Breasts, Female

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.