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Breast Reduction; Before or After Bariatric Surgery?

Posted on: September 25, 2013
By: DrDelgado

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.

Mommy Makeovee

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.

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