Dr. Leo Lapuerta does not set a cup size that qualifies a woman for breast reduction. His practice’s guidance names a different test: how the current size of the breasts affects her physical and mental health.
Dr. Lapuerta, a triple board certified plastic surgeon with more than 30 years of experience, performs breast reduction surgery in the Houston area, and his practice describes the candidate in some detail. Read as a set of questions, that guidance gives a woman considering the operation a way to measure her own situation before she books a consultation.
Does the weight cause physical problems?
The practice starts with the body. Oversized, heavy or drooping breasts can bring neck, back and shoulder pain, and for some women a reduction helps relieve the back pain caused by the extra weight. The amount removed depends on the size change, and the practice says it falls between two and eight pounds in most cases.
Physical symptoms also matter for coverage. Because large breasts can create physical problems, insurance may pay for a portion of the surgery when it is performed for medical reasons such as back pain. Coverage varies, so the practice asks patients to confirm details with their provider. After the first consultation, the office can submit a surgery recommendation letter to the insurer, and a billing and insurance coordinator works with each patient on the claim.
Does size shape daily choices?
The practice lists quieter reasons too. A woman who wears one size on top and another on the bottom has trouble finding swimsuits and other clothing that fit. Some women feel self-conscious and want a smaller size that draws less attention.
Those concerns count toward candidacy alongside pain. Dr. Lapuerta has described what draws him to this side of the work:
“Seeing the positive impact on a patient’s daily life when they regain form and function is so rewarding to me personally.”
Is the timing right?
Three conditions on the practice’s list concern timing and health. Candidates should be in good overall health. They should not have weight fluctuations planned for the future. And women who may want to breastfeed should raise that with Dr. Lapuerta before surgery, because a reduction can remove breast tissue that contains glandular tissue and ducts.
Expectations count as well. Dr. Lapuerta reviews medical history, performs a physical exam, shows each patient where the incisions will go and discusses how much tissue she wants removed. He also covers anesthesia options, the length of recovery and the restrictions and post-op care involved.
Can you accept the scars and the recovery?
A reduction leaves visible scars. A common approach is the anchor incision, also called a vertical T, which circles the areola and runs down along the natural curve and crease of the breast. Variations exist depending on breast size and goals. After resizing and reshaping the breast, the surgeon repositions the nipple and areola and lifts the breast so it sits higher on the chest, and the practice notes that some patients choose a breast lift along with the reduction while others do not need or want one.
Throughout, the surgeon works to protect the blood supply to the nipple and areola, so that blood flow can reestablish itself after repositioning and help prevent discoloration and loss of feeling. Dr. Lapuerta works to minimize scarring, but the practice is clear that scars will be visible, though they may fade somewhat with time. Nipple sensitivity may take 6 months or longer to return.
The surgery takes 2 to 4 hours as an outpatient procedure under general anesthesia. Dr. Lapuerta can operate at his own facility, the Plastic Surgery Institute of Southeast Texas, which is dedicated to plastic surgery, and he also holds privileges at other clinics and hospitals.
Recovery follows a set pattern. Patients can expect bruising, swelling and tenderness at first, with mild discomfort that pain medication can manage. They wear a surgical bra or compression garment for the first several weeks, and activity stays limited for several days, so the practice suggests patients may want to take the first week off work. Most return to work within 1 to 2 weeks and resume exercise after 4 to 6 weeks. The practice describes the recovery as generally shorter than recovery from augmentation, at about two weeks.
The first weeks
The visible change is immediate, and patients begin to notice results within a week or two, though swelling can take weeks to settle. The team calls patients after surgery to check on progress, and follow-up visits track how the incisions heal. For a candidate whose answers to the questions above line up, the consultation turns those answers into a specific plan: an incision pattern, an amount of tissue and a decision on whether to include a lift.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
