It is worth commenting that, while there may be a handful of approaches to doing a breast augmentation, there are about a hundred techniques described over the years for breast reduction. Few have been subjected to rigorous evaluation with measurements. We know now that the vertical technique fares better than the alternatives in terms of projection, upper pole projection, and aesthetic lower poles.

Can breasts be reduced by liposuction? Yes. In fact, for about half my male patients this is the procedure of choice. However, with liposuction there is no removal of extra skin and skin contraction is limited, so the trade-off is no scars but a looser skin envelope. Most women would rather not have a saggy breast after surgery, even if this means accepting more scars on the skin. A tight, perky breast with a shape more resembling that which she had before the effects of pregnancy and gravity over the years is a worthwhile justification for the scars.

There are tremendous differences in how breast reduction surgery is performed, the operative setting, the length of surgery, and the results from operator to operator. This is why when patients tell me, "My sister had a breast reduction and …," I find I have to address possible misconceptions. It is almost better if the patient did not have this knowledge because it may inaccurately color her perception of what to expect. I find myself explaining all the technical improvements we have incorporated to make this a more patient-friendly procedure. In fact our breast reduction patients usually experience less discomfort after surgery than our breast augmentation patients do and recover just as quickly. They are back at work about a week after surgery.

This is not an operation for a surgeon who does not have extensive plastic and cosmetic surgical training, or one who performs this surgery only once or twice a year. Expert judgment is necessary to obtain excellent results. Overresection or poor execution using older techniques can lead to bad outcomes. It is possible for part or all of the nipple or large areas of skin to be lost, necessitating additional surgery.

Expertise in Breast Reduction

An experienced surgeon will be very attentive to maintaining blood supply to the tissues, particularly the pedicle supporting the nipple, during the operation. Surgical times should not be over three hours. Blood transfusions should not routinely be needed. A dilute solution containing local anesthetic and epinephrine is injected into the breast tissue to reduce blood loss. The surgery is done under an intravenous sedation anesthetic, using a laryngeal mask airwary (LMA), with no intubation, paralysis, gas, or mechanical ventilation. Sequential compression devices are used to help prevent blood clots from forming in the legs during surgery. The surgery usually takes two hours and patients go home the same day.

The operation is very similar to a breast lift. The incisions are the same. Rather than removing just extra skin and a small amount of breast tissue, a substantial volume of extra fat and breast tissue is removed simultaneously.

How much breast tissue is removed? If less than 300 grams is removed, I regard the procedure as more of a lift, and less of a reduction. Insurance companies use 500 grams as their guide. The average resection volume in my practice is about 525 grams per side, but occasionally I remove over 1000 grams per side.

Photographs Shortly After Surgery - Breast Reduction

Portrait, S.K. before and five days after breast reduction.

Portrait, A.D. before and five days after breast reduction