Neil J. Zemmel, MD, FACS
Megan J. Goff, PA-C
Rachel M. Duke, NP, CANS
Short Pump Office
11934 W Broad Street, Suite 200
Richmond, VA 23233

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Breast Reduction

Breast Reduction Overview

Breast reduction, also known as reduction mammaplasty, is the plastic surgical procedure that reduces the size of the breasts. The operation has a 50-year history and has undergone a number of evolutionary changes. Today, breast reduction is one of the most common procedures performed in the United States and is a large part of our practice.

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Candidates for Breast Reduction Surgery

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Women seek breast reduction surgery for a number of reasons. The most common reason is chronic neck, back, and shoulder pain. The pain has often been treated with pain medicines and physical therapy without relief. The larger size of the breast is refractory to diet and exercise. Many women seeking breast reduction are unable to purchase properly fitting bras, and this only exacerbates their symptoms. These women are also unable to find properly fitting clothing. Often many women complain of rashes beneath the breasts that are unresponsive to medical treatment. Surgery is their final and last option.

Many women seek breast reduction surgery for both medical and cosmetic reasons. Often these women have larger breasts but also desire the beneficial cosmetic effects of the surgery. This includes a smaller, lifted, higher, “perkier” breast. Conceptually the breast reduction and breast lift operations are very similar. The main difference is that in breast reduction breast tissue is removed, where in a straight breast lift breast tissue is repositioned, and none is removed.

Many women report immediate improvement in their chronic pain symptoms right after surgery. Despite recovering from the surgery itself, many women report immediate significant improvement in neck, back, and shoulder pain.

Many patients report to Dr. Zemmel that they can even breathe better after surgery. Our surgeon has many patients who have subsequently lost a significant amount of weight after the procedure. These women say that reducing the size of the breasts has unburdened their whole upper bodies and has allowed them to significantly increase their physical activity level. This side is one of the most important beneficial side effects of breast reduction surgery. Not only does it improve or cure upper body chronic pain, but improves the overall health of our patients.

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Your Consultation with Our Surgeon

Your consultation with Dr. Zemmel will last 30 to 45 minutes, and will consist of an interview and a full exam. Our surgeon will learn of your goals and desires regarding the surgery. They will review your medical history and make sure you are medically fit for surgery. You will tell your surgeon of all of the different ways having large breast is difficult for you. Please mention any neck pain, back pain, shoulder pain, rashes beneath the breasts, and grooving or cuts from bra straps. Also please mention any prior medicines used to treat the chronic pain and any physical therapy you may have received. Your surgeon will then perform a full breast exam and take a number of measurements:

  • Your initial cup size will be noted
  • The height and width of your breasts will be noted
  • The quality of the skin and presence of stretch marks will be noted
  • The diameter of the nipple/areola and position on the breast
  • Quality and distribution of breast tissue
  • Presence of any cysts, lumps, or masses
  • The width of your chest and rib change

Your surgeon will then estimate that total mass of breast tissue that will be removed from each breast. For insurance-based cases, Dr. Zemmel will submit a letter on your behalf to your insurance carrier for preauthorization. Once authorization has been obtained, your surgery will be scheduled. Women seeking a cosmetic breast reduction will be provided a full quote with a listing of all of the fees necessary for the procedure.


Chimere Hendrickson

November 20, 2013


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Preparing for Your Breast Reduction

After your surgery has been scheduled, you will return to the office to meet with your surgeon for a preoperative visit. During your second consultation, your surgeon will go over the entire procedure in detail once again. He will also perform another examination and go over what your expected outcome will be. The type of incision used, the final position of the areola, and your approximate final cup size will be discussed. Your surgeon will also discuss in detail the risks, benefits and alternatives to the procedure and your recovery period.

You will receive a packet containing your prescriptions, pre-operative instructions, and post-operative instructions. We advise you to fill the prescriptions before surgery. You will be given a list of medications, vitamins, and herbal supplements to avoid 2 weeks before surgery. Please review this list and follow all instructions in detail.

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Technical Aspects of Breast Reduction Surgery

Type of Breast Reductions

There are several techniques for breast reduction surgery, and in properly selected patients, they all can give excellent results. Our board-certified plastic surgeon tailors his approach to each patient and does not use a “one size fits all” approach.

All breast reduction techniques use a pattern of skin incisions to allow your surgeon access inside the breast. The second step is removal of breast tissue and skin. This reduces the size and gives overall new shape to the breast. This is followed by lifting of the nipple and areola and then closure of the incisions. The net effect is to produce a smaller, higher, “perkier” breast and to relieve the burden of large breasts on your upper body.

Vertical Breast Reduction

Women who have a moderate amount of excess breast tissue to be removed and a relatively small amount of excess skin and nipple ptosis (sagging) may be a candidate for this technique. This procedure requires an incision around the areola and a vertical incision down the center of the breast giving a lollipop scar pattern. The benefit of the technique is that does not require the horizontal incision underneath the breast, and therefore, recovery is slightly easier. The strength of the lift is not quite as powerful as a full reduction. In women with significant sagging of the breasts and a very low nipple/areola, a full reduction pattern (Wise pattern) may be necessary to optimize size and shape.

Wise Pattern Breast Reduction

For women who have a large amount of excess breast tissue and skin to be removed a full breast reduction incision pattern, or Wise incision pattern will be necessary. This procedure calls for an incision around the areola, a vertical incision, and a horizontal incision under the crease of the breast. This incision pattern is known as the “upside down T” or the anchor pattern. A full reduction pattern will allow your surgeon to remove a maximum amount of skin and breast tissue and give you the most power lift and reshaping possible.

Breast Reduction Using Liposuction

is the non-invasive surgical procedure where fatty tissue between the skin and muscle layers is removed through tiny incisions. This technique has been used to reduce the size of the breasts in both men and women. The goal of a liposuction breast reduction is to remove excess fatty and breast tissue and allow the skin to redrape over the remaining tissue. This will give a smaller breast with improved shape. This procedure is also especially useful in men with breast enlargement (gynecomastia) and is the preferred choice of our surgeon for the treatment of enlargement of the male breast.

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Recovery from your Breast Reduction

Dr. Zemmel admits many of his breast reduction patients overnight to the hospital for observation. This allows our doctors and nurses to closely monitor your initial recovery and progress. Your post-operative pain will be well controlled with intravenous medicines; you will receive medicine for nausea if necessary and be made as comfortable as possible.

Your surgeon will then see you the next morning to change your bandages and discharge you when ready. At home you will rest and relax and frequently move about. Expect to perform light activities of daily living 2 or 3 days after surgery. You may shower 2 days after surgery. Your breasts will be tight and swollen for approximately 1 week after surgery. Many women compare it to engorgement with milk during pregnancy and breast-feeding. Most women do very well and have very little difficulty during the first week. During the second week, you will begin to feel more normal as the postoperative soreness resolves. Most women take 10 to 14 days off from work to recover.

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Your Results

During the first couple of weeks, your breast will feel tight and swollen. This usually resolves rapidly after the first week. You will notice that your result will evolve over time. Your breast will initially be high and tight, and over a few weeks time, they will settle and become more rounded. You will notice your breasts taking on a more natural teardrop shape over time. Over the next several months your breast will continue to soften and you scar will lessen.


Chimere Hendrickson

November 20, 2013


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Complications of Breast Reduction Surgery

The risks of breast reduction surgery include, but are not limited to, bleeding, infection, damage to other tissue structures, tissue loss, thickened scars, nipple loss, loss of nipple sensation, and breast asymmetry. Although complications are very rare, they occasionally happen, and our surgeon and team take every precaution to reduce the risk of complications. If complications do occur, your surgeon will make every effort to correct the problem.

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Insurance Coverage for Breast Reduction Surgery

Most insurance plans will cover breast reduction if the patient meets the proper criteria for surgery.

It is necessary to demonstrate significant long-term physical symptoms including back, shoulder, and neck pain. Often patients have rashes beneath the breast, which are unresponsive to treatment with topical medications. Each of the major insurance carriers requires our surgeon to submit your height, weight, and an estimate of the amount of breast tissue removed. Pictures from below the neck level will also be submitted to show the degree of breast enlargement, bra strap grooving, and rash if present. It may take several weeks to obtain preauthorization from you insurance carrier. Once our office has obtained approval, then your surgery will be scheduled.

We accept payment for breast reductions from the following insurance carriers:

  • Anthem/Blue Cross Blue Shield
  • Aetna
  • Cigna
  • United Health Care
  • Medicare
  • Southern Health/Coventry
  • Virginia Health Network (VHN)
  • Optima Health

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Contact Richmond Aesthetic Surgery

If you would like more information on breast reduction procedures, or if you would like to schedule an in-person consultation, please contact Richmond Aesthetic Surgery today.
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