• Length of Surgery: 3-4 hours
• Anesthesia: General
• Outpatient vs Inpatient: Outpatient (Ambulatory)
• Recovery Time: 5-7 days

Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.  

During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of cosmetic breast surgery, such as  Dr. William P. Adams and Dr.  Louis Strock.

Dr. Couto has also authored book chapters and publications in peer-reviewed journals related to breast surgery.

This surgery is designed to reduce the breast to a size that is proportional to the body and  lift the breast and nipple to its ideal position. This is achieved by removing excess glandular tissue, fat, and skin to create a smaller, firmer, and more symmetrical breasts. At the same time the nipple areola complex is rejuvenated by lifting it and reducing its size.

The consultation is divided into 4 parts: 

1)Health History Evaluation

• A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery.  Dr. Couto will emphasize the importance of avoiding nicotine products (e.g cigarette, nicotine patch, vape, etc), having blood sugar levels well controlled if the patient has a history of diabetes, and the importance of adequate body weight. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results.  Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result. 

2)Discuss with the Patient About Surgical Goals

• Dr. Couto has a deep discussion with the patient to learn about their concerns, and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet our patient’s expectations.  We focus on learning the presence of symptoms as a result of breast weight, the patient’s desired breast cup sizes and appearance.   

3)Breast Analysis & Surgical Recommendations

• Dr. Couto performs a focused physical exam and comprehensive breast analysis.  We examine the size, shape, and descent of the breasts, identify any existing breast or chest asymmetries, and evaluate the contour and proportion of the breasts in relation to the body. After the examination, Dr. Couto discusses with the patient the indicated breast reduction technique and explains in detail everything pertaining to the procedure and its recovery.

4)Pricing and Scheduling Information

• Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved to book the procedure with us.

Skin Incisions: 

The tradeoff of breast reduction surgery is a well concealed scar on the breast. These skin incisions are used to resect excess breast tissue, fat, and skin, and reshape/lift the breast and nipple-areola complex.  

Dr. Couto utilizes two type of skin incisions techniques for the breast reduction:

• Circumvertical or “Lollipop” Skin Incision: This technique consists of placing a scar around the border of the areola. This periareolar incision enables us to reduce the size of the areola and lift the nipple areola complex into its ideal position.  An additional vertical incision that runs from the inferior aspect of the areola to the breast crease is made. The purpose of the vertical incision is to remove excess breast tissue from the lateral and/or inferior aspect of the breast, and also excising horizontal skin excess; thus, shaping the breast into a narrower and perkier breast.  This technique is used when there is a mild degree of excess breast tissue and skin. 
• Wise Skin Pattern or “Anchor” Incision:  This technique follows the same path as the lollipop incision, but also has an horizontal incision along the breast crease. This is the most common technique used for breast reduction, indicated for moderate and severe breast hypertrophy. This additional horizontal incision enables the surgeon to resect a greater amount of breast tissue and remove the loose skin of the inferior pole of the breasts. Therefore, the breast is treated in all dimensions, vertically and horizontally. Ironically, this scar along the breast crease is the one that most people are worried about, but is the least noticeable, since it hides well in the breast crease.

A breast reduction with mesh support is a variation of a traditional breast reduction, where soft tissue support is added to slow down the breast descent that occurs post-surgically as we continue to age.  After any breast surgery, the skin continues to age and the breasts continue to be exposed to gravity; therefore, with time the breasts will take their natural course and descend. An effective way to delay this descent is by adding soft tissue support to the breast. This is achieved with the use of a biological mesh (Galaflex Ⓡ) that is placed  in the breast at the time of surgery, serving as an internal bra. With time the body absorbs this mesh and leaves in place a reinforced layer of  collagen. 

  Patient with:

• Large Breasts
• Symptoms Associated with Large Breasts 
• Nipple Descent 
• Increase Nipple-Areola Size
• Breast Asymmetry
• Congenital Breast Deformities

Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will  thoroughly review with the patient the preoperative/postoperative instructions and the medication regimen with the patient. We also schedule the post-operative appointments. 

We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products can affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 6-8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.

We provide the patient with a detailed postoperative protocol to ensure a  comfortable and quick recovery. Following surgery, it is common to feel soreness and sensitivity around the surgical site; however, this is easily manageable with our postoperative pain regimen medication. Furthermore, we start all our patients in a scar therapy to optimize your scar healing process and results.   We recommend our patient to take 5-7 days of work (less if working from home) and avoid lifting anything heavier than 10 pounds for 4-6 weeks. Patients can resume their aerobic exercise (e.g. running, walking, spinning) 2 weeks after surgery. However, you will be able to resume your gym exercises and full activities 4-6 weeks after surgery. Although the final results of the breast reduction can be seen within 3 months from surgery, the final appearance of your scars will be observed in 1 year after surgery.