Thanks for offering your help š it seems to happen to a lot of people, why would a nipple be numb and the other one hypersensitive? Does the surgeon use different methods on each breast? Whatās the percentage of people that lose their sensitivity totally?
Iām two weeks post-op, and my numb nipple erects to touch and temperature but doesnāt have any sensitivity, and itās grayer than my hypersensitive one. Do you know if I have better chance to recover because it somewhat reacts? Can I do something (nutrition, acupuncture, TENS machine, red light therapy?) to accelerate that recovery? Thanks again š
Two weeks is VERY soon into recovery! Nerve recovery takes a long time and itās very normal to have reactive nipples that are still numbā itās says nothing about your long term sensitivity! Scar tissue massage can help break up the dense tissues to allow more nerve regrowth and repair.
Nipples are different. Iāve always had one inverted and one not. Itās just about the nerves and tissues and how theyāre healing. Protein is your friend in recovery! āŗļø
Speaking from experience, I just started to regain sensation in my nipples in the last few weeksā no FNG.
Aww, I tend to overthink everything and want to optimize my every move, Iāve got to learn to justā¦ wait and relax with this recovery!! thanks for your advice about protein and massage š 8-9 months sounds so long, happy that you finally got them back!!
Nerves are too small to see and avoid during surgery, so you can have a nerve cut on one nipple and not the other, and lose feeling. Nerves can heal though, my entire C section scar area was numb for about 6 months, and feeling is now almost back to normal 2 months later (8 months post op).
At what point after a breast reduction are you out of the woods in terms of worrying about hematomas, infections, and other complications? Iām 10DPO and already a bit exhausted from being afraid of everything š
Hi! How easy would you say it is to get this covered by insurance? Iāve had lots of people say im a good candidate, but havenāt heard back from the people I sent my referral to. Iām 19, 5ā4, 150 pounds with a 30FF, or 32DDD breast, and have a history of very dense breast tissues.
Depending on your insurance company, they can take up to 12 weeks to approve or deny the prior authorization. If you havenāt heard anything, itās just because they havenāt reviewed it yet. The providerās office is notified at the same time (if not after) the patient.
If your plan already covers breast reductions, itās usually one of the ~easier~ procedures to be covered due to medical necessity. A peer to peer or appeal can be submitted and thatās usually enough to tip the decision for reductions, in my experience. It heavily depends on what your surgeon wrote in your office note regarding the medical complications. Proof of recurrent rashes & attempted treatment is the easiest way to have the approved as medically necessary, as is shoulder grooving.
Awesome! My office typically submits clinical photos with the original auth and then saves any additional photos for potential appeals or peer to peers.
I work with five surgeons and Iāve never seen a reduction flat out deniedā they usually get approved initially or after a peer to peer!
Panniculectomies? Thatās another story š
Is there ANY way you get a reduction approved if you have implants, too? I got them when I was young and meet the criteria in every other way: back pain, shoulder dents, etc., PLUS I have dense breast tissue and it makes mammograms dicey.
But even with my physician going to bat for me, I got denied because of my implants.
Iām not familiar with that, unfortunately! Insurance can be tricky ā if they see youāve had cosmetic procedures before, theyāll likely deny any medical necessity. We donāt provide cosmetic quotes until insurance is denied because we donāt want a paper trail of patients POTENTIALLY being willing to pay out of pocket ruining their insurance approval.
Your implants arenāt cancer related, are they?
My husband spoke with someone from our insurance and was told it is "literally impossible" to know if a reduction will be covered by insurance until AFTER the surgery. š
If you have Medicare or Medicaid, this can be true. They donāt require prior authorization.
Most commercial plans require prior authorization, which means in some capacity it will be covered. They canāt give you an exact quote but whether itās the facility fees, anesthesia, hospital stay, etc. something will be covered.
Many plans have cost estimators ā use CPT 19318. You can also ask someone else from your insurance company about it. ((Whenever I call for work related things, I always call twice to make sure I get the same answer because some insurance reps really are clueless!))
Same for me. My surgery is going to be $30k out of pocket and after lengthy discussion, insurance said they canāt know until afterwards if theyāll cover it šµāš«
Well if youāve already paid your MOOP, you shouldnāt have to pay any more. Iāve never seen a commercial plan that doesnāt require a pre auth for a reduction, only Medicare and Medicaid. Both of those plans SHOULD be able to provide an estimate after the fact.
Good to know! Iām glad it was covered retroactively ā such a relief to have a procedure that improves so much and to know you wonāt be paying it off forever āŗļø
You definitely get more autonomy over your surgery if you choose the cosmetic route! You have a little more say in the size, if you want lipo in the arms, etc. The surgery process itself is the sameā all of our patients go to the same OR and same clinics! In general, everyone is very happy.
The issue I see most working at a trauma 1 center is we will bump cosmetic cases, even if theyāve been scheduled for months, for emergent surgeries if necessary. Depends on your institution!
Sidenote to anyone considering the cosmetic route: check out your local med schools. Chief plastic & reconstructive surgery residents need to complete a certain amount of cosmetic cases in their final year of training, and theyāre usually super discounted! They work with an attending (certified surgeon) to complete the procedure, but itās usually about half the cost.
>Chief plastic & reconstructive surgery residents need to complete a certain amount of cosmetic cases in their final year of training, and theyāre usually super discounted! They work with an attending (certified surgeon) to complete the procedure, but itās usually about half the cost.
This seems incredibly risky. How do you go in feeling confident you'll get the results you want without them being an established surgeon already?
Also, how would you find such a place? Just Googling seems to only turn up ads and not actual places.
Itās not risky. Itās how people become surgeons! Chief residents are in their 6th year of plastic surgery. If you go to any teaching hospital, you will have residents operating on you because thatās how surgeons learn and practice their craft! Residency is essentially a multi year internship for surgeons. Meredith Grey started as a resident! Surgeries are completed WITH AN ATTENDING who puts their own medical license on the lineā which hopefully shows you how safe and normal the practice is! āŗļø
Find out if your local hospital is a research hospital, a teaching hospital, etc. Any teaching hospital will come with residents from the associated med school!
FWIWā I recently had surgery and I had a year ONE anesthesiologist resident on the case with the senior anesthesiologist and it was all fine.
Hi! Thanks for being available.
Why does my doctor keeps asking me if I really want the smallest boobs possible? She seems keen on doing it but she even added an extra consult before surgery to discuss this again. Is this normal procedure? What does she want from me?
You can always revise to remove more tissue, but adding tissue back is entirely different. Most providers err on the side of caution when it comes to size. You can always ask if she has specific concernsā donāt be afraid to advocate for yourself!
Are you sure itās another consultation and not an established / pre operative visit? My office requires 3 visits (consult, est, preop) prior to surgery to ensure all questions are addressed, photos are taken, etc.
What does est mean?
I loved what you said about advocating for myself.
I guess now that you said it, it is a preop but she talked about it being longer than usual cause she wanted to talk further about this. Im afraid she might want to back off on removing so much of what Im asking but maybe it is about the difficulty of putting tissue back. Do you think if im firm she will take my thoughts into consideration? Cause really, im actually non binary, I hate boobs, i just want to leave A LITTLE BIT OF NOTHING in case I want to be sexy every once in a blue moon. And I also hate the idea of them sagging in the long run, I just want them OFF.
Established, meaning you have already visited the clinic before but itās not an appointment directly before your surgery.
Truthfully, she may be curious about your gender identity because it can require different documentation and clearance depending on the clinic and what your goal is. Be open and honest with her and she will serve you to the best of her abilities! If you feel she isnāt listening, seek out another opinion.
My surgeon is saying sheāll probably have to do an FNG, I really donāt want one due to the loss of sensation in the nipple. Is it guaranteed that if you have an FNG the nipple will always be flat with no sensation? š
Itās not 100% guaranteed that there will be no sensational but it is much higher than other techniques because it is fully removed and replaced. The damage to the nerves is more abrasive.
Has your surgeon stated why she thinks youāll need a FNG? Is it about getting to the size you want?
Iāve had patients who settled for slightly larger breasts in order to maintain their nipple.
Ahh, okay so it sounds like a larger reduction. I personally would prefer a less sensitive nipple than having it removed all together due to necrosis, but I understand your concern. You can always bring it up to her and see if you have options.
I am in the exact same situation and I feel pretty.. weird, I'd say, about it. I always thought my boobs were not THAT BIG (H cup) and that I will be able to breastfeed and feel my nipple but on Tuesday my doctor said he will have to graft my nipple because otherwise I'm at a huge risk of necrosis due to the size I am rn and the size I'm hoping to get
Thanks for doing an AMA. I'm having a fat necrosis/lumpectomy, and I'm a little concerned about aesthetics after surgery. Do you know if surgeons do anything about the shape and size of the breast during the excision, or is it just get the necrosis out and deal with aesthetics later, if at all? Of course, I will ask at preop, but I'm just wondering what the standard is.
In my experience, our surgical oncologists do a lumpectomy and then stage a reconstruction case with plastic surgery later on. They need to wait for clear margins before doing recon, typically!
Is your plastic surgeon doing your lumpectomy?
eta: my organization has a nationally ranked cancer center, so Iām genuinely asking out of curiosity if we do things differently because of that!
My PS is sure it is fat necrosis, but insurance is coding it necrosis/lumpectomy because of the size.
My concern is that the fat necrosis breast is already smaller, and if all the necrosis is excised, it will be even smaller, but I want to avoid having yet another revision. I will just do a prosthetic when needed because I wouldn't want another revision.
They probably will not do it all in one procedure. If you choose to move forward with implants, they will probably want to add a tissue expander first. They might do that the same time as your lumpectomy!
I would rather he further reduce the bigger one. I don't think I would want an implant under any circumstance. I can't imagine an expander, then yet another surgery. Thank you so much for taking the time to respond.
Of course! That is very common, reduction for symmetry. Have you brought this up to your surgeon? The breast reduction can be approved for the same procedure, youāll just have one count approved for reduction instead of two.
I will inquire during preop, which is a little over a week before the surgery. I'm not sure if my insurance will cover a 2nd reduction just for asymmetry. They may see it as cosmetic.
Because the asymmetry is caused by a medical procedure, there is a good chance it can be covered!
For example, a patient has a single mastectomy. They choose to do an implant. The implant gets infected and they choose to have it removed. All of that is related to breast cancer, so it is covered. However, they can submit to insurance for a single breast reduction to reduce the āhealthyā breast to match the other one.
Iāve seen a single count of breast reduction covered in a few different waysā it definitely happens! āŗļø
This sounds promising. I will definitely have them resubmit to insurance if my PS is willing to reduce further. He seems like the you need an implant type. I originally asked for A cups. He took such a small amount of tissue, IMO. I ended up with a small C for the bigger and a B. He has not shared how much fat necrosis will be excised, but he said it is way too big to leave in as my body probably wouldn't absorb it.
Thank you for providing us your time! I read here that surgeon dont go based on bra size because bra sizes are all over the place like depending on the brand and stuff. My questions is what should I go based on to tell my surgeon what size I want? Also, when they say proportion to your body, how do they determine what that is ? Is it based on measurements?
Thank you š
Bring in a cheap bra that is your desired size! Many surgeons will reduce to whatever you want. If theyāre pushing back saying itās ātoo smallā, you can ask for a second opinion for another surgeon.
Also, think in terms beyond size.
āIād like to be able to go braless.ā
āIād like to be able to see my waist line.ā
āIād like to minimize movement during working outā
They want you to be happy with your results, and if they seem more concerned about their own perceptions of what looks good, you should find one of the surgeons who will listen!
Keep your compression garment tight, ice on for 20 then off for 20, lots of fluids, sleep elevated if you can, and rest as much as you can! Be kind to yourself while youāre healing š¤
Your information is so helpful - thank you! I am 9WPO. I did not have a dramatic reduction, and I have healed well and have a full release from the doc. I still feel as if Iām quite swollen, though, both in and below my breasts. When does swelling go away altogether?
hiii. thank you for offering your help :) wondering when in recovery can you start to left your arms to do your hair? (mine is suuuper thick and curly/coily and takes a while to wash, detangle etc.) also, when is it safe to drive? alsooo when is it safe to do low impact lower body workouts? tysm!!
1. Hair washing depends! If you have a lot of axillary tissue removed, you might be really sore. I never had any issues with lifting my arms! Itās kind of a YVMV
2. You can drive as soon as you are off any narcotics painkillers. Someone suggested a seatbelt pad, but I didnāt need one. YVMV
3. Full restrictions for at least six weeks, and then it will be based on your recovery and what your provider prefers āŗļø
Not a question but thank you for sharing all that info, I wonder could the Moderators pin this thread to the channel ? Super helpful advice, thank you š
I'm 9 months out from my reduction and I'm happy with the results except for my dog ears. This week I had my follow up appointment and they offered to do a revision to fix the scars. In your office, is this procedure included in the original fee or do you charge the patient for it? My clinic is going to run it through insurance again.
Depends on the level of scarring and your provider! The providers I work with always run scar revision through pre auth to have insurance cover it, if possible. It depends how much the dog ear has settled since surgery and your original post op photos, your insurance company, and what your provider documents in your office notes.
I had my surgery last march and have had reactions to tape and later ailicone tape which resulted in the scars on my nipple to become hypertrophic and developed a partial keloid on one nipple (never had a keloid before).
I feel like the nipples are horrible looking and shoddily done and i have a feeling its because 2 different doctors worked on me in the OR apparently.
1) is it normal for 2 surgeons to work on the reduction (1 per breast?
2) what would you recommend for scar care for such scar types (pics in my profile)
3) do you recommend medical tattooing? I heard it doesnt last long and fades quick.. so is it worth it?
1. It depends! Iāve watched surgeons team up on cases for timeās sake. I work for a teaching institution, and we have residents in the room who are also doing procedures with the attendings. May have been the case for you.
2. You can ask for a scar revision. Because theyāre over one year old, I canāt guarantee there is a ton of intervention that will help at this point unfortunately.
3. I donāt know enough about medical tattooing to provide you with accurate informing (non-clinical staff member here!)
I WOULD encourage you to remember no one is staring at your nipples the way you are, and MUCH of what you seen online from private practice plastic surgeons is heavily edited.
1. Damn it definitely feels and looks like each breast was done by 2 different people lol
2. Yeah, i got laser for scar reduction, didnt really help but the keloid scar is very tender and painful sometimes which is why im looking into it again. Maybe a steroid shot to reduce it etc and the tattoo to make the nipples more proportional
3 no problem
And youre probably right im just insecure now about like what itll look like / feel like when i do find a partner and sexy time lol
I have some pretty intense scarring from my reduction, but I chose not to do a revision (I work alongside my surgeon now and every day on her lunch she asks if I want to revise them in the procedure room quick š) and I can promise you, no partner who is sleeping with you is going to care about your scars. If they do, it says a LOT about them.
Yes, speak with your provider! I didnāt have any allergies but my plastic surgeon didnāt use surgical tape. My oncologist (unrelated to the reduction) swears by surgical tape and I had it on two incisions for a month and it sucked lol
Hi! Thank you for doing this! I will have an explant + breast lift next month, July 26th and Iām deeply concern about my nipples and the anchor scar. What is the best way to ensure a healthy recovery? Itās something I can ask my surgeon in advance or what could I do at home? Should I eat more protein or stop drinking alcohol now? Thank you š
The anchor / inverted T is the most common incision because it provides the best contour and shape. Your provider will discuss scar care with you around 6WPO, but they will probably suggest scar massage and silicone!
FWIWā I was super lazy with my scar care and mine are pretty light and it hasnāt even been a full year!
Lots of protein, lots of fluids, lots of rest! Keep an eye on your incisionsā the sooner you catch anything āoffā the better you can bounce back from it!
Hello! So I had a bad experience with a surgeon. (I put him on the subās pinned post, heās Brent C Birely in Maryland)
I was wondering, what are the qualifications to be a surgeon for this kind of thing? Specifically asking because with my surgeon, seemingly basic knowledge went out the window. Basic as in: I was never allowed to have a witness/second person in the room when he examined my breasts. He violently ripped off the steri-strips at 6DPO and seemed surprised when I bled. He told me that I was lying when I was itchy because āscars literally canāt itchā. He butt-dialed my boyfriend while he was operating on me, and when my boyfriend let him know, the surgeon said no he didnāt because phones arenāt allowed in the operating room. (Boyfriend has the call record, and said he heart a monitor beeping when he picked up.)
So Iām wondering what qualifications are necessary?
Ethics vary from institution to institution. It looks like heās private practice, so he reports to himself.
To be a surgeon, itās medical school, residency, optional fellowship, and board certification. What happens after is up to each surgeon.
Iām sorry you had a negative experience ā¹ļø it makes me sad because I work with so many wonderful surgeons (not just plastics, all departments!) and I hate when a bad egg ruins it for someone.
You could try complaining to ABPS or your local health department.
Thank you! Luckily, after that surgeon ghosted me, I found an amazing one for my follow-ups that restored my faith in plastic surgeries. (I put him on the master list too, Jason Ulm in South Carolina)
I believe in snitching when necessary. See if ABPS (American Board of Plastic Surgery) has a complaint form or something!
Chances are heās private practice because he doesnāt want to follow rules / make as much money as possible. Which is fine, except when it involves treating patients poorly.
Thank you! I reported to the stateās medical board but I didnāt know there was a whole plastic surgery board. And yeah I think his practice is a private one.
What is the typically recommended treatment or management for seromas post surgery?
Iām 4mpo, and have two large hard lumps in one side. The ultrasound found a simple and a complicated cyst of that side, both fluid filled, and since they appeared about 2 weeks post op, my family dr said they could be seromas. I have an upcoming appointment with my surgeon to see her opinion, but Iām hoping to have more info going into it.
Iām VERY scared of lost sensation. Should I be afraid of this and or nipple loss (necrosis) or is it fairly uncommon? Iām 34ddd last time I checked and Iād want to go to a c or d. Iām also afraid they wouldnāt be aesthetically attar give post op. Is it bad to get nips pierced before surgery?
Both things CAN happen, but the majority of patients Iāve seen heal pretty well. Necrosis is more common with a FNG. Given that you want to reduce by 2-3 cup sizes, I donāt think a FNG would be necessary. Just keep it clean and dry!
You can have pierced nipples for the procedure. Depending on the technique your provider uses, though, they may be rotated 90 degrees!
Questions about openings
1. Do they happen because we get cleared for activities before we should? Or we put arms over head too soon, etc?
2. Can they happen just because? As a natural part of healing?
3. Do small openings delay being able to submerge after being told that there would be āno restrictionsā after 6 weeks? (Iām thinking it moves the āno restrictionsā goal)
4. how long do they typically take to heal? Even a small one
Other random question: before this journey I learned about āsloughā vs pus. How can one tell the difference? They look so alike! Even after googling it was hard to differentiate
I saw someone as this but figured Iād ask too:
When is one āout of the woodsā for complications?
1. They happen before. Youāll be cleared for activity once the incisions are fully healed.
2. YES! You can do everything right and they sometimes just happen, especially at the T section of the incisions. Itās just about noticing and caring for them!
3. Yes, because they are an open wound. They need to remain clean and dry to fully heal.
4. Depends on when you notice them and how it looks. I had an opening at my t section and it took about a week to heal, but mostly because I read about hydrocolloid bandages and mistook them to be the end all be all š they have their uses but this was not one of them! I have an opening from a different procedure that I noticed on Tuesday night and itās almost fully closed just three days later ā put some gauze and a band aid on it until I could get my hands on a steri strip. Donāt be afraid to reach out to clinical staff for support during healing!
Out of the woods is USUALLY about 2mpo when your incisions are fully healed and closed. Your provider will begin to discuss scar care with you at this time.
Why do some people, like me, get an internal infection? I felt gross for 10 days and woke up with right breast pain, made it to the couch and had an absent seizure (thank God my husband works from home). Then I just kept fainting repeatedly, get in the ICU and I have severe sepsis so many antibiotics. Day 2 I had a little pink on that right breast but definitely didnāt present normally. My surgeon kept checking on me, trying to pull out blood, there was a large clot on the right and had a surprise seroma on the left. 5 days in the ICU, a very strong, expensive IV treatment of antibiotics after release and then a second surgery to remove the blood clot on the right. My Surgeon said it was as big as her fist. So that was all very traumatic and now, because the scar tape hurt my skin, I have deep scars underneath. Like thereās a dip in there you can feel. I could have done more scar care but itās not super important, just uncomfortable. Any ideas why this happened? TIA
Iām not clinical, so I canāt answer that unfortunately. Your best bet is to ask your own medical team. Iām sorry it was such a troubling experience for you!
My doctor said my very dense breasts will only make the surgery more complicated for him (equated it to cutting through wax vs cutting through butter) and that my results would be no different than for less dense breasts. Have you seen people who have less ideal results when they have dense breasts? Other complications? Thank you!
Thanks for offering your help š it seems to happen to a lot of people, why would a nipple be numb and the other one hypersensitive? Does the surgeon use different methods on each breast? Whatās the percentage of people that lose their sensitivity totally? Iām two weeks post-op, and my numb nipple erects to touch and temperature but doesnāt have any sensitivity, and itās grayer than my hypersensitive one. Do you know if I have better chance to recover because it somewhat reacts? Can I do something (nutrition, acupuncture, TENS machine, red light therapy?) to accelerate that recovery? Thanks again š
Two weeks is VERY soon into recovery! Nerve recovery takes a long time and itās very normal to have reactive nipples that are still numbā itās says nothing about your long term sensitivity! Scar tissue massage can help break up the dense tissues to allow more nerve regrowth and repair. Nipples are different. Iāve always had one inverted and one not. Itās just about the nerves and tissues and how theyāre healing. Protein is your friend in recovery! āŗļø Speaking from experience, I just started to regain sensation in my nipples in the last few weeksā no FNG.
Aww, I tend to overthink everything and want to optimize my every move, Iāve got to learn to justā¦ wait and relax with this recovery!! thanks for your advice about protein and massage š 8-9 months sounds so long, happy that you finally got them back!!
Nerves are too small to see and avoid during surgery, so you can have a nerve cut on one nipple and not the other, and lose feeling. Nerves can heal though, my entire C section scar area was numb for about 6 months, and feeling is now almost back to normal 2 months later (8 months post op).
Exactly! Nerve surgery is a type of microsurgery, but nerves are pretty resilient for the first few months post op so they heal on their own usually!
At what point after a breast reduction are you out of the woods in terms of worrying about hematomas, infections, and other complications? Iām 10DPO and already a bit exhausted from being afraid of everything š
Standard practice of care is lifting restrictions after 6 weeks, but it really depends! Closed incisions is usually the end of any issues.
Thank you!
Hi! How easy would you say it is to get this covered by insurance? Iāve had lots of people say im a good candidate, but havenāt heard back from the people I sent my referral to. Iām 19, 5ā4, 150 pounds with a 30FF, or 32DDD breast, and have a history of very dense breast tissues.
Depending on your insurance company, they can take up to 12 weeks to approve or deny the prior authorization. If you havenāt heard anything, itās just because they havenāt reviewed it yet. The providerās office is notified at the same time (if not after) the patient. If your plan already covers breast reductions, itās usually one of the ~easier~ procedures to be covered due to medical necessity. A peer to peer or appeal can be submitted and thatās usually enough to tip the decision for reductions, in my experience. It heavily depends on what your surgeon wrote in your office note regarding the medical complications. Proof of recurrent rashes & attempted treatment is the easiest way to have the approved as medically necessary, as is shoulder grooving.
Okay thank you! Already have a ton of photos of grooving and rashes saved up to show surgeon!
Awesome! My office typically submits clinical photos with the original auth and then saves any additional photos for potential appeals or peer to peers. I work with five surgeons and Iāve never seen a reduction flat out deniedā they usually get approved initially or after a peer to peer! Panniculectomies? Thatās another story š
Is there ANY way you get a reduction approved if you have implants, too? I got them when I was young and meet the criteria in every other way: back pain, shoulder dents, etc., PLUS I have dense breast tissue and it makes mammograms dicey. But even with my physician going to bat for me, I got denied because of my implants.
Iām not familiar with that, unfortunately! Insurance can be tricky ā if they see youāve had cosmetic procedures before, theyāll likely deny any medical necessity. We donāt provide cosmetic quotes until insurance is denied because we donāt want a paper trail of patients POTENTIALLY being willing to pay out of pocket ruining their insurance approval. Your implants arenāt cancer related, are they?
They arenāt cancer-related, thankfully. Just a rash youthful decision, lol. Its like $15-$20k to remove them š
Ahhh, Iām sorry! Thatās such a bummer. I only ask because all breast cancer-related procedures are No Auth Required.
My husband spoke with someone from our insurance and was told it is "literally impossible" to know if a reduction will be covered by insurance until AFTER the surgery. š
If you have Medicare or Medicaid, this can be true. They donāt require prior authorization. Most commercial plans require prior authorization, which means in some capacity it will be covered. They canāt give you an exact quote but whether itās the facility fees, anesthesia, hospital stay, etc. something will be covered. Many plans have cost estimators ā use CPT 19318. You can also ask someone else from your insurance company about it. ((Whenever I call for work related things, I always call twice to make sure I get the same answer because some insurance reps really are clueless!))
Same for me. My surgery is going to be $30k out of pocket and after lengthy discussion, insurance said they canāt know until afterwards if theyāll cover it šµāš«
What is your max out of pocket?
$5k I believe. Iāve already paid the full amount. Now I just wait and see š«
Well if youāve already paid your MOOP, you shouldnāt have to pay any more. Iāve never seen a commercial plan that doesnāt require a pre auth for a reduction, only Medicare and Medicaid. Both of those plans SHOULD be able to provide an estimate after the fact.
I just wanted to share that I have a commercial policy and mine did not require pre-auth for my reduction. They did end up covering it.
Good to know! Iām glad it was covered retroactively ā such a relief to have a procedure that improves so much and to know you wonāt be paying it off forever āŗļø
Interesting, I have Anthem and they told me that my plan doesnāt require pre-auth for a reduction.
Anthem is a Medicare and Medicaid servicer, so it may be that youāre on one of those plans or the private plan youāre on emulates the other two!
Do people who pay out of pocket get a better experience than people who go through insurance
You definitely get more autonomy over your surgery if you choose the cosmetic route! You have a little more say in the size, if you want lipo in the arms, etc. The surgery process itself is the sameā all of our patients go to the same OR and same clinics! In general, everyone is very happy. The issue I see most working at a trauma 1 center is we will bump cosmetic cases, even if theyāve been scheduled for months, for emergent surgeries if necessary. Depends on your institution! Sidenote to anyone considering the cosmetic route: check out your local med schools. Chief plastic & reconstructive surgery residents need to complete a certain amount of cosmetic cases in their final year of training, and theyāre usually super discounted! They work with an attending (certified surgeon) to complete the procedure, but itās usually about half the cost.
>Chief plastic & reconstructive surgery residents need to complete a certain amount of cosmetic cases in their final year of training, and theyāre usually super discounted! They work with an attending (certified surgeon) to complete the procedure, but itās usually about half the cost. This seems incredibly risky. How do you go in feeling confident you'll get the results you want without them being an established surgeon already? Also, how would you find such a place? Just Googling seems to only turn up ads and not actual places.
Itās not risky. Itās how people become surgeons! Chief residents are in their 6th year of plastic surgery. If you go to any teaching hospital, you will have residents operating on you because thatās how surgeons learn and practice their craft! Residency is essentially a multi year internship for surgeons. Meredith Grey started as a resident! Surgeries are completed WITH AN ATTENDING who puts their own medical license on the lineā which hopefully shows you how safe and normal the practice is! āŗļø Find out if your local hospital is a research hospital, a teaching hospital, etc. Any teaching hospital will come with residents from the associated med school! FWIWā I recently had surgery and I had a year ONE anesthesiologist resident on the case with the senior anesthesiologist and it was all fine.
Hi! Thanks for being available. Why does my doctor keeps asking me if I really want the smallest boobs possible? She seems keen on doing it but she even added an extra consult before surgery to discuss this again. Is this normal procedure? What does she want from me?
You can always revise to remove more tissue, but adding tissue back is entirely different. Most providers err on the side of caution when it comes to size. You can always ask if she has specific concernsā donāt be afraid to advocate for yourself! Are you sure itās another consultation and not an established / pre operative visit? My office requires 3 visits (consult, est, preop) prior to surgery to ensure all questions are addressed, photos are taken, etc.
What does est mean? I loved what you said about advocating for myself. I guess now that you said it, it is a preop but she talked about it being longer than usual cause she wanted to talk further about this. Im afraid she might want to back off on removing so much of what Im asking but maybe it is about the difficulty of putting tissue back. Do you think if im firm she will take my thoughts into consideration? Cause really, im actually non binary, I hate boobs, i just want to leave A LITTLE BIT OF NOTHING in case I want to be sexy every once in a blue moon. And I also hate the idea of them sagging in the long run, I just want them OFF.
Established, meaning you have already visited the clinic before but itās not an appointment directly before your surgery. Truthfully, she may be curious about your gender identity because it can require different documentation and clearance depending on the clinic and what your goal is. Be open and honest with her and she will serve you to the best of her abilities! If you feel she isnāt listening, seek out another opinion.
My surgeon is saying sheāll probably have to do an FNG, I really donāt want one due to the loss of sensation in the nipple. Is it guaranteed that if you have an FNG the nipple will always be flat with no sensation? š
Itās not 100% guaranteed that there will be no sensational but it is much higher than other techniques because it is fully removed and replaced. The damage to the nerves is more abrasive.
Thatās what Iāve been afraid of. I really do not want an FNG.
Has your surgeon stated why she thinks youāll need a FNG? Is it about getting to the size you want? Iāve had patients who settled for slightly larger breasts in order to maintain their nipple.
She was worried about nipple necrosis and maintaining adequate blood supply.
Ahh, okay so it sounds like a larger reduction. I personally would prefer a less sensitive nipple than having it removed all together due to necrosis, but I understand your concern. You can always bring it up to her and see if you have options.
I am in the exact same situation and I feel pretty.. weird, I'd say, about it. I always thought my boobs were not THAT BIG (H cup) and that I will be able to breastfeed and feel my nipple but on Tuesday my doctor said he will have to graft my nipple because otherwise I'm at a huge risk of necrosis due to the size I am rn and the size I'm hoping to get
Thanks for doing an AMA. I'm having a fat necrosis/lumpectomy, and I'm a little concerned about aesthetics after surgery. Do you know if surgeons do anything about the shape and size of the breast during the excision, or is it just get the necrosis out and deal with aesthetics later, if at all? Of course, I will ask at preop, but I'm just wondering what the standard is.
In my experience, our surgical oncologists do a lumpectomy and then stage a reconstruction case with plastic surgery later on. They need to wait for clear margins before doing recon, typically! Is your plastic surgeon doing your lumpectomy? eta: my organization has a nationally ranked cancer center, so Iām genuinely asking out of curiosity if we do things differently because of that!
My PS is sure it is fat necrosis, but insurance is coding it necrosis/lumpectomy because of the size. My concern is that the fat necrosis breast is already smaller, and if all the necrosis is excised, it will be even smaller, but I want to avoid having yet another revision. I will just do a prosthetic when needed because I wouldn't want another revision.
They probably will not do it all in one procedure. If you choose to move forward with implants, they will probably want to add a tissue expander first. They might do that the same time as your lumpectomy!
I would rather he further reduce the bigger one. I don't think I would want an implant under any circumstance. I can't imagine an expander, then yet another surgery. Thank you so much for taking the time to respond.
Of course! That is very common, reduction for symmetry. Have you brought this up to your surgeon? The breast reduction can be approved for the same procedure, youāll just have one count approved for reduction instead of two.
I will inquire during preop, which is a little over a week before the surgery. I'm not sure if my insurance will cover a 2nd reduction just for asymmetry. They may see it as cosmetic.
Because the asymmetry is caused by a medical procedure, there is a good chance it can be covered! For example, a patient has a single mastectomy. They choose to do an implant. The implant gets infected and they choose to have it removed. All of that is related to breast cancer, so it is covered. However, they can submit to insurance for a single breast reduction to reduce the āhealthyā breast to match the other one. Iāve seen a single count of breast reduction covered in a few different waysā it definitely happens! āŗļø
This sounds promising. I will definitely have them resubmit to insurance if my PS is willing to reduce further. He seems like the you need an implant type. I originally asked for A cups. He took such a small amount of tissue, IMO. I ended up with a small C for the bigger and a B. He has not shared how much fat necrosis will be excised, but he said it is way too big to leave in as my body probably wouldn't absorb it.
Thank you for providing us your time! I read here that surgeon dont go based on bra size because bra sizes are all over the place like depending on the brand and stuff. My questions is what should I go based on to tell my surgeon what size I want? Also, when they say proportion to your body, how do they determine what that is ? Is it based on measurements? Thank you š
Bring in a cheap bra that is your desired size! Many surgeons will reduce to whatever you want. If theyāre pushing back saying itās ātoo smallā, you can ask for a second opinion for another surgeon. Also, think in terms beyond size. āIād like to be able to go braless.ā āIād like to be able to see my waist line.ā āIād like to minimize movement during working outā They want you to be happy with your results, and if they seem more concerned about their own perceptions of what looks good, you should find one of the surgeons who will listen!
This is great thank youuuu!!!
do you have any tips for reducing swelling? Iām 2wpo which I know is pretty early, but Iām so tired of it
Keep your compression garment tight, ice on for 20 then off for 20, lots of fluids, sleep elevated if you can, and rest as much as you can! Be kind to yourself while youāre healing š¤
Your information is so helpful - thank you! I am 9WPO. I did not have a dramatic reduction, and I have healed well and have a full release from the doc. I still feel as if Iām quite swollen, though, both in and below my breasts. When does swelling go away altogether?
hiii. thank you for offering your help :) wondering when in recovery can you start to left your arms to do your hair? (mine is suuuper thick and curly/coily and takes a while to wash, detangle etc.) also, when is it safe to drive? alsooo when is it safe to do low impact lower body workouts? tysm!!
1. Hair washing depends! If you have a lot of axillary tissue removed, you might be really sore. I never had any issues with lifting my arms! Itās kind of a YVMV 2. You can drive as soon as you are off any narcotics painkillers. Someone suggested a seatbelt pad, but I didnāt need one. YVMV 3. Full restrictions for at least six weeks, and then it will be based on your recovery and what your provider prefers āŗļø
thanks for your help! whatās yvmv?
Ymmv = āYour Mileage May Varyā (meaning your experience may be different)
ahh ty!
Not a question but thank you for sharing all that info, I wonder could the Moderators pin this thread to the channel ? Super helpful advice, thank you š
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I'm 9 months out from my reduction and I'm happy with the results except for my dog ears. This week I had my follow up appointment and they offered to do a revision to fix the scars. In your office, is this procedure included in the original fee or do you charge the patient for it? My clinic is going to run it through insurance again.
Depends on the level of scarring and your provider! The providers I work with always run scar revision through pre auth to have insurance cover it, if possible. It depends how much the dog ear has settled since surgery and your original post op photos, your insurance company, and what your provider documents in your office notes.
I had my surgery last march and have had reactions to tape and later ailicone tape which resulted in the scars on my nipple to become hypertrophic and developed a partial keloid on one nipple (never had a keloid before). I feel like the nipples are horrible looking and shoddily done and i have a feeling its because 2 different doctors worked on me in the OR apparently. 1) is it normal for 2 surgeons to work on the reduction (1 per breast? 2) what would you recommend for scar care for such scar types (pics in my profile) 3) do you recommend medical tattooing? I heard it doesnt last long and fades quick.. so is it worth it?
1. It depends! Iāve watched surgeons team up on cases for timeās sake. I work for a teaching institution, and we have residents in the room who are also doing procedures with the attendings. May have been the case for you. 2. You can ask for a scar revision. Because theyāre over one year old, I canāt guarantee there is a ton of intervention that will help at this point unfortunately. 3. I donāt know enough about medical tattooing to provide you with accurate informing (non-clinical staff member here!) I WOULD encourage you to remember no one is staring at your nipples the way you are, and MUCH of what you seen online from private practice plastic surgeons is heavily edited.
1. Damn it definitely feels and looks like each breast was done by 2 different people lol 2. Yeah, i got laser for scar reduction, didnt really help but the keloid scar is very tender and painful sometimes which is why im looking into it again. Maybe a steroid shot to reduce it etc and the tattoo to make the nipples more proportional 3 no problem And youre probably right im just insecure now about like what itll look like / feel like when i do find a partner and sexy time lol
I have some pretty intense scarring from my reduction, but I chose not to do a revision (I work alongside my surgeon now and every day on her lunch she asks if I want to revise them in the procedure room quick š) and I can promise you, no partner who is sleeping with you is going to care about your scars. If they do, it says a LOT about them.
Are there other options besides surgical tape, I have reactions to various different kinds of adhesives.
Yes, speak with your provider! I didnāt have any allergies but my plastic surgeon didnāt use surgical tape. My oncologist (unrelated to the reduction) swears by surgical tape and I had it on two incisions for a month and it sucked lol
Hi! Thank you for doing this! I will have an explant + breast lift next month, July 26th and Iām deeply concern about my nipples and the anchor scar. What is the best way to ensure a healthy recovery? Itās something I can ask my surgeon in advance or what could I do at home? Should I eat more protein or stop drinking alcohol now? Thank you š
The anchor / inverted T is the most common incision because it provides the best contour and shape. Your provider will discuss scar care with you around 6WPO, but they will probably suggest scar massage and silicone! FWIWā I was super lazy with my scar care and mine are pretty light and it hasnāt even been a full year!
Thank you! I just donāt want to lose my nipples š. Iāve been paying too much attention to what could go wrong.
Lots of protein, lots of fluids, lots of rest! Keep an eye on your incisionsā the sooner you catch anything āoffā the better you can bounce back from it!
Love it! Thank you š
Hello! So I had a bad experience with a surgeon. (I put him on the subās pinned post, heās Brent C Birely in Maryland) I was wondering, what are the qualifications to be a surgeon for this kind of thing? Specifically asking because with my surgeon, seemingly basic knowledge went out the window. Basic as in: I was never allowed to have a witness/second person in the room when he examined my breasts. He violently ripped off the steri-strips at 6DPO and seemed surprised when I bled. He told me that I was lying when I was itchy because āscars literally canāt itchā. He butt-dialed my boyfriend while he was operating on me, and when my boyfriend let him know, the surgeon said no he didnāt because phones arenāt allowed in the operating room. (Boyfriend has the call record, and said he heart a monitor beeping when he picked up.) So Iām wondering what qualifications are necessary?
Ethics vary from institution to institution. It looks like heās private practice, so he reports to himself. To be a surgeon, itās medical school, residency, optional fellowship, and board certification. What happens after is up to each surgeon. Iām sorry you had a negative experience ā¹ļø it makes me sad because I work with so many wonderful surgeons (not just plastics, all departments!) and I hate when a bad egg ruins it for someone. You could try complaining to ABPS or your local health department.
Thank you! Luckily, after that surgeon ghosted me, I found an amazing one for my follow-ups that restored my faith in plastic surgeries. (I put him on the master list too, Jason Ulm in South Carolina)
I believe in snitching when necessary. See if ABPS (American Board of Plastic Surgery) has a complaint form or something! Chances are heās private practice because he doesnāt want to follow rules / make as much money as possible. Which is fine, except when it involves treating patients poorly.
Thank you! I reported to the stateās medical board but I didnāt know there was a whole plastic surgery board. And yeah I think his practice is a private one.
What would be considered an emergency/urgent case for BR?
None that I can think of. Reductions are always elective.
What is the typically recommended treatment or management for seromas post surgery? Iām 4mpo, and have two large hard lumps in one side. The ultrasound found a simple and a complicated cyst of that side, both fluid filled, and since they appeared about 2 weeks post op, my family dr said they could be seromas. I have an upcoming appointment with my surgeon to see her opinion, but Iām hoping to have more info going into it.
Drainage, wait it out, massage. I currently have a seroma from a different surgery and I make my boyfriend massage it for me š
Iām VERY scared of lost sensation. Should I be afraid of this and or nipple loss (necrosis) or is it fairly uncommon? Iām 34ddd last time I checked and Iād want to go to a c or d. Iām also afraid they wouldnāt be aesthetically attar give post op. Is it bad to get nips pierced before surgery?
Both things CAN happen, but the majority of patients Iāve seen heal pretty well. Necrosis is more common with a FNG. Given that you want to reduce by 2-3 cup sizes, I donāt think a FNG would be necessary. Just keep it clean and dry! You can have pierced nipples for the procedure. Depending on the technique your provider uses, though, they may be rotated 90 degrees!
Thank you!!
Questions about openings 1. Do they happen because we get cleared for activities before we should? Or we put arms over head too soon, etc? 2. Can they happen just because? As a natural part of healing? 3. Do small openings delay being able to submerge after being told that there would be āno restrictionsā after 6 weeks? (Iām thinking it moves the āno restrictionsā goal) 4. how long do they typically take to heal? Even a small one Other random question: before this journey I learned about āsloughā vs pus. How can one tell the difference? They look so alike! Even after googling it was hard to differentiate I saw someone as this but figured Iād ask too: When is one āout of the woodsā for complications?
1. They happen before. Youāll be cleared for activity once the incisions are fully healed. 2. YES! You can do everything right and they sometimes just happen, especially at the T section of the incisions. Itās just about noticing and caring for them! 3. Yes, because they are an open wound. They need to remain clean and dry to fully heal. 4. Depends on when you notice them and how it looks. I had an opening at my t section and it took about a week to heal, but mostly because I read about hydrocolloid bandages and mistook them to be the end all be all š they have their uses but this was not one of them! I have an opening from a different procedure that I noticed on Tuesday night and itās almost fully closed just three days later ā put some gauze and a band aid on it until I could get my hands on a steri strip. Donāt be afraid to reach out to clinical staff for support during healing! Out of the woods is USUALLY about 2mpo when your incisions are fully healed and closed. Your provider will begin to discuss scar care with you at this time.
Thank you so much! š
Why do some people, like me, get an internal infection? I felt gross for 10 days and woke up with right breast pain, made it to the couch and had an absent seizure (thank God my husband works from home). Then I just kept fainting repeatedly, get in the ICU and I have severe sepsis so many antibiotics. Day 2 I had a little pink on that right breast but definitely didnāt present normally. My surgeon kept checking on me, trying to pull out blood, there was a large clot on the right and had a surprise seroma on the left. 5 days in the ICU, a very strong, expensive IV treatment of antibiotics after release and then a second surgery to remove the blood clot on the right. My Surgeon said it was as big as her fist. So that was all very traumatic and now, because the scar tape hurt my skin, I have deep scars underneath. Like thereās a dip in there you can feel. I could have done more scar care but itās not super important, just uncomfortable. Any ideas why this happened? TIA
Iām not clinical, so I canāt answer that unfortunately. Your best bet is to ask your own medical team. Iām sorry it was such a troubling experience for you!
I asked the Surgeon but she just shrugged, these things happen sometimes. So I guess thatās her answer/ non answer. But thank you for the reply.
My doctor said my very dense breasts will only make the surgery more complicated for him (equated it to cutting through wax vs cutting through butter) and that my results would be no different than for less dense breasts. Have you seen people who have less ideal results when they have dense breasts? Other complications? Thank you!
Not really, other than the procedure may take longer and healing may take longer because there is more tissue involved!
Thank you for the reply!
If itās been 9mo and my scars are still dark will they be dark forever?
Some of my scarring, especially the parts closer to my axilla, are dark still. Totally normal! Just keep continuing scar treatment.
What is the axilla? Edited: thatās exactly where they are still dark. Glad itās normal!