Tumescent Liposuction of the Female Breast
Tumescent liposuction of the female breast totally by local anesthesia can produce both a significant breast reduction and a moderate but gratifying breast lift. The use of microcannulas permits breast reduction with minimal postoperative pain, rapid postoperative recovery, quick return to normal activities, and virtually no scaring. Not only can liposuction reduce the female breast by more than 50 percent in size, the breasts are also lifted to a significant degree.This breast lift is the result of the reduced weight of the breast, which allows the breasts' natural elastic properties to contract and produce elevation. The breasts do not change shape after tumescent liposuction, they simply become smaller and somewhat elevated. After liposuction, the breast's shape is simply a smaller version of the shape before liposuction.No Surgical Scars
Surgical scars are not visible in most patients after breast
reduction by tumescent liposuction using microcannulas. Evidence of
micro-incisions usually disappears within a few months. The use of
microcannulas permits the use of extremely small round incisions that
are 1 millimeter (approximately 1/25 of an inch) in diameter. These tiny
incisions produce scars that are much smaller than 1 millimeter and
therefore almost invisible. In contrast, traditional breast reduction is
associated with much larger scars and more visible scars. Patients
whose natural skin color is darkly pigmented can expect to have some
tiny spots of increased pigmentation at the incision sites where the
microcannula enters the skin. This post-inflammatory hyperpigmentation
usually fades away after 1 to 2 years.
Tumescent Liposuction Lifts the Breasts
Both breast reduction and breast lift can be accomplished by
tumescent liposuction. Liposuction reduces breast size in direct
proportion to the volume of fat removed. Liposuction reduces the weight
of the breast and allows the natural elastic tissue in the breast to
retract and produce a visible breast lift.
Older Techniques for Breast Reduction
Older techniques for breast reduction, known as surgical-excision
breast reduction, involved cutting the breast with a scalpel to excise
or remove large amounts of breast tissue. Problems associated with
surgical-excision breast reduction include the risk of keloids or
excessively large scars, uneven sized breasts, abnormal appearance of
the skin near the nipple, impaired nipple sensation, and possible nipple
damage. Other risks include bleeding, blood clots or hematoma in the
breast, seromas (fluid collection in the breast), fat necrosis with cyst
formation in the breast, and scarring of the deep breast tissue that
can produce mammogram abnormalities. Besides requiring general
anesthesia, breast reduction by excision is also associated with
significant pain and prolonged recovery.
Advantages of Breast Reduction
Advantages of breast reduction by tumescent liposuction using
microcannulas include 1) Rapid recovery. The typical patient can return
to work and normal social activity within two to three days after
surgery, 2) Virtually no scars, 3) Reduction of 20 to 50 percent of the
breast volume, 4) Minimal risks of postoperative complications.
Problems with Excessively Large Breasts
Excessively large female breasts cause pain and suffering, physical
impairment and psychological problems. Athletic activity is
significantly limited. Chronic changes in posture in an effort to
compensate for the weight of excessively large breasts can lead to
chronic pain in the back, neck, and shoulders. Chronic pressure from bra
straps can cause permanent indentations of the shoulders. Large breasts
can predispose women to candida yeast infections of the skin in areas
where the skin rubs together, such as between the breasts and beneath
the breasts. A woman who has very large breasts may regard them as
cosmetically undesirable. Finding a bra that fits and is comfortable may
be impossible. Clothing does not fit well.
Who is a Good Candidate?
Some women are likely to have better results than other women after
breast reduction by liposuction. Tumescent breast reduction totally by
local anesthesia is only appropriate for a certain subset of women.
However, for the appropriate patient, the results of tumescent
liposuction can be extremely gratifying. The best candidates for breast
reduction by tumescent liposuction have breasts that contain a large
proportion of fat. For example, women who have passed through menopause
typically have breasts that contain a larger proportion of fat than do
teenagers. A good candidate must also have realistic expectations.
Breasts Containing a Large Proportion of Fat
After menopause, much of the glandular tissue in the breasts is
replaced by fatty tissue, thus, old women with large breasts are usually
very good candidates for tumescent liposuction of the breasts. Young
women who continue to have menstrual periods and are somewhat overweight
might also have breasts that contain a significant amount of fat, and
therefore would also be good candidates for liposuction of the breasts.
The proportion of fat in the female breast can be determined by a
mammogram.
Realistic Expectations
Breast reduction by liposuction will produce a smaller version of
the breasts that a woman had before liposuction. One can expect the
breasts to be significantly smaller, to be elevated and to show
virtually no scars. However, the breasts' overall shape will be very
similar to their shape before liposuction. Liposuction will usually not
produce young "perky" breasts. The elevation of breast position is the
result of decreased breasts' weight and the elastic properties of the
suspensory ligaments in the breast.
Who is Not a Good Candidate?
Not every woman is a good candidate for liposuction breast
reduction. Some women have breasts that will require traditional breast
reduction surgery with large excisions and large scars. Women who are
not ideal candidates for breast reduction by liposuction include those
whose breasts contain more glandular tissue than fat tissue.
Unrealistic Expectations
Women who expect perfect breasts after liposuction breast reduction
have unrealistic expectations. For example, most women who have had a
baby, should not expect breast reduction surgery to recreate the
"perfect" breasts of a virgin. There is usually no surgical procedure
that can achieve this unrealistic goal.
Excessively Pendulous Breasts
Excessively pendulous breasts usually contain only a small
proportion of fat. If breasts that appear to sag or droop significantly
and contain only a small amount of tissue, then liposuction will not
provide satisfactory cosmetic improvement. Such "empty" breasts contain
little fat and therefore will not be improved by liposuction. Cosmetic
improvement of "empty" breasts usually requires excision of skin, as
well as breast implants.
Thin Young Women
Thin young women who have breasts containing mostly glandular breast
tissue with little fat are often not good candidates for breast
reduction by liposuction. For example, a relatively thin woman with
large breasts often has breasts that contain a high proportion of
glandular breast tissue and almost no fat. In such cases there is little
fat in the breasts and liposuction will not produce a significant
reduction.
Excessively Large Breasts
Liposuction can usually be expected to provide no more than a 55
percent reduction in breast size. Women who need more than a 55 percent
reduction in breast size might be happier with the results of
traditional surgical breast reduction surgery despite the unsightly
scars associated with the excision of skin and breast tissue.
Excessively Dense Breast Tissue
Some women have breasts that contain a large proportion of glandular
tissue, and relatively little fatty tissue. Liposuction can remove fat,
but glandular breast tissue is largely resistant to liposuction.
Fibrocystic disease of the breast can make liposuction more difficult.
However, when fibrocystic disease is only mild to moderate in degree
then some women can achieve sufficient results.
Existence of a Breast Lump
Any significant breast mass must be evaluated with a mammogram and
possibly a breast biopsy prior to breast reduction. Cosmetic breast
surgery is not appropriate until the surgeon has established that there
is a minimal likelihood of breast cancer. Breast surgery in any patient
with a significant family history of breast cancer requires very careful
consideration and detailed informed consent.
Milk Production After Breast Reduction
If a woman becomes pregnant after tumescent liposuction of the
breasts, there is a reasonable chance that she will be able to breast
feed. With the use of microcannulas, tumescent liposuction produces very
little damage to the glands and ducts that produce milk. In contrast
with breast reduction techniques that use scalpels to cutout large
portions of breast tissue, the glands and ducts are usually damaged and
blocked by excessive scar tissue that prevents milk production and
breast feeding.
Preoperative Mammograms
Preoperative mammograms should be considered in order to rule out
existing malignancies, and to establish a up-to-date baseline mammogram
with which future mammograms might be compared. Similarly, after breast
reduction, mammograms should be done within 3 to 6 months in order to
establish new base-line mammograms. With traditional breast reduction by
surgical excision, it is not uncommon to encounter postoperative
inflammatory nodules, and lipid filled pseudocysts. These conditions may
make it difficult to interpret future mammograms without good baseline
mammograms for comparison. Inflammatory nodules and pseudocysts are rare
after tumescent liposuction of the female breast.