgery which restricts the amount of food going into the stomach and small intestines thereby limiting absorption of calories. The second would be Restriction where there is a surgical reduction of the size of the stomach and the small intestine, limiting the physical amount the stomach can hold.
In the study reported in the Journal, 29 women with a body mass index of about 54, 15 of the women had breast reduction surgery first and felt that their breasts looked much better; however even though exercising was easier, all 15 of the women still needed bariatric surgery in order to reach their weight loss goals. Most of the women were not sorry that they had breast reduction surgery because of the immediate relief from back, neck and shoulder pain, but they said that they would recommend to other women to wait until after their bariatric surgery so that an additional reduction mammoplasty surgery may be avoided. The women found that, with the weight loss provided by bariatric surgery, their breasts were reduced further in size, causing more sagging breast skin. Most of these women said if the cost of secondary breast reduction was something they could afford or if insurance would cover it they would proceed.
71% of the 14 women who had bariatric surgery first thought that their breasts looked worse after the weight loss and half of them planned to have breast reduction surgery, with more of them wanting it if they could afford it. So the conclusion of the study reports that women are dissatisfied with the appearance of their breasts after massive weight loss with or without breast reduction surgery prior. So it is recommended that a woman waits for their breast reduction after completing bariatric surgery. Now available at Dr. Delgado’s “Non-Surgical Center of Excellence”, is “CoolSculpting” which is a non-invasive treatment for pockets of remaining fat, this can be addressed at the time of your consultation.
Even though this study was for women, men have similar issues after massive weight loss. Men will find that they have a lot of redundant loose skin hanging from their chest requiring surgical excision, or gynecomastia surgery. Due to the skin being so stretched, it is very likely that the man will need a second stage male breast reduction surgery.
For both men and women, in addition to their breasts needing a reduction after bariatric surgery, most will also need an abdominoplasty or even a total body lift. This can be very disheartening to the patient that has been through massive weight loss only to find that the remaining loose skin leaves them feeling as disappointed in their body as before the weight loss. Hopefully the bariatric surgeon will explain thoroughly to the patient exactly what they can expect after their weight loss so that additional surgeries involving great amounts of skin tightening can be planned on both emotionally and financially. Depending on the patients, specific insurance policy, they may find they have coverage for the bariatric surgery and the breast reduction surgery; however, they may have to pay out of pocket for the body lift. The body lift generally includes the abdomen, arms and thighs, which most insurance companies would consider cosmetic surgery. Every case is individual and needs to be addressed with the insurance company by a top cosmetic plastic surgery specialist who is familiar with the process insurance companies require.
September 2nd, 2013 Miguel A. Delgado Jr, MD
This is a 32-year-old resident of San Rafael, California who is seen in the Novato office in Marin County. She is 5 feet 4 inches, 130 pounds, and underwent a short scar vertical breast reduction at the Marin Cosmetic Surgery Center. Her size was reduced from a size F to a size C. The photographs are seen approximately nine months after surgery and the incisions are starting to fade quite nicely.
San Francisco, CA-In addition to discomfort, women with large heavy breasts who are seeking breast reduction surgery, also may have unsightly stretch marks. Stretch marks, also called striae, form within the middle layer of the skin, known as the dermis. They are initially red, pink or purple but usually fade with time to white or silver and become much less noticeable. As disturbing as they may be, they do not pose any health issues.
Women who are planning to have breast reduction surgery, many times will ask if the surgery will remove the stretch marks on their breasts. In some cases, it will, but it depends on where the stretch marks are located, only the skin removed with stretch marks will be improved. There will be scars from the surgery, however all will fade with time from red to faint silver, similar to a tummy tuck procedure as far as removing many stretch marks as the skin is tightened and loose skin is excised.
There are not any miracle products to erase stretch marks. There are many creams advertised for stretch mark removal, but for them to work, it would need to penetrate the epidermis and get into the subcutaneous layer, so you may only see some minor improvement. Sometimes, the stretch marks can be improved and lightened with lasers.
Stretch marks can be caused by; pregnancy and some birth control methods that cause hormonal changes, also weight gain, when the skin gets stretched. In addition, corticosteroid creams and lotions may be the cause, even oral or systemic steroids. There are some medical conditions such as adrenal gland disorders, Cushing’s syndrome (a hormonal disorder caused by high levels of cortisol) and some connective tissues disorders are attributed to the formation of stretch marks.
Dehydration and lack of exercise can be a reason for development of stretch marks on the breasts. Anything that causes rapid changes in the size of the breasts can mean the sudden development of stretch marks, not only for women but also noted for some men if they develop gynecomastia (male breasts).
The Mayo Clinic states that stretch marks can be hereditary; if your Mother has them you may get them too. Accelerated growth for teenagers with developing breasts may lead to stretch marks. Also, according to the Mayo Clinic, there is not any way to prevent stretch marks other than maintaining a healthy weight and avoiding excessive weight gain.
Some women report that, after breast augmentation surgery, stretch marks don’t seem to be as bad. Breast implants can make the stretch marks appear less obvious, however, having an implant that is too large may put too much stress on the skin that already has loss of elasticity and may cause sagging.
Inverted T or Anchor
Vertical Scar or Short Scar
The different types of reduction mammoplasty surgery will remove stretch marks within the area of excised skin. See the pictures to see the differences. During your consultation with Dr. Delgado who is a breast surgery specialist, he will explain what type of breast reduction surgery he recommends for you and the possibility of removal of some stretch marks.
July 31st, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-Due to all the medical problems that having large breasts, also known as macromastia, can cause (see previous blog), many health insurance policies will cover all or part of breast reduction surgery. However, it is getting more difficult to get approval and with all the changes with health insurance it may become even harder.
In the meantime, if you have a policy that specifically has an exclusion for breast reduction surgery there isn’t much you can do except get a different policy. If you work for a company that offers medical insurance, review all insurance plans offered and switch to one that will cover the cost of breast reduction surgery during the open enrollment period (which is usually in November). The new insurance will probably cost more, but then you can switch back to your previous one at the next open enrollment.
If your insurance does not have an exclusion, that’s a big plus, but you still may have a few hoops to jump through to get approval. Understanding what most insurance companies require and why makes it a little easier to go through the process.
The insurance company will want to know what you have tried to help alleviate your symptoms. For example, have you invested in high quality support bras? For many women, even with top quality bras, they end up with shoulder grooves from the straps which
themselves can be painful. Next, have you tried physical therapy including exercises to strengthen your back muscles to help counteract the additional weight carried on your chest? Have you tried anti-inflammatories to ease back, neck and shoulder pains? It is unlikely that these methods are going to give you any lasting relief, but the insurance company will want to know as they are not anxious to give approval. You can expedite your approval process if you have documentation of all these things ahead of time. Get a letter from the physical therapist, receipts for bras, a letter from your General Practitioner that you have tried anti-inflammatories.
Another requirement some insurance companies have is that you need to be within a certain weight range, and if you are above the limit they may not cover your reduction mammoplasty procedure until you lose weight. This is understandable because for many women when they lose weight they will also lose fat in their breasts, and the back pains may have resolved themselves; therefore, surgery will not be covered. Not only will their breast reduction surgery not be covered, they are left with droopy sagging breasts, and if they desire a breast lift, that won’t be covered either as it is considered cosmetic surgery. Insurance companies will not cover a procedure they consider cosmetic unless it is causing physical pain and/or complications; psychological distress is not considered a reason to cover a procedure, such as gynecomastia, which is male breast reduction.
Losing weight can be very difficult for many women with large breasts as exercising is a challenge. It is important to note that large breasts are not only due to excess fat, for many women it is a combination of fat and tissue and, therefore, losing weight may not make much of a difference.
Having a consultation with a Board Certified Plastic Surgeon who specializes in breast surgery will be your best option. Your surgeon is very familiar with all the ins and outs of the insurance companies and will be able to advise you on the probability of getting coverage.
In addition to all of the requirements mentioned above, one of the main requirements of the insurance company will be how much tissue is needed to be removed. Most say it must be 500 grams per breast or more, otherwise they consider the procedure to be cosmetic in nature, and they will not cover it. Your surgeon will be able to tell you approximately how much tissue you would need to have removed and the probability of your qualifying.
Even after all of these steps have been taken there have been cases where the insurance company has turned down their clients for surgery. While this is extremely frustrating, don’t give up just yet! The next step would be for your surgeon to appeal your case; this can be more successful than you might think. When an appeal is requested, the insurance company brings in an impartial medical doctor to review the case. The doctor will contact your surgeon to discuss your issues. Many times after the surgeon and doctor consult the denial is reversed, and surgery is approved!
Dr. Delgado has had many years of experience with situations such as these, successfully obtaining approval from insurance companies on behalf of his patients.
July 15th, 2013 Miguel A. Delgado Jr, MD
This is a 32-year-old resident of San Rafael, California who was seen in the Novato office in Marin County. She is 5 feet 4 inches, 130 pounds, and underwent a short scar vertical breast reduction at the Marin Cosmetic Surgery Center. Her size was reduced from a size F to a size C. The photographs are seen approximately nine months after surgery and the incisions are starting to fade quite nicely.
San Francisco, CA-Women who have suffered with large breasts will tell you of several conditions that cause them continued misery. Both physical and psychological symptoms of macromastia may affect the quality of life.
Having the extra weight that large pendulous breasts pose, women tend to lean back for support. Leaning back will disrupt the body’s natural support structure around the spine and puts a lot of strain on the lower back muscles which will affect; bending, sports activities and even sleeping. Exercise can be very difficult, jogging with bouncing breasts can be painful and even walking, to the point that many women will avoid exercise all together which will only lead to weight gain and larger breasts.
The resulting poor posture may lead to chronic nerve problems such as numbness and tingling in the arms and hands. Efforts to get extra support from a specialty bra will include large straps may cause grooving into the shoulders, and possible rashes and the extra pressure on the shoulders may result in neck pain.
It is hard to keep the area under large breasts dry which ultimately leads to rashes and yeast infections. In addition, the extra breast weight on the chest may cause breathing difficulties and possible pain in the lungs from the added pressure. However, it is possible that something other than large breasts could be causing breathing problems and needs to be evaluated by your physician.
Unwanted attention from the opposite sex can result in a great deal of mental stress which may lead to low self-esteem and loss of self-confidence resulting in depression and poor quality of life.
Shopping for clothes can be very frustrating and become a chore; it is very difficult to find clothing that fits properly around the chest and then correct for the rest of the body.
Treatment for macromastia without surgery would be with anti-inflammatories, chiropractic adjustments, massage, heat packs, physical therapy, etc. but such treatments rarely will bring lasting permanent relief. Large breasts get progressively heavier with age and gravity.
Fortunately, most insurance companies cover breast reduction surgery for women. Unlike gynecomastia, the condition of breast enlargement for men, where insurance companies will rarely approve male breast reduction surgery.
That is not to say that women won’t have to jump through many hoops to get insurance coverage for their breast reduction surgery, they will, but for a cosmetic plastic surgeon that is used to the ins and outs with the insurance companies, approval can be obtained in most cases. There are exceptions; some insurance companies have a specific exclusion for breast reduction surgery, or they may have a required minimum of breast tissue that needs to be removed. Some insurance companies require documentation of methods tried before approval such as; weight loss, physical therapy, good support bras, analgesics, etc.
In the disappointing event of the insurance company denying coverage, the experienced breast reduction specialist will make an appeal on your behalf. In this case, the insurance companies usually have a medical doctor review the case and speak to the referring physician. I have done this for many patients with the result that approval has been granted on appeal in most instances.
Breast reduction surgery provides one of the highest satisfaction rates with patients experiencing almost immediate relief of symptoms after surgery.
July 1st, 2013 Miguel A. Delgado Jr, MD
This is a 19-year-old female resident of San Francisco who presents for a breast reduction. She is 5 feet 2 inches, 130 pounds. At Marin Cosmetic Surgery Center she underwent a vertical short scar breast reduction reducing her size from a DDD to a C cup. She is seen approximately six months after surgery with nicely healing scars.
San Francisco, CA-When young girls start to go through puberty and their bodies start to change, they begin to struggle with self-esteem and body image. They want to be accepted by their friends and can be greatly influenced by the media as to how they think they are “supposed” to look. It is reported that as much as 44% of high school girls are attempting to lose weight. Many girls agonize over breast development worried that their breasts are too small and even try to convince their parents to allow them to have breast augmentation before they have finished developing. Then there is the young woman whose breasts start to grow and seem like they will never stop.
Breast development can start as early as 8 years old or as late as 13. If the breasts continue to grow and become very large, the condition is referred to as juvenile macromastia and even larger breasts juvenile gigantomastia. In the early stage of development, the breast bud will begin to develop. Then the nipple area begins to look a little puffy, but the nipple remains flat. The next stage of development, the breast itself gets a little bigger, and the areola darkens and gets puffier. The hormone estrogen is secreted by the ovaries and is responsible for breast growth. Usually the process for breast development can take 3 to 5 years, but up to 10 years for some. During the time that the breast is developing, girls may experience breast pain and tenderness, and the skin may feel itchy as it stretches.
When the breasts grow too large for a teenage girl, she will most likely suffer physical and psychosocial consequences. The emotional devastation is exacerbated by unwanted attention from classmates leading to destruction of self-esteem and poor body image. Some girls develop such serious psychological problems that it can sometimes even lead to suicide.
Breast size is usually determined by your genes but not always. The amount of body fat versus breast tissue one has can make a difference. If a girl loses weight her and her fat ratio is much higher than the breast tissue, then her breasts may get smaller, although then they may sag as there is not as much fat to fill them out leading to possible breast revision surgery in the future. Teens that are already at a normal weight but want to lose weight in their breasts risk vitamin and mineral deficiency.
Exercise will not make breasts larger or smaller or perkier as there are not any muscles in the breast.
Young girls suffering with large breasts are advised to:
•Stand up straight, hunching over does not hide large breasts but will add to back pain.
•Wear a super supportive bra
•Pick clothing that doesn’t accentuate your breasts, avoid large patterns, horizontal stripes, pencil skirts, and tight jeans
•Avoid necklines that show cleavage
Another option, some girls try to hide their large breasts by using minimizer type bras, while this might help to make the breasts look smaller, the compression can be very uncomfortable and not good for breast health.
The third way some girls seek a reduction of their macromastia is by liposuction, for some this can be a very successful type of breast reduction, but for those with very large breasts, it will only reduce by a small amount. This leaves the most effective way for breast reduction, and that is breast reduction surgery, also known as a reduction mammoplasty. There are risks involved for the younger girl. First, the breast may continue to grow necessitating a second surgery at a future date, there may be loss of nipple sensitivity and the ability to breastfeed may be compromised, and lastly there will be breast reduction scars.
Breast reduction surgery for a teenager is appropriate in some cases, even with the known risks. Almost all women that seek breast reduction surgery state that the removal of the extra weight has freed them of back and neck pain and increased their quality of life, they enjoy having a conversation with people who now look them in the eye.
When parents are aware that their daughter may be facing such a situation, it would be wise to have a consultation with a breast reduction surgeon who is Board Certified in Plastic Surgery to discuss all options and see breast reduction before and after pictures.
June 16th, 2013 Miguel A. Delgado Jr, MD
This is a 52-year-old resident of San Francisco was seen for a breast reduction. She underwent a vertical short scar breast reduction in which her size was reduced from a DD to size C. Notice the reduction in the size of the areola.
What many people think of as the nipple is actually the nipple and the areola. The nipple is the part that projects out and delivers milk via the milk ducts, and the darker pigmented circle of skin from which the nipple projects is the areola. As with the rest of our body, the breasts, nipples and areolas come in all sorts of shapes and sizes. For many people, men included, having large or puffy areolas or protruding or inverted nipples can cause a great deal of embarrassment. This is especially true when the nipple protrudes to the point of being visible through clothing. Corrective surgery can be done for both the nipple and areola or separately.
The size and shape of the nipple areola complex can be genetic, or some changes may have occurred due to weight fluctuations, aging, pregnancy and or breastfeeding. In any case, together the nipple areola complex is one of the most important cosmetic aspects of the breast.
When women elect to have breast reduction surgery, many opt to have the areola reduced and/or the nipple shortened. Men who have male breast reduction surgery, also known as gynecomastia surgery, may also have areola and/or nipple reduction at the same time. In some cases, the breast may not need to be reduced, allowing the areola/nipple revision procedure to be performed as a somewhat minor surgery.
The ideal nipple is shaped like a cylinder with a dome like curved top. There is no standard to the length of the nipple; some people prefer them to be shorter and some like them longer. Inverted nipples can look flat or like a slit or hole in the normal place of the nipple. This happens in different degrees with the severity graded from 1 to 3 with 3 being the most severe. For grade 2 and 3 breast feeding may be a problem. Inverted nipples usually result from a narrow nipple base and or short milk ducts. It can affect one or both nipples.
For the elongated nipple, the tip is often removed and sutured, or the nipple may be shortened by excising skin along the neck of the nipple. If it is the width of the nipple that needs to be reduced, a pie shaped wedge of skin is usually removed from under the nipple.
The goal in surgery is to reshape the nipple and get projection while preserving the sensitivity of the nipple and leaving the milk ducts intact.
To reduce the size of the areola, two concentric incisions are made around the edge of the areola with the inner circle the new radius, leaving the area around the nipple intact, still attached to its blood supply and the milk ducts. Then removing the donut shaped piece of tissue and skin the outer circle is stitched to the inner circle in a purse string fashion creating the new smaller areola.
Whatever your goals are, your first step would be to schedule a consultation with Dr. Delgado and he will be able to explain your options in detail. If you are considering a combination of procedures, be sure to let him know so he can discuss the possibility with you.
May 31st, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-Haute MD is an upscale internet site that connects the most trusted doctors and specialists with the country’s most discerning patients. Breast reduction patients searching for a Board Certified Plastic Surgeon will find the network is an exclusive by invitation only membership, where only one doctor is selected for each area. There are nine medical specialties selected; body, breast, face, hair, Lasik, nose, orthopedic, skin, smile.
As you explore their fascinating site, note that Dr. Delgado has been selected as the breast and body specialist for all of the San Francisco Bay Area.
In addition to being a great resource for patients searching for exceptional physicians, Haute MD is an informative site with great articles on health and beauty trends.
May 15th, 2013 Miguel A. Delgado Jr, MD
Dr. Miguel Delgado in surgery
There are different situations where a secondary breast reduction may be requested. One would be the young patient who may have had a reduction mammoplasty before she finished developing. Another may be the patient who gained weight after her original surgery and the remaining fat cells have grown larger. Then there is the patient who just wishes to be smaller than from the original surgery.
In most cases, a secondary procedure can be done. It is a little trickier, and close attention needs to be made regarding breast shape and blood supply of the nipple/areolar complex, which has been disrupted from the original surgery.
If the surgery is going to be done by a different surgeon, it is helpful to have the original operative report. Sometimes that is not possible, but it can still be done safely and efficiently as long as selection of the secondary surgeon is made carefully. Be sure to find a Board Certified Plastic Surgeon that specializes in breast surgery, ask a lot of questions and be sure to see before and after pictures of actual patients of the surgeon.