The goals of reconstructive plastic surgery are different from cosmetic procedure as it is conducted to make the patients appear as normal as possible and/or improve body functions.

Because reconstructive surgery is deemed as “medically” necessary (to help people live a more normal life), it is often covered health insurance.  By contrast, cosmetic surgery is an elective procedure so a patient has to shoulder all the expenses.

One of the most common procedures in reconstructive plastic surgery is breast reduction that is used to treat macromastia in which the busts become abnormally large (each breast weighs more than 600 grams).  Women with this condition often suffer from chronic back and shoulder pain because of the excess weight, limited physical activities, irritation along the breast crease and cleavage, and poor body posture.

Because patients with macromastia suffer from chronic physical pain and discomfort, some states even require automatic health coverage for those who are “medically” qualified to undergo breast reduction surgery.

But when breast reduction is performed on patients who are asymptomatic (e.g., they do not experience pain and discomfort) but just want to achieve a more symmetrical figure, it is considered a cosmetic and elective procedure, and as a result, it is not covered by health insurance.

Another common example of a procedure that can be used both in reconstructive and cosmetic surgery is rhinoplasty or nose surgery.

Rhinoplasty is the second most popular cosmetic surgery in the US last year, with about 252,000 patients who had the procedure.  However, this is also given to those who are suffering from breathing difficulty, deformities caused by abnormal nasal growth or birth defect, and irregularities due to accidents.

It is possible to perform cosmetic and reconstructive rhinoplasty at the same time.  For example, a person undergoes a procedure to correct his deviated septum (tissue separating the nostrils) so he can breathe more easily and another one to reduce the size of his bulbous nostrils.

In this case, only the reconstructive part of rhinoplasty is covered by health insurance while the procedure that involves reducing a patient’s nostrils is not because its only purpose is to improve the appearance of the nose.

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 address the aesthetic problem and physical effects of having inordinately large bust, plastic surgeons use a specific procedure called breast reduction surgery which typically involves several incisions that will let them manipulate the surrounding tissue and remove any excess skin.

Since every patient has a varying amount of excess skin, tissue, and fats, plastic surgery specialists have developed different breast reduction techniques in order to achieve the most desirable outcome.

For women with larger breasts that have moderate to significant sagginess, and patients with medium-sized bust that severely sags, the anchor-shaped incision is usually the best approach.  But since it uses the most extensive excisions, plastic surgeons warn that this technique involves longer recovery compared with other breast reduction procedures.

As its name suggest, this technique involves a surgical cut that resembles a nautical anchor as it uses an incision that surrounds the edge of areola, another one starting from the areola down to the fold of the breast, and another excision that covers the entire breast crease.

Through these surgical incisions, plastic surgery specialists can access and manipulate the glandular tissue and remove the excess skin and fats.  If needed, they will also reduce the size of the areola to make it appear more natural on smaller breasts.

Despite the effectiveness of the anchor-shaped incision, plastic surgeons usually find this as too extensive on medium-busted women with moderate to severe sagginess.  For this reason, they have developed a modified breast reduction technique in which they use a lollipop-shaped excision.

In this minimally invasive, plastic surgery doctors use the same incision sites in the anchor incision, minus the excision that covers the crease of the breasts—the area which usually takes the longest time to heal.  And because of this, most patients can expect not just one less scar but also shorter recovery period.

But regardless of which technique is used, breast reduction involves risk of complications, post-operative pain and discomfort, and recovery.

For most patients, they can return to work within two to four weeks after the procedure, although they should avoid strenuous activities and heavy lifting for up to six weeks to promote faster healing.

According to plastic surgery specialists, one of the most obvious benefits of having breast reduction is that patients will most likely improve their self-confidence; this is because the appearance and size of breasts have a significant impact on the body image of many women.

Aside from improving the body’s contour, this plastic surgery procedure can also treat chronic pain in the neck, back, and shoulder caused by the weight of larger breasts.  In case that this treatment is used to address such problems, some insurance companies may provide coverage for patients.

It is important to note that plastic surgery, if used for reconstructive or as a way to help patients live a more normal life, will most likely be covered by insurance policy.  However, this is not the case for surgeries that are performed solely to improve one’s appearance.

Meanwhile, some patients with extremely large bust have a posture that bends forward due to the weight of their breasts.  For this reason, breast reduction surgery is an effective way to improve their posture while allowing them to move without any difficulty, according to plastic surgeons.

Another problem of having inordinately large breasts is difficulty to engage in sports and other physical activities.  In extreme cases, some patients even find it hard to perform daily life’s activities especially if their breasts are too large that they sag and almost reach the tummy.

Fortunately, breast reduction surgery can also address this problem, thus allowing women to enjoy sports and live a normal life.  This can be an empowering experience for most patients who were once hindered by their large bust.

While this procedure usually provides a lasting result, plastic surgeons warn that this may be affected by pregnancy and weight gain.  For this reason, they generally recommend their patients to postpone the surgery if they are still planning to have children or if their weight is unstable and fluctuating.

Plastic surgeons also believe that breast reduction will not prevent the breasts from becoming saggy in later years due to the physical effects of aging and gravity, although this condition will take time and would not happen instantly.

To address these problems, plastic surgeons use a procedure called reduction mammaplasty which is more commonly referred as breast reduction.  In this surgery, they use different techniques to provide the most desired result and address a specific anatomical feature.

While this plastic surgery is primarily used to reduce the size of breasts that are too large in proportion to the overall body frame, doctors also use this to correct asymmetrical bust line (one breast is much larger than the other).

Most plastic surgeons agree that breast reduction can be performed at any age, although majority of them recommend patients to wait until the bust development has stopped.  Also, women who are planning to have children are usually advised to postpone the procedure—since it may have a significant effect on the shape and size of the breasts—unless they are suffering from physical discomfort which must be immediately addressed.

As with any plastic surgery, consultation and physical examination are conducted to determine a patient’s health and her anatomical features, expectations and goals, and the right approach which must be utilized.

For women with large breasts that severely droop, plastic surgeons recommend the anchor-incision technique.  As the name suggests, this approach involves incisions shaped like a nautical anchor: a circular cut around the areola or the pigmented part of the breast; a vertical incision starting from the nipple down to the crease; and another cut made horizontally across the breast fold.

Through these incisions, plastic surgery specialists can remove the excess skin and reshape the breast tissue.  And if there is an enlargement of the areola, they may also reduce its size and reposition this to a new location.

Because of the extensiveness of the anchor incision approach, this is not ideal for women who only want to slightly reduce the size of their breasts.  With this consideration, surgeons have come up with different modified breast reduction techniques which usually involve fewer scars and shorter downtime.

For this type of patients, the lollipop incision is usually the most recommended approach.  This technique also uses the same incision sites in the anchor incision, minus the horizontal cut across the breast crease, and as a result, they can expect one less scar and shorter recovery.

In 2009 alone, about 5.2 million reconstructive plastic surgery procedures were performed in the US, according to the American Society of Plastic Surgeons (ASPS).  This is an increase of 5 percent from the previous year.

In a survey conducted by ASPS, the top five reconstructive plastic surgery procedures in 2009 were (in respective order) tumor removal, laceration repair, scar revision, hand surgery, and maxillofacial surgery.

While cosmetic procedures are not usually covered by insurance companies, it is important to note that reconstructive surgeries are typically included in the insurance policy as these are medically necessary, according to plastic surgeons.

However, certain cosmetic surgeries may also be used as a reconstructive procedure.  For example, rhinoplasty (or more commonly referred as “nose job”) can improve the aesthetic feature of the nose while correcting abnormal growth or injury that is usually associated with difficulty in breathing, frequent nosebleed, and recurring nasal infection.

Another example of cosmetic treatment which can also serve as a reconstructive procedure is the breast implant surgery (either with the use of saline- or silicone-filled implants).  According to plastic surgeons, this approach is ideal for women who had tumor removal surgery and want to regain the volume of their bust.

To perform reconstructive breast implant surgery, doctors usually place tissue expander under the chest muscle to create enough room for the implants.  After this, they will inject this balloon-like device with saline solution every one or two weeks to stretch the skin and tissue.

Once the device has created enough room for the implants, surgeons will then remove and replace this with saline or silicone implants.

Meanwhile, breast reduction surgery is another cosmetic procedure that may be sometimes considered as a reconstructive treatment.  With this, some insurance companies cover the expenses related to this surgery, although most of them require that it should involve a significant amount of skin and tissue and that the patients should be suffering from physical symptoms related to extremely large bust size.

Some big-breasted women suffer from poor body posture, inability or difficulty to engage in sports, skin irritation in the breast crease, and chronic pain in the back, neck, and shoulder.

While the condition is not life threatening, this may have a negative impact to some men, particularly on their emotional health.  In fact, some sufferers have reported relationship problems with the opposite sex and low self-esteem.

Contrary to a popular belief, gynecomastia does not improve even with rigorous exercise and diet since the problem is primarily caused by excess breast tissue and skin rather than fats.  For this reason, plastic surgeons use breast reduction surgery that can remove the excess tissue through strategically placed incisions.

To start this procedure, plastic surgeons administer general anesthesia or intravenous sedation to their patients.  Once the drug has taken its effect, they may perform liposuction if there is a significant amount of fatty deposits in the breasts.

Breast liposuction involves the use of a cannula, a thin hollow tube attached to a vacuum pump.  This instrument is inserted to small incisions in the fatty area and is moved back and forth to dislodge the fats, which is then removed from the body.

Once the fats are removed, doctors in plastic surgery will create several incisions directly into the breasts.  In most cases, they use the almond-shaped incision (starting from the crease traveling to the upper part of the breast) together with a circular incision around the edge of areola.

However, there are cases in which the U-shaped incision provides a better result.  In this approach, the middle of the upper incision curves downward to allow doctors to relocate the areola to a higher position.

In the almond-shaped incision, the scar line travels horizontally in the middle of the areola, while in the U-shaped incision, the scar is placed along the breast crease which makes it look like a natural fold of skin.

If needed, some plastic surgeons also reduce the size of an enlarged areola to further make the male breasts appear smaller and more natural.

Because of the invasiveness of the procedure, most doctors in plastic surgery see this as the last resort to treat gynecomastia.  With this, they may require their patients to lose some weight (for those who are overweight) or change their medication if a certain drug is causing the problem before conducting any surgery.

Oftentimes, breast reduction surgery is performed using excision technique to enable surgeons to remove the extra skin, fats, and tissue.  However, there are cases in which the enlargement is primarily caused by a considerable amount of fatty deposits which can be treated with liposuction alone.

The advantage of liposuction surgery over excision technique is that visible scarring is almost not a concern with the use of smaller incisions (about 1 to 2mm in diameter).  In fact, these tiny holes in the skin are left open after the procedure in order to allow the excess body fluids and anesthetic solution to drain out.

(Liposuction Cannula)

Despite the benefits of breast reduction via liposuction, not all women with excessively large breasts can benefit from this procedure; to fully enjoy its benefits, a patient’s bosom should contain a large proportion of fats rather than tissues.  Meanwhile, plastic surgeons have noticed that after the menopausal stage, more fats tend to accumulate in the bust area than during teenage years.

On the other hand, young women who are relatively thin often have more glandular tissue and have small amounts of fats in their breast.  Consequently, they will not benefit from breast reduction via liposuction and have to resort to an excision-based technique.

If given to the right patient, the procedure can reduce the bust size by 20 to 50 percent and even slightly lift the breasts as it eliminates the extra weight caused by the fatty deposits.  However, patients should remember that it cannot change the fundamental shape of their breasts which will simply turn into their smaller version.

During a breast reduction via liposuction, most doctors use the tumescent technique which has become the standard due to its safety and effectiveness.  In this approach, the fatty areas are injected with fluids that can make them firmer and swollen, thus easier to be dislodged from the tissue.

With the use of tumescent fluids, liposuction today involves less post-op pain and discomfort, lower surgical trauma, and quicker recovery.  In fact, many patients can return to work a day or two after their surgery.

These are the other benefits of tumescent liposuction compared with other fat removal techniques: less swelling and bruising after the procedure; more accuracy on the part of a surgeon; and ability to collect more fats without exposing the patients to high levels of trauma.

Health insurance company policies differ so widely the only smart thing to do is ask what information they need to cover your breast reduction.

A bare minimum: a letter from your plastic surgeon requesting authorization and summarizing the (key phrase!) medical necessity for surgery along with side, ¾ and front view photos of the overly large breasts.

What happens in the procedure? Read about breast reduction.

Don’t be surprised if the insurance firm asks for a letter from an orthopedic surgeon or wants you to see one of their doctors.

Also, don’t be surprised if your request is turned down. Many companies automatically trash a first request because they know most people won’t follow up. Just be the bad penny that won’t go away.

In your own letter(s), be sure and mention the hardships of very large breasts, including:

• Back, neck or spine pain
• Groves in the shoulder bones due to the weight of bra straps
• Difficulty getting exercise
• The need to wear two bras to support the weight
• Difficulty finding a bra that covers the breasts
• Evidence that diets have failed to remove any breast weight
• Any pain killers you must take for the condition
• Rashes that may form on your skin at the bottom of bra cups
• Difficulty in doing breast self exams for cancer
• Pain while performing mammograms

Make sure everything is accurate and verifiable. You can bet the insurance company will go over everything with a fine tooth comb!
According to RealSelf.com, the average U.S. price for breast reduction — based on 73 patient reviews – is $8300. So the time invested in letters from medical professionals is worth your while.

By the way, 88 percent of those same patients said plastic surgery for breast reduction was worth it. (Read what RealSelf.com doctors say about breast reduction and health insurance firms.)

Virtually all insurance firms require that at least 500 grams (a little more than a pound) be removed from each breast.

As a new service to help potential patients, California Surgical Institute will perform a quick check to see if your case qualifies for health insurance coverage. Just fill out the form about breast reduction coverage.

Your surgeon will give you a list of items to keep on hand and things to do, but the better you prepare and care for yourself, the better your surgical outcome will be.

Think of the surgery as an athletic event for which you must prepare the body!

Before surgery, make sure your nutrition, sleeping and exercise are up to par. Your diet should include healthy amounts of protein which provides the building blocks for cells.

Being in good physical shape helps you heal faster because the increased circulation brings more blood and nutrients to the surgical area.

So, in the weeks before surgery, you’ll do yourself a favor if you can just find a half an hour daily to walk.

Insufficient sleep is hard on your immune system. Do whatever it takes to get optimum Z’s in the weeks leading up to your rejuvenation surgery.

Due to some longer incisions, those tips are especially useful for body procedures including:

• Tummy tuck
• Breast reduction
• Breast Lift
• Body shaping after gastric band weight loss

Afterwards, your healing will be helped if you continue your surgeon’s pre-surgical smoking ban. Also, stay away from products like aspirin and herbs that increase bleeding.

Plastic surgeons require you to give up smoking before operations because tobacco injures the blood vessels and restricts healthy blood circulation. In fact, smokers require more anesthesia during their surgery.

Unless your surgeon says otherwise, many experts recommend some movement after surgery. Just walking around will aid blood circulation, stimulate your appetite and help other body functions.

Another standard tip is having somebody with you during your healing time to help with bandages, dressings and surgical drains, if any.

If you have flown in for plastic surgery, your surgeon has probably given you post-op instructions.

Flying just after surgery can be problematic, depending on the procedure.

For instance, recent breast augmentation patients would not want to reach up to the overhead bins on a plane. Rhinoplasty patients are sensitive to the pressure changes experienced in air travel.

What are your tips for caring for yourself before and after surgery?