eMedicine Specialties > Plastic Surgery > Breast

Breast Reduction, Liposuction Only

Author: Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy
Coauthor(s): Daniel Christopher Kennedy, MBBS, FRACS, Consultant Surgeon, Unit Head Supervisor of Surgical Training, Department of Plastic and Reconstructive Surgery, Mater Public Hospital; Director of Medical Services, Pacific Day Surgery
Contributor Information and Disclosures

Updated: Jul 7, 2009

Introduction

Traditional methods of breast reduction involve remodeling the breast mound based on an inferior, superior, or central pedicle and then trimming and redraping the skin over the new shape. Unfortunately, these techniques necessitate long scars. Minimizing scars in breast surgery has been an important goal in the previous 2 decades, with many techniques developed specifically for this purpose.1

Among them is round block mammaplasty, described by Benelli in 1990, which produces only a periareolar scar.2 In 1987, Lassus modified a technique described in the mid 1960s, producing a periareolar and vertical scar.3 In the late 1980s, Lejour applied suction lipectomy as an adjuvant to surgical resection in female macromastia.4

Liposuction is one of the most commonly performed procedures in plastic surgery and has been used safely in many body regions. Several authors have reported on the safety and efficacy of suction lipectomy, power-assisted liposuction, and ultrasound-assisted lipoplasty in gynecomastia.5,6,7,8,9

In 1991, Matarasso and Courtiss described their results using suction mammaplasty to reduce moderate breast hypertrophy in the absence of ptosis.10 In 1993, Williams suggested liposuction of the breast to treat a unilateral hypertrophy in an adolescent breast maldevelopment.11

Skin retraction secondary to scarring in the superficial plane where traditional or superficial liposuction is performed is a well-known phenomenon; a controlled iatrogenic tightening of the skin envelope is produced.

In 1997, the authors reported their experience in extending the indications to liposuction of the female breast in selected patients, even in large breast hypertrophy (resection >800 g).12 Others have reported on breast reduction in females by liposuction-assisted procedures.

In 2004, Rohrich and colleagues reported that liposuction-only breast reduction has become one of the current techniques for breast reduction, with satisfactory results for both surgeons and patients.11

For information on other breast reduction techniques, see the Breast section of eMedicine's Plastic Surgery journal.

Problem

Female breast hypertrophy or macromastia is a condition of abnormal enlargement of the breast tissue in excess of the normal proportion.

This condition may be caused by gland hypertrophy, excessive fatty tissue, or a combination of both. It varies in severity from mild (<300 g) to moderate (300-800 g) to severe (>800 g).

Macromastia can be unilateral or bilateral and can occur in combination with ptosis, a term used when the nipple has descended below the inframammary crease.

Etiology

Large breasts frequently develop during pubertal breast development but also occur after pregnancy, weight gain at any age, or menopause.

Macromastia typically is caused by fat hypertrophy rather than glandular hypertrophy. Many females are destined genetically to have large breasts, which often is aggravated by pregnancy or weight gain. Iatrogenic causes include asymmetry following a mastectomy or lumpectomy. Rarely, a young patient may experience virginal mammary hypertrophy resulting in massive breast hypertrophy and a high recurrence rate following a reduction procedure.

Presentation

The typical patient presents with back pain, neck pain, breast pain, embarrassment, difficulty with sports, and clothing limitations. Those with more ptotic breasts develop intertrigo. Poor posture is common, and grooving of the shoulder from the force of the bra strap may occur. The patient may be overweight.

Indications

Breast liposuction is indicated when a minor-to-moderate reduction is requested and no ptosis correction is required. Other indications include the following:

  • Selected women needing larger reduction who do not want the scar associated with an open reduction or loss of sensation in their breasts and are willing to accept some ptosis
  • As a secondary mammaplasty procedure rather than an open revision
  • For asymmetry up to 1 cup size
  • In young patients with virginal hypertrophy, a condition with a high recurrence rate, as a temporary procedure before the end of the growth phase

Relevant Anatomy

The female breast normally grows during puberty under the influence of estrogen and progesterone. It is formed by 15-20 lobules of glandular tissue, each drained by a lactiferous duct. Each duct has an opening on the nipple. These lobules constitute the mammary gland and are interspersed with fat lobules.

This fat tissue confers the rounded contour and most of the bulk of the breast (approaching 90%), except during pregnancy and lactation.

The abundant blood supply to the breast comes from perforators from the internal thoracic artery, external thoracic artery, thoracodorsal artery, and the third to fifth intercostal arteries.

Lateral and anterior cutaneous branches of the second to sixth intercostal nerves supply innervation of the breast. The third and fourth intercostal nerves most frequently innervate the nipple, but variations occur.

Any pattern of breast reduction involving parenchymal excision may disrupt nipple-areola sensation.

Contraindications

Mammography demonstrating breast hypertrophy to be mostly glandular contraindicates this procedure. Liposuction reduction mammaplasty is contraindicated in any female with mammographic findings that raise suspicion. Presence of ptosis and poor skin condition with little tissue elasticity also are contraindications to this procedure.

More on Breast Reduction, Liposuction Only

Overview: Breast Reduction, Liposuction Only
Workup: Breast Reduction, Liposuction Only
Treatment: Breast Reduction, Liposuction Only
Follow-up: Breast Reduction, Liposuction Only
Multimedia: Breast Reduction, Liposuction Only
References
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References

  1. Goes JC, Landecker A. Ultrasound-assisted lipoplasty (UAL) in breast surgery. Aesthetic Plast Surg. Jan-Feb 2002;26(1):1-9. [Medline].

  2. Benelli L. A new periareolar mammaplasty: the "round block" technique. Aesthetic Plast Surg. Spring 1990;14(2):93-100. [Medline].

  3. Lassus C. Breast reduction: evolution of a technique--a single vertical scar. Aesthetic Plast Surg. 1987;11(2):107-12. [Medline].

  4. Lejour M. Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg. Jul 1994;94(1):100-14. [Medline].

  5. Boni R. Tumescent power liposuction in the treatment of the enlarged male breast. Dermatology. 2006;213(2):140-3. [Medline].

  6. Hodgson EL, Fruhstorfer BH, Malata CM. Ultrasonic liposuction in the treatment of gynecomastia. Plast Reconstr Surg. Aug 2005;116(2):646-53; discussion 654-5. [Medline].

  7. Rohrich RJ, Ha RY, Kenkel JM. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. Feb 2003;111(2):909-23; discussion 924-5. [Medline].

  8. Samdal F, Kleppe G, Amland PF, Abyholm F. Surgical treatment of gynaecomastia. Five years' experience with liposuction. Scand J Plast Reconstr Surg Hand Surg. Jun 1994;28(2):123-30. [Medline].

  9. Stark GB, Grandel S, Spilker G. Tissue suction of the male and female breast. Aesthetic Plast Surg. Fall 1992;16(4):317-24. [Medline].

  10. Matarasso A, Courtiss EH. Suction mammaplasty: the use of suction lipectomy to reduce large breasts. Plast Reconstr Surg. Apr 1991;87(4):709-17. [Medline].

  11. Rohrich RJ, Gosman AA, Brown SA. Current preferences for breast reduction techniques: a survey of board-certified plastic surgeons 2002. Plast Reconstr Surg. Dec 2004;114(7):1724-33; discussion 1734-6. [Medline].

  12. Grippaudo FR, Kennedy DC. Liposuction reduction mammaplasty using the tumescent technique. Proceedings of 8° European Congress of IPRAS;. June 22-25, 1997;Lisbon, Portugal. 120.

  13. Sadove R. New Observations in Liposuction-Only Breast Reduction. Aesthetic Plast Surg. Mar 9 2005;[Medline].

  14. McMahan JD, Wolfe JA, Cromer BA, Ruberg RL. Lasting success in teenage reduction mammaplasty. Ann Plast Surg. Sep 1995;35(3):227-31. [Medline].

  15. Di Giuseppe A. Breast reduction with ultrasound-assisted lipoplasty. Plast Reconstr Surg. Jul 2003;112(1):71-82. [Medline].

  16. Brauman D. Liposuction breast reduction. Plast Reconstr Surg. Oct 2005;116(5):1558-9; author reply 1559-61. [Medline].

  17. Moskovitz MJ, Muskin E, Baxt SA. Outcome study in liposuction breast reduction. Plast Reconstr Surg. Jul 2004;114(1):55-60; discussion 61. [Medline].

  18. Abboud M, Vadoud-Seyedi J, De Mey A, et al. Incidence of calcifications in the breast after surgical reduction and liposuction. Plast Reconstr Surg. Sep 1995;96(3):620-6. [Medline].

  19. Baker TM, Stuzin JM, Baker TJ, Gordon HL. What's new in aesthetic surgery. Clin Plast Surg. Jan 1996;23(1):3-16. [Medline].

  20. Brauman D. Reduction mammaplasty by suction alone [letter; comment]. Plast Reconstr Surg. Dec 1994;94(7):1095-6. [Medline].

  21. Courtiss EH. Reduction mammaplasty by suction alone. Plast Reconstr Surg. Dec 1993;92(7):1276-84; discussion 1285-9. [Medline].

  22. Gasparotti M. Superficial liposuction: a new application of the technique for aged and flaccid skin. Aesthetic Plast Surg. Spring 1992;16(2):141-53. [Medline].

  23. Goddio AS. Skin retraction following suction lipectomy by treatment site: a study of 500 procedures in 458 selected subjects. Plast Reconstr Surg. Jan 1991;87(1):66-75. [Medline].

  24. Gorney M. Caveat against using ultrasonically assisted lipectomy in aesthetic breast surgery [letter; comment]. Plast Reconstr Surg. May 1998;101(6):1741. [Medline].

  25. Gray LN. Liposuction breast reduction. Aesthetic Plast Surg. May-Jun 1998;22(3):159-62. [Medline].

  26. Klein JA. Tumescent technique for local anesthesia improves safety in large- volume liposuction. Plast Reconstr Surg. Nov 1993;92(6):1085-98; discussion 1099-100. [Medline].

  27. Matarasso A. Suction mammaplasty: the use of suction lipectomy to reduce large breasts. Plast Reconstr Surg. Jun 2000;105(7):2604-7; discussion 2608-10. [Medline].

  28. Matarasso A. Superficial suction lipectomy: something old, something new, something borrowed.... Ann Plast Surg. Mar 1995;34(3):268-72; discussion 272-3. [Medline].

  29. Moskovitz MJ. Liposuction breast reduction: reply. Plast Reconstr Surg. 2005;116(5):1559-1561.

  30. Pers M, Nielsen IM, Gerner N. Results following reduction mammaplasty as evaluated by the patients. Ann Plast Surg. Dec 1986;17(6):449-55. [Medline].

  31. Teimourian B, Massac E, Wiegering CE. Reduction suction mammoplasty and suction lipectomy as an adjunct to breast surgery. Aesthetic Plast Surg. 1985;9(2):97-100. [Medline].

  32. Williams CW. Adolescent breast maldevelopment: buying time with liposuction. Aust N Z J Surg. Dec 1993;63(12):983-4. [Medline].

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Further Reading

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Keywords

breast reduction, suction mammaplasty, liposuction-only mammaplasty, breast liposuction, liposuction breast reduction, breast reduction scar, breast reduction scarring, round block mammaplasty, suction lipectomy, macromastia, power-assisted liposuction, ultrasound-assisted lipoplasty, UAL, gynecomastia, breast anatomy, breast tissue, reduction mammaplasty, breast ptosis, skin elasticity, hypertrophic breast

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Contributor Information and Disclosures

Author

Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy
Francesca Romana Grippaudo, MD is a member of the following medical societies: International Confederation for Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel Christopher Kennedy, MBBS, FRACS, Consultant Surgeon, Unit Head Supervisor of Surgical Training, Department of Plastic and Reconstructive Surgery, Mater Public Hospital; Director of Medical Services, Pacific Day Surgery
Daniel Christopher Kennedy, MBBS, FRACS is a member of the following medical societies: Australian Medical Association and Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Pankaj Tiwari, MD, Assistant Professor, Division of Plastic Surgery, Ohio State University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Saleh M Shenaq, MD†, Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston
Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law Medicine and Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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