Large pendulous breasts suck. They give you neck pain, shoulder pain, rashes under your breasts. You hunch over due to the weight and droopiness. Forget about jogging. Oh, and the lovely feeling of the breast sticking to your skin on a warm summer night. But the scars of a breast reduction aren’t so nice either, particularly the large anchor style scar of the inferior pedicle technique. (Please do see my lollipop, shorter scar on my vertical breast reduction.)
So you hear about a breast reduction by liposuction with no scar, easier recovery, and can reduce my breast size by 30-50%? Sounds fantastic! Great! Sign me up!
I saw a woman recently for a breast reduction. She presented to me with chronic pain and large, pendulous breasts which were rock hard. She is a smart woman But even she, who is a doctor, was pulled in by the media, hype, flashy office, promise of no scar and quick recovery.
I have to be honest. I went to our national meeting and saw beautiful results of breast reduction by liposuction. I left the meeting and thought, I should look into that. The next day I met my patient. I have never in my decade of private practice seen a breast like hers. It was droopy, hard, painful. She relates to me her story. “I researched the procedure and talked to a few plastic surgeons. I work a lot, and couldn’t take weeks of downtime. I wanted to do something where I would heal quickly. They had a hard time getting the fat out of me. Afterwards, I am bigger than I was before. I have chronic pain throughout the breast every day. I wish I could go back in time.”
Liposuction of the breast has issues.
1. It does not lift. A major benefit of a traditional breast reduction is the lift you get. Most women want the reshaping, firming, and lifting as much as they want the reduction in size. Some surgeons advocate when you remove tissue, the weight of the breast is lighter, so the skin will lift. In younger patients with good skin tone, this may be true. But this leads to the second issue…
2. Breasts, particularly young breasts, have a lot of breast tissue. Breast tissue is dense, firm, and won’t reduce with liposuction. Liposuction can only remove fat. So for many 18 year olds with large breasts, liposuction is not an option as a significant portion of their breast is not fat. Older women (read 60s, 70s, 80s) breasts are mostly fat. But then the liposuction will not correct the drooping, just reduce the size.
3. The lift is important. What bothers large breasted women is neck pain, back pain, poor posture. A study came out of Sweden (where they have nationalized healthcare and it is easier to study such things) showing the act of LIFT improved symptoms. In other words, even if the breasts were not reduced, the pure act of lifting them improved symptoms.
4. What happens to breast tissue when you liposuction? Particularly ultrasonic or laser liposuction? We always worry when we do anything to the breast about
- cancer. could this increase the rate of cancer?
- imaging to look for cancer. could this obscure cancers? give us calcifications?
5. Pathology. Whenever I remove any breast tissue, I always send it to pathology. Rate of breast cancer in women is 1 in 6. When liposuction is done, the tissue is sheared, you have no idea where it came from in the breast, and it usually is not even sent to pathology.
So. I do a lot of liposuction. I have written a chapter in a major plastic surgery 7 volume set on liposuction. I am a fan. But when it comes to the breast, I am timid. The issues I listed are real. And after having met my patient, who is a 50 year old woman with rock hard, scarred, abnormal, painful breasts, I have to wonder if the scar is so bad.