graydrBy Lawrence N. Gray, physician MD

Lipoplasty-only breast reduction can result in an average reduction of two cup sizes. It is as effective as traditional surgery for eliminating symptoms and significantly reduces scarring and complications. This procedure allows women to retain nipple sensation and the ability to breast feed. The author, who uses this method of breast reduction exclusively, describes his technique and results over a four-year period. (Aesthetic Surg J 2001;21:273-276.)

Reduction mammaplasty, one of the most common plastic surgery procedures, is extremely effective in eliminating back, neck, and shoulder pain. Unfortunately, the traditional method of breast reduction may lead to patient dissatisfaction. Complications including infection, hematoma, seroma, dehiscence, fat necrosis, and skin loss may occur in as many as 50% of patients.(1) Unacceptable scarring has also been reported.(2) In addition, reduction mammoplasty may result in diminished nipple sensation, poor shape, and the inability to breast feed. Patients not only desire relief from symptoms but also want procedures with low risk, quick recovery, and minimal scarring. Recent meetings and papers have focused on shortening the scar in reduction mammaplasty; lipoplasty-only breast reduction (LOBR) represents the ultimate in short scars.

Lipoplasty has been used successfully to treat gynecomastia and minor breast hypertrophy(3,4) and has been used in conjuction with excisional techniques.(5,6) Because the breast is more than 70% fat in the lateral and preaxilllary areas and 61% fat in the central breast area, significant reduction is possible with lipoplasty alone.(7) Previously, I reported on its use in 45 patients.(8)

For patients older than 40 years, preoperative mammograms should be obtained before LOBR. Mammograms may also be helpful for estimating fat content in other patients. Patients receive tumescent anesthesia with sedation; the tumescence provides maximum distention of the gland and connective tissue. One liter of lactated Ringer’s solution is mixed with 400 mg of lidocaine and one ampule of 1:1000 epinephrine; the average breast requires 2 L.

fig1Figure 1
Lipoplasty is then performed through a medial and lateral stab incision along the inframammary fold (Figure 1). The entire breast and the subcutaneous fat are treated with 2-, 3-, and 4-mm straight and angular cannulas. I have tried internal and external ultrasonography as well as oscillating cannulas without any noticeable benefits. Because the entire procedure is usually performed in less than one hour and results in minimal blood loss, it is frequently performed along with other procedures.

After the procedure, patients wear a surgical bra for the first week, followed by a sports bra for one month. Drains and taping are not used. Patients have minimal restrictions, similar to those imposed after other lipoplasty procedures, and usually return to normal activity within the week. After surgery, firmness in the breast is managed with massage.

fig2Figure 2
From 1996 through 2000, I performed 475 LOBR procedures that resulted in 100% symptom relief without nipple numbness. More than 30% of my patients had declined traditional reductions because of concerns about scarring and potential complications. Lipoplasty is the only method of reduction I perform, and I have found it to be successful in all patients, young and old, including patients with diabetes, hypertension, mental or physical impairments, keloids, and in patients who smoke (Figures 2, 3, and 4).

The average volume removed per breast is 800 ml (range 250 to 2650 mL). The average breast reduction is two cup sizes. The skin envelope has contracted in all patients as a result of the volume removed and the superficial lipoplasty of the skin.

fig3Figure 3
The average nipple retraction in relation to the sternal notch is 6 cm (range 2 to 13 cm). All enlarged areolas were noted to contract. Among 92 women who had simultaneous procedures, most commonly lipoplasty of the abdomen, no associated complications occurred.

Women have been able to breast feed after having this procedure. Mammogram results are improved, compared with those after traditional breast reductions, showing increased density without any worrisome microcalcifications. Six patients who had previous traditional breast reductions noted that lipoplasty resulted in an easier recovery.

Complications have been rare, and when they occurred, minimal: three seromas responded to aspiration, and one hematoma and a minor skin loss healed without further surgery. Two patients required additional reduction. One of the early patients underwent a secondary lipoplasty, and the other patient had a unilateral traditional breast reduction when her mammogram and magnetic resonance imaging scan showed virtually no fat. Five bilateral mastopexies were performed subsequently.

fig4Figure 4
LOBR has proven to be as effective as traditional surgery for eliminating symptoms and has significantly reduced scars and complications. It results in moderate skin tightening, and patients rarely request a mastopexy. Most patients are not concerned with achieving ideal nipple position. They appreciate significant financial savings from a brief outpatient procedure that is covered by most insurance policies and allows a quick return to normal activity. Both patients and surgeons will appreciate that additional procedures can be performed at the time of LOBR without an increase in the risk of complications.

References
  1. Davis GM, Ringler SL, Short K. Sherrick D, Bengtson BP. Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction. Plast Reconstr Surg 1995; 96:1106-1110.
  2. Cruz-Korchin NI. Effectiveness of silicone sheets in the prevention of hypertropic breast scars. Ann Plast Surg 1996;37:345-348..
  3. Teimourian B, Massac E, Wiegering CE. Reduction suction mammoplasty and suction lipectomy as an adjunct to breast surgery. Aesthetic Plast Surg 1985;9:97-100..
  4. Matarasso A, Courtiss EH. Suction mammaplasty: the use of suction lipectomy to reduce large breasts. Plast Reconstr Surg 1991;87:709-717..
  5. Toledo LS, Matsudo PK. Mammaplasty using liposuction and the periareolar incision. Aesthetic Plast Surg 1989;9:97-100..
  6. Lejour M. Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg 1994;94:100-114..
  7. Cruz-Korchin N, Lorchin L, Climent C, Diez E, Gonzalez C. Macromastia: how much of it is fat? Poster exhibit, Annual Meeting, ASPS, 1999..
  8. Gray LN. Liposuction breast reduction. Aesthetic Plast Surg 1998;22:159-162..

Copyright ©2001 by The American Society for Aesthetic Plastic Surgery, Inc. Reprinted from the May/June 2001 Aesthetic Plastic Surgery Journal by permission of Lawrence N. Gray, MD.