Liposuction-Assisted Breast Reduction
Liposuction was first introduced as the sole technique for reduction mammaplasty (breast reduction surgery) in 1991 by Matarasso and Courtiss. Surgeons who administer liposuction breast reduction feel that some of the complications associated with traditional breast reductions, such asinfection, wound dehiscence, skin loss, numbness, and aesthetically unpleasing scars, may be avoided through use of liposuction.
The technique of breast reduction assisted by liposuction is most appropriately employed when the patient has minimal breast ptosis (droop) or if the ptosis is of secondary importance. If ptosis correction is a major concern to the patient, liposuction alone may not be the optimal technique. The elastic recoil of the skin following liposuction will improve ptosis to some degree, but results are not predictable.
Breast reduction with ultrasound-assisted lipoplasty is a technique that has been reported to be safe and eff ective in reducing the fatty volume and providing breast lift. It is considered as effective as an adjunct to liposuction breast reduction.
Patients with predominantly fatty, as opposed to glandular, breasts are the optimal candidates for liposuction breast reduction. A precise ratio is difficult to determine by physical examination alone, although the ratio of fat to glandular tissue is known to increase with age. The quantity of adipose deposits elsewhere on the body may also be helpful in predicting the amount of fatty tissue in the breasts.
Marking the Breasts Prior to Liposuction Breast Reduction Surgery
The areas of increased breast fullness are marked pre-operatively. The lateral breast and fold extending to the back is frequently an area of concern. If not addressed, this region may become more noticeable and concerning to the patient after reduction of the breast size. Breast asymmetry should also be noted pre-operatively, brought to the patient’s attention, and incorporated into the plan.
The additional percentage to be removed from the larger breast will be approximated in advance. The region between the clavicle and the upper pole of the breasts is marked and avoided, as the perforators in this region increase the chance of hematoma formation. If there is concern that an insufficient volume of breast parenchyma (the breast tissue itself) will be removed by liposuction only, the breasts may be marked for a resection technique as a standby option.
Liposuction Breast Reduction Surgery Technique
The procedure is performed with the patient in the supine position with arms secured on arm boards. Incisions of about 5 mm are placed on the medial and lateral aspects of the breast, approximately 1–2 cm above the infra-mammary fold. A tumescent solution, usually
consisting of 1 litre of Lactated Ringer’s, 30 ml of 1% lidocaine and one ampule of epinephrine, is infiltrated bilaterally. Straight cannulas of 3 and 4 mm are used in a criss-cross fashion to obtain an adequate and symmetric breast reduction.
Outcomes of Liposuction-Assisted Breast Reduction Surgery
The outcomes of liposuction breast reduction in over 200 women was reported by Grey. The average volume suctioned was 850 ml from each breast, with an average reduction in the nipple-to-sternal notch distance of 6 cm. All patients reported resolution of preoperative symptoms. There were no reported infections, loss of nipple sensation, skin loss, or inability to breastfeed.
One hematoma and one seroma occurred, and one post-liposuction bilateral mastopexy and three breast cancer-associated unilateral mastopexies were performed.
Another outcome study in liposuction breast reduction was undertaken by Moskovitz and others. Of the 78 patients who responded to the survey, 93% reported resolution of shoulder pain, 96% reported elimination or improvement of intertrigo (skin rash in the breast fold), 88% reported elimination or improvement in their shoulder ruts, and 72% reported improvement in their posture. Seventy percent of the patients reported a decrease in ptosis (breast droop), while 24% stated that ptosis was unchanged and 6% felt it had worsened.
Overall patient satisfaction was high, with 92% stating that they would recommend this technique to a friend and 87% claiming that they would choose this method again.
In an appropriately selected patient population, liposuction breast reduction is considered to be a reasonable alternative to traditional breast reduction techniques. While postoperative nipple position and degree of ptosis correction is unpredictable, this technique does provide the advantages of significantly smaller scars, high patient satisfaction, and an overall lower rate of complications.
