Breast Reduction, Nipple Grafting Workup

Updated: Jun 07, 2017
  • Author: Curtis S F Wong, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Workup

Laboratory Studies

Perform a complete blood count to ensure anemia (hemoglobin < 10 g) or thrombocytopenia are not present. (As blood loss with this procedure should be minimal, the author does not recommend autogenous banking of blood.)

Provide photographic documentation to the insurance company for authorization and for comparison of before and after photos to help the patient appreciate what has changed.

Other laboratory tests may be indicated depending on the additional health problems the patient may have or the medications she may be taking. This includes prothrombin time, activated partial thromboplastin time, complete or basic metabolic profiles, and urinalysis. An ECG is performed if indicated by the patient's history or if required by the surgical facility.

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Imaging Studies

Mammography is indicated in any patient who is 40 years or older and has not undergone one in the prior 6-9 months. This is in compliance with the guidelines established by the American Cancer Society. The author also considers mammography in patients older than 30 years when they have a strong family history of breast cancer. Mammography (and possibly ultrasound or other imaging studies) is also used in the evaluation of palpable masses noted on physical examination. Postoperative baseline mammograms are obtained approximately 6 months after the surgery or at the discretion of the surgeon. This is to provide a baseline for comparison with future mammograms and document what changes may have occurred following surgical intervention.

Obtain chest radiographs if indicated by examination findings or the patient's history.

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Other Tests

An ECG is performed if a patient's history warrants. In addition, some surgical facilities have guidelines requiring ECGs at certain patient ages.

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Diagnostic Procedures

Manual lifting of the breasts may result in considerable relief or resolution of symptoms. This is a strong indicator that the procedure will result in relief for the patient.

Progression of symptoms over the course of the day when upright and wearing a bra also support the probability of a health benefit following reduction surgery.

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Histologic Findings

Tissue is sent for pathologic examination to rule out carcinoma or other atypia.

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