Candidates
Initial Consultation
Traditional Breast Reduction
Scarless Breast Reduction
Recovery

Good candidates for breast reduction

• Women that have pendulous breasts (often signifies more glandular tissue than fat)
• Women who are thin (thin women tend to have more glandular tissue than fat)
• Women that have excessively large breasts (liposuction normally only provides a 30-50% reduction in size)
• Women that have excessively dense breast tissue (often signifies more glandular tissue than fat)
• Women before menopause (during menopause fat replaces glandular tissue)

Initial Consultation

At the initial visit, your doctor will likely ask you to describe in detail what you would like improved. Be specific about what you would like done. If your surgeon fully understands your expectations, she'll be able to determine whether your goals are realistic. Your surgeon will examine your breasts. She talk to you about the what size you want your breasts to be and will show you where she intends to position the nipple and areola.

You are at increased risk for complications if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.

Because the size, shape, and amount of tissue in the breast will change after reduction, most women are advised to have a preoperative mammogram and a postoperative mammogram six months to a year after surgery for comparison.

Procedure/Techniques

Anesthesia: General
Location: Hospital
Surgery time: 3-4 hours

A mammoplasty is a surgical procedure that reduces, lifts and reshapes the breasts. It can also reduce the size of the areola (the dark skin surrounding the nipple). Many women seek breast reduction to alleviate painful discomfort and other conditions (back pain, shoulder pressure, rashes, skin tags, etc.) as well as to improve the appearance of their breasts.

The procedure is usually performed under general anesthesia. The operation takes about 3-4 hours, and you may require an overnight stay or be allowed to go home the day of surgery.

During mammoplasty, the surgeon makes an incision which is normally in a keyhole pattern: a circle around the aerola and two incisions down the breast which will be closed to form one line. Fat and extra tissue are removed. The surgeon then repositions the nipple and areola to a higher position and removes excess skin from beneath the breast.

In Figure 1the outlined areas show where skin, breast tissue, and fat are typically removed and how the areola and nipple are repositioned. The arrows show how skin formerly above the nipple is brought down and sutured together to reshape the breast. After surgery, scars will appear around the areola and in the crease under the breast.

Figure 1

In some cases, the nipple and areola are transferred as a skin graft to their new position. This is only done when absolutely necessary, since nipple sensation is almost completely lost. Drains are then placed on the sides of the breasts to drain blood and excess fluid. The drains are not removed for 1-2 days. The incisions are then sutured closed and taped.

Scarless Reduction

Liposuction reduces the breasts by removing excess fat. If there is enough elasticity in the skin, it will retract and produce a visible breast lift. Advantages of breast reduction by liposuction over traditional methods:

• Less trauma to the breast
• Faster recovery
• Less visible scars
• Fewer postoperative complications

The best candidates for breast reduction by liposuction have breasts that contain a large proportion of fat. If your breasts have more glandular tissue than fat, a mammoplasty may be more appropriate. The proportion of fat in the breast can be determined by a mammogram.

Candidates for Scarless Breast Reduction

Types of women more likely to have more fat than glandular tissue in their breasts:

• Women that do not have pendulous breasts (often signifies more glandular tissue than fat)
• Women who are not thin (thin women tend to have more glandular tissue than fat)
• Women that do not have excessively large breasts (liposuction normally provides a 30-50% reduction in size)
• Women that do not have excessively dense breast tissue (often signifies more glandular tissue than fat)
• Women after menopause (during menopause fat replaces glandular tissue)

Breast reduction by liposuction will produce a smaller version of the breasts that a woman had before liposuction. The breast's overall shape will be very similar to their shape before liposuction.

Liposuction removes fatty tissue from the breast, and mostly spares the glandular breast tissue that is responsible for milk production (breastfeeding is normally not affected). There is so little trauma to the breast tissue that mammograms usually appear normal after liposuction of the female breast. In contrast, after a mammoplasty, mammograms may show calcification and other changes in appearance.

After liposuction of the female breast, there is a gradual decrease in postoperative swelling over the subsequent 2-4 months. There may be temporary lumpiness for several weeks after surgery. This is not visible and is part of the healing processes.

Recovery

Pain Level: Moderate to severe discomfort. 1-2 weeks of pain medication
Sutures: Removed after 1 week
Drains: Removed after 1-2 days
Swelling and Bruising: 2-3 weeks
Numbness: 1-2 weeks.
Work: 2 weeks. If your job is strenuous or requires lifting, you may want to wait longer.
Exercise: Wait 3-4 weeks
Final result: 6 months

On the day of surgery your chest may be painful, bruised and swollen and you may feel nauseated. Pain medication will be prescribed for your comfort.

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