For patients who will undergo breast surgery via areola incision, they should ask their doctors if they will receive a pedicle technique in which the nipples and areolas are relocated but not completely severed from the wedge of tissue that contains the milk glands and primary nerves.

The pedicle technique has become a standard in breast reduction surgery in an effort to preserve the nipple sensation, although this is not used in treating excessively large breasts as it can limit the amount of excess tissues, fats, and skin a surgeon can remove during an operation.

For women who want to undergo breast implant surgery but are concerned with the risk of permanent numbness in the nipple, most doctors would probably recommend the underarm incision in which they will stretch the tissue rather than cut it to place the device inside the breast pocket.

If the nerves are only stretched, the sensation usually returns sooner unlike if they are cut or cauterized (burned).  But regardless of the incision site, there is always the risk of partial or complete loss of sensation after a breast augmentation surgery.

Another way to reduce the risk of permanent numbness is to avoid using an implant which has a diameter larger than the base of the breast.  For example, a patient who chooses a 12 cm diameter implant even if her breast’s diameter is only 10 cm is more likely to experience this problem than a woman who “considers” her anatomy.

Some plastic surgeons also claim that placing the implants under the muscle can lower the rate of nipple numbness than if the devices are placed behind the tissue or partially under the muscle.

In case that nipple numbness occurs after a breast surgery, it may take up to two years before the sensation will return.  Meanwhile, research has shown that most women can increased their ability to breastfeed five years after the procedure because the damaged nerves and glands can repair themselves over time.

Experts suggest that massaging the nipples and breast skin regularly may encourage a complete or sooner return of sensation by reinforcing neural pathways in the brain; this is done by lightly touching the area with fingers for a few minutes several times each day.

If the procedure is performed not just for cosmetic reasons but primarily to treat the physical symptoms associated with large, heavy breasts, there is a chance that some insurance companies provide coverage for the surgery’s cost.

In order to get approval from insurance providers, a patient must be able to meet certain criteria while her plastic surgeon must prove that the procedure is beyond cosmetic reasons and is needed to alleviate or treat the physical symptoms of large and heavy breasts.

One of the most important criteria is the discomfort and physical symptoms experienced by a patient because of her inordinately large breasts.  For this reason, most insurance companies require at least 500 grams (or about 1.10 lbs.) of tissue and fats to be removed from each breast before they consider a surgery as a “reconstructive” and medically necessary procedure.

In addition, a plastic surgeon must describe in his letter all the efforts of his patient to resolve macromastia (or breast enlargement) which had failed.  Photos can also be helpful to show the severity of the condition which makes the surgery a necessity rather than a procedure to improve one’s appearance.

Most insurance companies also stipulate that a patient should be near her ideal body weight, and unfortunately, this requirement is relatively “tricky” since it is often difficult or even impossible to perform exercise and lead an active lifestyle if the breasts are too large and heavy.  For this reason, a plastic surgeon should highlight this dilemma in his letter and tell an insurance provider that breast reduction can allow a woman to shed her extra weight.

In case that a patient is overweight, it would be helpful if her surgeon will state in the letter that she already had macromastia even if she was previously near her ideal body weight.

Meanwhile, it is important that both the surgeon and his patient only provide honest information to the insurance companies since it is considered a crime to give misleading and false claims.

With this consideration, breast reduction surgery is covered by insurance if this is reconstructive in nature, meaning, it is performed to treat the physical symptoms associated with large, heavy breasts and not just to aesthetically improve the body.

To qualify for insurance coverage, a patient should meet these following criteria:

• Experiencing physical symptoms such as poor body posture, discomfort along the bra strap, chronic pain in the back, neck and shoulder, skin irritation in the crease or breast fold, and difficulty to perform exercise.
• The estimated weight of tissue and fats to be removed from each breast should be 300 grams or more.
• Wearing a C cup bra or larger.
• A patient should be near her ideal body weight and/or body mass index (BMI).  Unfortunately, many women with enormously large breasts find it hard or even impossible to exercise because of their condition, consequently, it is important that a surgeon states this dilemma and mentions that breast reduction surgery can allow their patients to lead an active lifestyle.
• Suffering from a condition called macromastia in which the breasts become extremely large because of heightened sensitivity and/or high levels of female hormones in the bloodstream.  If each breast weighs 600 grams, this is already considered a case of macromastia.
• Have already tried other non-surgical treatments such as supportive bras, weight loss, and physical therapy which did not improve the symptoms related to large, heavy breasts.

Even if some patients meet the criteria for breast reduction coverage, there are cases in which insurance companies deny their claims because of policy exclusion or the lack of information.  For this reason, it is important to carefully read the policies before contacting the insurance agents.

In case the reason for denial is the lack of information, a patient and her plastic surgeon can make an appeal by providing more evidence such as photographs and supporting letters of other doctors and therapists.  And if the insurance providers cite policy exclusion as the cause of rejection, a patient can file an appeal to her state department since many states nowadays mandate breast reduction coverage for patients who fit the criteria.

But in case the non-surgical procedures did not solve the problem, plastic surgeons will most likely recommend gynecomastia surgery which involves incisions to remove the excess tissue and fats.  If needed, liposuction is also performed to further improve the breast’s contour by eliminating the extra fatty tissues.

But as an invasive procedure, male breast reduction surgery involves certain risks particularly for men who have health conditions that may predispose them to delayed healing, infection, bleeding, unnecessary scarring, and other complications.  For this reason, patients should meet these following requirements before they are considered as a good candidate for this surgery:

• They have realistic goals and expectations
• Well-rounded individuals
• Physically healthy with no serious illness
• Their breast development has stabilized
• They have passed their puberty stage (during this period, the hormonal imbalance may lead to overdeveloped breasts which will resolve on their own within several months)
• They are bothered by the appearance of their enlarged breasts

Because gynecomastia surgery often involves incisions, it is very important that the patients do not suffer from diabetes and other illnesses that inhibit the healing process and expose them to higher risk of infection and unnecessary scarring.

In most cases, the result of this cosmetic procedure can last a lifetime, although this may be affected or even completely reversed by a significant weight fluctuation.  With this consideration, plastic surgeons recommend their patients to maintain their normal weight through a healthy diet and regular exercise.

Also, doctors only perform this procedure on men who are within 25 to 30 percent of their recommended body weight.

Aside from being physically fit and having a normal body weight, it is also important that the patients are not smokers.  But in case that they are, they should quit the bad habit well in advance of the surgery and during their recovery to prevent the risk of skin necrosis (or death of skin tissue that may lead to unnecessary scarring).

According to a previous study, patients who are smoking are 1,500 times more likely to develop skin necrosis after a surgery compared to non-smokers because the nicotine affects the circulatory system and inhibits the oxygen from reaching the wound.

To guide you during your recovery after surgery, the California Surgical Institute has provided a list of answers to the most frequently asked questions about what you should do and expect during the healing time:

1.  Question:  Should I assign someone who will care for me during my recovery?

Answer:  Yes.  Assign a capable adult who will tend to your needs for at least three days following your surgery.  But in case that your procedure is an extensive one, it is best that you opt for an overnight stay at a hospital.

2.  Q:  How long is my recovery?

A:  The length of your recovery will largely depend on the treated area, extensiveness of the procedure, type of plastic surgery, and your body’s healing capability.

These are the most common cosmetic procedures and their estimated recovery time:

• breast augmentation – three to 12 months
• eyelid surgery – eight weeks to seven months
• tummy tuck – eight weeks to nine months
• traditional liposuction – eight weeks to 12 months
• facelift – eight weeks to 10 months

3.  Q:  When can I resume my work and normal activities?

A:  Most patients can return to normal activities (excluding strenuous exercises) and “quiet” work” 10 days after their surgery.  But to be on the safe side, you should always ask your doctors on when you can safely resume your daily life activities.

4.  Q:  Why is it dangerous to remain sedentary or bed-ridden for a long period of time after my surgery?

A:  If you remain in bed for a long period of time, you are at risk of developing blood clots in your legs and lungs and other serious complications.  Ideally, you should take a short, gentle walk as soon as you can in order to promote a good blood circulation.

5.  Q:  What are the most common postoperative symptoms should I expect?

A:  It is most likely that you will experience swelling, bruising, tenderness, soreness, pain and discomfort, temporary numbness in the treated area, and nausea as the anesthesia wears off.

But a week after your surgery, most of these symptoms will become less pronounced.

In case that there is no improvement within a week, you should immediately visit your plastic surgeon to determine if you are experiencing delayed healing and other complications.

6.  Q:  How can I minimize the swelling?

A:  Swelling is more common after a facelift, eyelid, rhinoplasty or nose surgery, otoplasty or ear tucking, neck lift, and tummy tuck.  To minimize this symptom, you should elevate your head and shoulder with pillows within seven to 10 days following your surgery.

Ice packs can also be helpful in minimizing the swelling and bruising.

7.  Q:  Why should I avoid aspirin and anti-inflammatory medications during my recovery?

A:  These drugs, which are sometimes called as blood-thinners, can increase bleeding during surgery and recovery and can also inhibit the body’s healing ability.  Herbal supplements and vitamins, particularly those containing green tea, vitamin E, ginseng, and ginkgo biloba have also been found to increase bleeding.

Just to be on the safe side, you should tell your surgeon all the current medications you are taking.

8.  Q:  Why is it important that I avoid smoking and second-hand smoke before my surgery and during the recovery period?

A:  The nicotine can inhibit normal blood circulation, thus significantly increasingly your risk of developing skin necrosis or death of skin tissue, a complication that often leads to delayed healing and unnecessary scarring.

9.  Q:  What is the most ideal diet during my recovery after plastic surgery?

A:  Because your body will need to repair itself after a surgical procedure, your diet should be high in protein.  However, you should watch your sodium intake since too much of this may aggravate swelling.

10.  Q:  Why is it important to wear compression garments particularly during the first few days of my surgery?

A: If you undergo breast augmentation, breast lift, breast reduction, liposuction, facelift, body lift, and tummy tuck, your doctor will require you to wear a compression garment for a certain period of time in order to prevent sagging, provide support to the new contour, and minimize swelling.

11.  Q:  What are the tell-tale signs of complications related with surgery?

A:  You should immediately seek medical attention if you experience any of the following: abnormal heart rate, swelling and bruising which do not subside after a week, delayed healing, and other conditions which are “out of ordinary.”

12.  Q:  How can I avoid or at least minimize the appearance of scars?

A:  Never expose the incision sites to direct sunlight for six to 12 months in order to avoid dark pigmentation.  You can also use petroleum jelly or special creams, ointments, and lotions especially those containing vitamin E and C, glycolic acid, onion extract, Retin-A, and emu oil.  However, you should only apply these creams after the surgical wound is completely closed (to be on the safe side, you should ask your doctor).

13.  Q:  Aside from using creams and lotions, what are the other ways to remove or minimize the appearance of scars?

A:  Scar revision procedures may include laser resurfacing, anti-inflammatory agents to flatten and/or soften the scar tissue, and medical tattooing to camouflage the dark pigments.

14.  Q:  Is the result of plastic surgery supposed to last a lifetime?

A:  It will depend on the type of procedure.  For example, the result of tummy tuck, body lift, breast reduction, and liposuction can last a lifetime as long as you will maintain a stable, normal weight and avoid future pregnancy.

Rhinonoplaty or nose-reshaping surgery is also supposed to last a lifetime unless you experience unexpected nasal growth.  For this reason, most doctors require their patients to be at least 15 years old to make sure that their nose is fully developed.

But if you will undergo a breast augmentation, expect that you will have a revision surgery at some point in your life since breast implants are not designed to last forever.

While this surgery can be performed at any age, most doctors recommend their patients to wait until they are at least 18 years old, a stage in which their breasts are fully developed.  Most experts also advise women to postpone breast reduction if they are considering having children in the future since their ability to breastfeed may be compromised.

Because breast reduction is relatively extensive, surgeons often perform this under general which can put a patient to sleep during the entire operation.  However, the surgery is typically conducted in an outpatient basis which means that a woman can return home on the same day of the procedure.

Nowadays, doctors use different incision patterns and techniques in order to achieve the most desired outcome.  But for women with excessively large breasts, the most ideal is the standard approach which involves an anchor-shaped incision—one around the perimeter of the areola, another cut that travels vertically from the nipple down to the breast crease, and a third one that horizontally covers the crease.

In some cases, the horizontal incision is removed particularly when only a small amount of tissue and skin is removed from the bust.

Once the incisions are made, the extra tissue, fats, and skin are excised in order to reduce the size of each breast.

In many cases, the nipple and areola remain to their original position.  However, doctors who are treating women with inordinately large, heavy breasts will have to remove and reattach this area to a higher position in order to achieve a more natural result.  And if needed, the sized of an enlarged areola is also reduced.

One major downside of detaching the areola and nipple from their original nerves and blood vessels may result to reduced or permanent loss of sensation.  In some cases, this procedure may also lead to a woman’s inability to breastfeed.

After a breast reduction surgery, the incisions are closed with tiny sutures and the chest is then covered with an elastic bandage or gauze dressing.

These are the types of plastic surgery performed to aesthetically improve the breasts:

• Breast lift

Due to pregnancy and natural effects of aging, the breasts may drop due to their own weight and gravity.  To treat this problem, plastic surgeons use breast lift which often involves an anchor-shaped incision—the first one is around the areola, the second travels downward from the areola to the breast fold, and the third covers the entire crease of the bust.

While the anchor lift is very effective in removing the excess skin and manipulating the underlying muscles, this approach is relatively extensive for women with small- to medium-sized breasts.  With this consideration, plastic surgery specialists have developed modified breast lift techniques which are less invasive than the traditional approach.

In some cases, breast lift is combined with breast implant surgery if a patient wants to have a more prominent cleavage.

• Breast augmentation

Traditionally, this plastic surgery procedure is performed using saline- or silicone-filled implants to increase the bust size and create a good cleavage by making the upper poles appear fuller and rounder.

But for patients who only want to slightly increase their breast size (or less than a cup), fat grafting is usually considered as a better option.  In this procedure, plastic surgeons collect fats from the abdomen (or any area where there is a significant amount of fatty deposits) and then transfer these to the bust.

• Breast reduction

For women with an extremely large bust, they can have breast reduction surgery which uses an anchor-shaped incision, allowing plastic surgeons to remove the extra skin and fats and manipulate the surrounding tissues.

In some cases, breast reduction is not only treated as a cosmetic procedure but also as a way to address the physical symptoms such as back problem, chronic pain in the shoulder and neck, skin irritation in the breast crease, and difficulty to engage in sports and other rigorous activities.

If breast reduction is used to treat the physical symptoms stated above, it is important to note that it may be covered by some insurance providers.

Meanwhile, this procedure may also involve areola reduction to make it appear more natural to the breasts.

To treat the problems associated with overly large bust size, plastic surgeons use reduction mammaplasty which can trim off the excess fats, skin, and tissue.  If necessary, this is performed in conjunction with liposuction to further reduce the breast size by eliminating the extra fatty tissues.

In cosmetic and reconstructive plastic surgery, the most common breast reduction techniques are the anchor incision and its modified versions, the lollipop and donut incisions which are ideal for women with smaller breasts and/or moderate ptosis (sagging).

Women with inordinately large breasts with severe ptosis will benefit more with the anchor-shaped incision which is the most invasive technique as it involves excising the extra skin and  and tissue around the areola, across the breast crease, and the vertical area between the nipple and the crease.

While this approach provides a dramatic outcome, this is too extensive for women with smaller breasts and those with minimal to moderate ptosis.  For these patients, plastic surgery specialists will most likely recommend a minimally invasive approach which also provides a great result minus the excessive scarring.

For women with large bust and moderate to minimal ptosis, and patients with medium-sized breasts and severe sagging, the lollipop incision is the best option.  This technique also uses the same incision sites found in the anchor method, minus the one across the breast crease which is the area that takes the longest time to heal.  For this reason, women can expect faster recovery and one less scar.

Another less invasive technique in breast reduction is the donut incision which is performed by excising the tissue around the areola.  Meanwhile, the scars are well-hidden along the edge of the skin and areola which makes this technique appealing to many patients.

But to fully enjoy the benefits of donut incision, many plastic surgeons believe that patients should have a smaller bust with minimal ptosis.  On the other hand, this approach is not enough to address larger breasts particularly with severe sagging.

Some doctors in plastic surgery complement the donut incision with breast implants in order to correct a more pronounced sagging.  But since the weight of these materials may further exacerbate the ongoing ptosis, they always place these under the chest muscles to make sure that a thicker wall of tissue and skin can provide a reliable support.

For example, otoplasty which is a plastic surgery used to pin back the ears can be performed on patients as young as five.  Ideally, this procedure is conducted on children and teenagers because their tissue is easier to work with compared to adults.  But still, some patients choose to have this procedure in later years.

In case the ears of a child are extremely deformed, his parents can decide on his behalf.  But in the situation of a mild aesthetic problem, most plastic surgeons believe that it is better for parents to wait for their kids to ask for any medical intervention since not all them are bothered with their appearance.

To know if a teenager is a good candidate for plastic surgery, doctors not just perform physical examination (to determine the health status) but also discussion to explain the benefit and limitations of a certain procedure.  It is important to note that a good candidate should have realistic goals and expectations which can determine if he will be satisfied with the result.

During the discussion, plastic surgeons will also examine if their teenage patients have enough maturity that will help them cope with the temporary discomfort and downtime after a surgical procedure.  In general, cosmetic surgery is not recommended for patients who have erratic behavior, extreme mood swings, mental illness, and clinical depression.

Aside from having a stable mental and emotional health, teenage patients should also reach a certain age before they can receive a procedure, especially if performed for aesthetic reasons such as breast augmentation and breast reduction; however, the latter is sometimes conducted on women younger than 18 who are experiencing limited physical activities and discomfort because of their large, heavy busts.

If this procedure is performed below the age limit, patients may need a revision rhinoplasty.  However, most plastic surgeons do not follow this age requirement if the surgery is going to be performed as a way to reconstruct the nose after an injury or treat breathing problems due to abnormal growth and birth defects.

It is important to note that real gynecomastia is primarily caused by the excess tissue rather than the fats alone.  For this reason, men with large breasts due to overweight or obesity will most likely be required to shed their extra weight before they even consider having plastic surgery.

In severe cases of gynecomastia, a patient not only has overdeveloped breasts but also enlarged areola which is the pigmented part of the skin.  Fortunately, this problem can also be addressed with plastic surgery through a particular excision technique.

Since gynecomastia surgery is an invasive procedure, most plastic surgeons perform this using general anesthesia or intravenous sedation (rather than local anesthesia) to provide comfort to their patients.

Once the numbing effect of the drug takes effect, most plastic surgeons will start the procedure by performing liposuction through the use of a suctioning probe attached to a vacuum pump.  This instrument, which is inserted to several small cuts, is designed to dislodge and remove the fatty deposits from the body.

In most cases, the liposuction incisions are placed near the armpits and along the crease of the breasts.

Because liposuction can only remove the excess fats, plastic surgery specialists also use excision techniques to remove the excess tissue and skin to further reduce the size of the male breasts.  Meanwhile, the length and placement of the incisions largely depend on the severity of the problem and the expectations of a patient.

One of the most common gynecomastia surgical techniques is the U-shaped incision in which doctors create a continuous cut starting from the breast crease to the top of the areola, curving downward from the middle.  Another incision is made around the areola to free it from the skin.

With this approach, the scar falls along the breast crease which makes it almost unnoticeable.

Another common excision technique uses a diamond-shaped incision which starts from the breast crease to the top of the areola, curving upward from the middle.  With this procedure, a horizontal scar will form across the areola, making it more visible.

For patients who need a slight correction, they can benefit from a smaller incision placed below the areola where doctors can reshape the tissue and remove any excess skin.