I am writing this article because I am here to educate, even if don’t like what the article is saying. This was a journal article “Breast Reduction versus Breast Reduction Plus Implants: A Comparative Study with Measurements and Outcomes.” In this study they were looking at breast reductions, and discussing how adding an implant increases the fullness in the upper pole (the cleavage area which you see out of the top of your bra). They wanted to see 1. what was the difference in fullness? and 2. was this combination okay in terms of safety and complications.
The study was done on 80 consecutive patients. All women had vertical breast lifts (my favorite- the short scar technique which I do, which isn’t the traditional anchor scar, Wise pattern, inferior pedicle technique.) The author stated it has been shown the inferior pedicle breast reductions don’t give good projection of the breast and upper pole fullness, so he did not use that technique in the comparison, and used only the vertical lift.
What did he find?
- There was more upper pole projection in women with implants
- Pain was higher for patients who got the implants
- There was no difference in nipple numbness
- The women who did not put in implants had larger amounts removed (about 490g) vs. those who got the implants (370g)
- The average implant placed was 334cc
- No difference in overall complications. No implants were removed.
In his discussion, he cites other studies which show large breasted women get significant improvement in symptoms from small breast reductions (<400g), likely from the correction of the droopiness. (I totally agree with this.) There are decreases in back, shoulder and neck pain. Improvement in the ability to exercise. He concludes, breast reduction with implants is safe and effective, and a good option for women who want to restore upper pole fullness.
I will write briefly on this, but I want to be clear :
I do not like to put in implants on large breasted women to add the fullness in the upper pole.
With the vertical technique I see some variability, but the shape and lift I obtain tend to be great. The author has not followed the study out for years, and I urge he do so. Over time, natural tissue ages, and implants do not. The breast tissue starts to droop, and “falls off” the underlying implant. I have fixed many women with this issue: the implant sits up nice and perky, but the natural C cup, D cup, or more of tissue has slid off the underlying implant. This is sometimes called the Snoopy deformity. A breast implant adds pain, cost, weight, and a new host of issues which are implant related- implant deflation, migration, hardening- not to mention a guarantee you will need another surgery down the road. He did not have to remove an implant, but losing an implant to infection or extrusion is likely if reductions with implants is done on a wide scale.
Breast lifts with implants is a different story. These are women who do not have the breast size they want. They need the implant for volume. As they have little natural tissue, there is less differential aging of breast tissue vs. implant, so less risk of the Snoopy deformity. Large breasted women seeking breast reduction do not need volume. They want less. I agree it is safe to do a reduction with an implant. I acknowledge it gives more upper pole fullness. I just think the benefit in those areas doesn’t outweigh the negatives.
My general rule of thumb: use implants if you need volume, not for shape.