By 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.
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.