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Dr. Megan Dreveskracht
Nov 4, 2021
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BREAST REDUCTION
SEATTLE
Maybe it's the ache in your neck and shoulders by the end of every day, the grooves your bra straps leave behind, or clothes that were never really cut for a chest your size. If the size of your breasts has been running your life instead of the other way around, wanting that to change isn't vanity — it's reasonable. As a female plastic surgeon, this is one of the most rewarding procedures I offer in my practice.
WHAT IS A BREAST REDUCTION?
Women with large, heavy breasts often deal with real physical consequences — chronic neck and back pain, rashes or irritation underneath the breast, difficulty exercising, and self-esteem struggles tied to their chest. If that's been your experience, a Breast Reduction — the medical term is reduction mammaplasty — is a surgical procedure designed to reduce the size and weight of your breasts while keeping their natural shape and proportion. In some cases, with well-documented symptoms, this procedure may even be covered by insurance.
A CLOSER LOOK
A Breast Reduction isn't only about taking tissue away — it's also, by definition, a Breast Lift: the areola is reduced, the nipple and areola are elevated, and the breast itself is reshaped, not just made smaller. During your consultation, a lot of what I'm evaluating is where your fullness actually sits, since breasts that have gotten larger and heavier tend to widen laterally, toward the side of the chest, more than they gain centrally. My approach is usually to debulk that lateral fullness while preserving fullness on the medial, or inner, side of the breast, since that combination tends to read as more youthful and proportionate once you've healed.
THE PROCEDURE
A Breast Reduction can safely be done as an outpatient procedure in my AAAASF-accredited Ambulatory Surgery Center at the Nordstrom Medical Tower in downtown Seattle, under general anesthesia with our anesthesia team, and takes about 2 to 3 hours depending on complexity.
Before surgery, I mark the areas of skin and tissue to be removed while you're standing. Once we begin, I make incisions around the areola, down the breast, and — if your anatomy needs it — along the base of the breast. I remove the excess tissue and skin, reduce the areola to a proportionate size, and elevate the nipple and areola into their new position while keeping them attached to their original blood supply. The remaining breast tissue is then reshaped — generally debulking fullness from the outer, lateral side of the breast while preserving fullness toward the center, since that combination tends to look more natural once you've healed.
Once the shape is set, I sit you up to check your symmetry before closing the incisions. All of your stitches are placed beneath the skin and dissolve on their own — I don't use drains for a Breast Reduction. Your incisions are covered with tape, which stays on until your first post-operative visit, and you're placed in a soft, non-underwire bra before going home the same day. We'll ask you to hold off on showering until that first visit.
WILL MY INSURANCE COVER IT?
In some cases, yes. Insurance coverage generally requires well-documented symptoms, and many insurers also want to see that you've already tried conservative treatments — things like physical therapy or massage therapy — before approving surgery. Exactly how much and how long varies by insurance company, so it's worth calling yours directly to ask about their specific requirements before your consultation.
If your insurance does cover the procedure, they'll use a Body Surface Area calculation to determine the minimum weight of breast tissue that must be removed for coverage to apply. In some cases, that required amount leaves patients smaller than what they'd actually chosen for themselves, or smaller than what's proportionate to their frame — which is part of why some patients ultimately opt out of using their insurance altogether. If you do go the insurance route, I'm required to remove the amount of tissue your insurer dictates, and size can't be guaranteed either way.
It's worth saying plainly: if insurance denies your procedure, that doesn't mean you're not a good candidate. Living with breasts that are too large for your frame affects nearly every part of daily life, often in ways patients don't fully register until they're on the other side of their own Breast Reduction.
WHAT WILL MY INCISIONS LOOK LIKE?
Reducing your breast size, reshaping the breast, resizing the areola, and elevating the nipple all require incisions — there's no way around some scarring with this procedure. There are two incision patterns I use, depending on your anatomy and how much correction is needed. An "Anchor," or inverted-T, incision goes around the areola, down the lower breast, and along the breast crease, forming the shape it's named for. A "Lollipop," or vertical, incision goes around the areola and straight down the lower breast, without the horizontal component. Which pattern is right for you comes down to the size and shape of your breasts, and I'll tell you directly which one your anatomy calls for.
INCISIONS WITH A BREAST REDUCTION
VERTICAL BREAST REDUCTION
ANCHOR BREAST REDUCTION
AM I A GOOD CANDIDATE?
The ideal candidate for a Breast Reduction is in good overall health, at a relatively stable weight, and dealing with real physical and emotional symptoms tied to the size of their breasts — not just a cosmetic preference.
Beyond the basics, your candidacy comes down to a few specifics I evaluate in person during your consultation:
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Your age and cancer-screening history — patients over 40, or with a strong family history of breast cancer, will need cancer screening before we schedule surgery
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Whether you may want to breastfeed in the future — a Breast Reduction can alter your ability to breastfeed, and that's something we discuss in detail before deciding on timing
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Where your fullness sits and how your tissue is distributed, which helps determine whether you need a shorter Lollipop incision or the more extensive Anchor pattern
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Whether you're planning to pursue insurance coverage, since that route means accepting whatever minimum tissue-removal amount your insurer requires, which affects how much control you have over your final size
I'll also be honest about risk: the most common complication I see with a Breast Reduction is minor breakdown at the incision where the vertical and horizontal lines meet, called the T-junction. When it happens, it typically just needs some local wound care, and most patients heal normally from there.
BREAST REDUCTION RECOVERY
You'll go home the same day as your surgery, and we'll ask you to hold off on showering until your first post-operative visit, when your tape is changed. You'll wear a soft, non-underwire bra for a minimum of four weeks — underwire causes friction directly over your incisions in that window, and it's uncomfortable besides. I'd skip the compression bra, too; in my opinion it isn't necessary. A light, non-underwire sports bra that zips or clasps in front — so it's easy to get on and off — and extends low enough on your rib cage to sit below your incision line works better than anything more structured.
Recovery, week by week:
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Day of surgery: Discharged home the same day in a soft, non-underwire bra. No showering until your first post-op visit.
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Week 1: "T-Rex arms" — no heavy lifting, no reaching overhead, and nothing that significantly raises your heart rate or blood pressure. You can still bend your arms to about 90 degrees, so everyday tasks like washing your hair are fine.
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Weeks 1–2: Most patients take about one week off from work.
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Weeks 1–4: Restrictions continue — no lifting over 10 pounds, no reaching overhead.
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Week 4: All restrictions are lifted. As you return to exercise, focus on support — your breasts are smaller, but they still need real support — and on keeping incisions clean, since sweat collects under a sports bra. Shower right after you work out.
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Month 3: Swelling has settled enough to establish your baseline size, shape, and feel — this is when I'd wait to invest in any expensive fitted bras.
01
What Size Will I Be After My Surgery?
Unfortunately, it is difficult to predict size after a breast reduction. Providing photos & communicating effectively with your Plastic Surgeon is the best way to ensure that your vision and your surgeon's plan align.
02
Will I Be Able To Breastfeed After?
Breastfeeding can be affected after a breast reduction procedure. On average, about 60% of patients can successfully breastfeed following a breast reduction.
03
When Will I See Final Results?
Typically, the breasts need approximately 3-6 months before all the swelling has resided, which can all affect size, shape and feel of the breasts.
04
Will I Lose Sensation In My Nipples?
Loss of sensation of the nipples is a known complication of a breast reduction, albeit low risk. That risk increases, however, as the amount tissue removed from the breast increases.
BREAST REDUCTION
FAQ
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