Liposuction Only Breast Reduction Treatment & Management
- Author: Francesca Romana Grippaudo, MD, PhD; Chief Editor: James Neal Long, MD, FACS more...
No medical therapy is available for breast hypertrophy. A reduction diet is advised for patients who are overweight.
Reduction mammaplasty is the only known method of diminishing the size of the breast. It can be achieved with "open" techniques or in selected patients with liposuction only.
See the list below:
Evaluate skin elasticity and the degree of ptosis during the consultation.
Inform the patient about possible alternatives to reduce the hypertrophic breast and correct associated ptosis. Discuss open reduction techniques with parenchymal removal and skin resection as well as the related sequelae (ie, scars, possible loss of sensation, possible impairment to lactation).
Discuss possible complications and give the patient the opportunity to view pictures of average results of the described procedures. Answer all questions to give the patient realistic expectations.
Inform patients that should suction alone fail, a secondary mammaplasty procedure can be performed subsequently.
Breast liposuction can be a day hospital procedure or an overnight procedure, depending on the amount of fat tissue to be removed and the health or preference of the patient. It usually is performed under general anesthesia.
With the patient sitting fully erect, record the distance between the jugular notch and the nipple and from the nipple to the inframammary fold.
Record the presence of asymmetry.
No preoperative markings are required.
Position the patient on the operating table in a supine position. The arms are abducted to fully expose the breasts.
Infiltrate a solution in the deep and superficial plane of the breast. It is prepared freshly as follows:
Plain 0.5% bupivacaine (Marcaine), 20 mL, or plain lidocaine 2%, 20 mL
Epinephrine, 1:1,000,000-1:500,000 (1-2 mg) in 1 L of normal saline solution
See the list below:
In very large breasts, make a supplementary incision just above the medial aspect of the inframammary fold. This placement permits the surgeon the opportunity of conversion into a standard inferior pedicle reduction in the event of inadequate results after the lipoaspiration.
Perform pretunneling using the same blunt-tipped multihole cannula used to deliver the solution.
Begin infiltration in the deep plane and complete it superficially. Use an intravenous pressure bag to hasten the procedure. Widely infiltrate all the breast area with 800-1000 mL of fluid until the tissues become firm.
To achieve good vasoconstriction, wait 15 minutes before starting the procedure.
Use a blunt 4-mm cannula connected either to a medical grade vacuum device or to a syringe to suction the fat with fan-shaped movements, starting in the deep plane and ending superficially.
Stop the suction when the goal aspirate is reached or an unacceptably bloody aspirate is obtained.
At the end of the procedure, use a blunt 3-mm cannula that is not connected to a suction device to undermine the superficial layer of fat. This undermining is performed mostly in the medial and lateral upper areas of the breast. The purpose of this maneuver is to stimulate a controlled scar retraction to correct ptosis.
See the list below:
Recovery is quick, with most patients returning to everyday activities on the second day.
Patients are required to undergo a postoperative check at day 3 when the dressing is changed, and they are asked to wear a brassiere for 30 days.
See the list below:
Discharge the patient the same day or the day after surgery.
Instruct patients to shower from the third day postoperatively and encourage them to resume normal activities after the third day postoperatively.
Inspect the wounds after 1 week on an outpatient basis.
During the first week, the patient wears a crop top bra continuously, later exchanged for a normal support bra, which is worn continuously for at least 2 months. Make clear to every patient the importance of the moulding action obtained from wearing a support bra.
Except in very young patients in whom radiation is an issue, obtain a baseline postoperative mammogram in all patients 6 months following surgery to delineate changes that are due to surgery alone.
Early complications include the following:
Infections, which may require antibiotic therapy
Hematoma, which may require prompt drainage
Late complications include an unsatisfactory volume reduction, requiring a secondary revision.
Outcome and Prognosis
Liposuction reduction mammaplasty has proved to be an acceptable and satisfactory technique for a select group of patients. The procedure usually is well tolerated and the recovery much shorter than with open reduction mammaplasty.
Moskovitz' 2004 study investigating the outcome of liposuction-only breast reduction showed that the average time for patients to resume work is less than a week and to resume full exercise is 2 weeks, a much shorter time compared to that of other reduction mammaplasty techniques.
The breast usually is edematous and bruised in the immediate postoperative period.
As with other liposuction procedures, the final results are best evaluated after 6 months, although edema usually subsides 2-3 weeks postoperatively.
To date, no instance of tissue necrosis has been reported. Alteration of nipple sensation has been reported only rarely.
Long-term satisfaction rate generally is high, provided that the indications for this technique are respected with proper patient selection.[17, 16]
The situation in which the patient, happy with the scarless outcome, refuses a secondary procedure proposed by the surgeon to correct a residual ptosis of the breast or for a further reduction is not unusual.
Future and Controversies
Ultrasonic liposuction (UAL) of the female breast, proposed by some authors as an effective procedure, still remains a controversial topic because of the theoretical effects of "soft radiation." Traditional liposuction methods of the female breast do not have this possible drawback.
A 2003 investigation by Di Giuseppe showed no evidence of a suspect mass or calcifications in a group of patients treated with UAL of the breast and evaluated with mammographic studies during a 4-year follow-up period.
In 2005, Brauman warned of the change in breast density occurring after liposuction, claiming that breast cancer is more difficult to detect in a denser breast. Moskovitz answered this criticism with the observation that a change in breast density is a common finding after any reduction mammaplasty.
Whether to send the material aspirated in a liposuction mammaplasty to a pathologist for examination is an open question.
After an open reduction mammaplasty, the removed tissue is routinely sent to the pathologist for examination. After a breast liposuction, it is possible for the pathologist to examine the aspirated material.
Several studies have demonstrated this material to be only fat in up to 99% of patients. In the few patients in whom breast parenchyma cells were found, determining the location in the breast was impossible. For this reason, obtaining a preoperative mammogram is mandatory, not only to screen for the patient's eligibility for the procedure but also to detect evidence of cancer.
Jakubietz et al critically evaluated the literature on liposuction breast reduction. Their findings showed an unanimously high patients satisfaction with this safe and faster procedure compared with traditional resection techniques, the latter offering the advantage of a better shape control of the breast.
The debate is still open whether is preferable to achieve a better breast shape and a scar or a scarless procedure with a limited control on final shape improvement.
For excellent patient education resources, see eMedicineHealth's patient education article Liposuction.
Goes JC, Landecker A. Ultrasound-assisted lipoplasty (UAL) in breast surgery. Aesthetic Plast Surg. 2002 Jan-Feb. 26(1):1-9. [Medline].
Benelli L. A new periareolar mammaplasty: the "round block" technique. Aesthetic Plast Surg. 1990 Spring. 14(2):93-100. [Medline].
Lassus C. Breast reduction: evolution of a technique--a single vertical scar. Aesthetic Plast Surg. 1987. 11(2):107-12. [Medline].
Lejour M. Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg. 1994 Jul. 94(1):100-14. [Medline].
Boni R. Tumescent power liposuction in the treatment of the enlarged male breast. Dermatology. 2006. 213(2):140-3. [Medline].
Hodgson EL, Fruhstorfer BH, Malata CM. Ultrasonic liposuction in the treatment of gynecomastia. Plast Reconstr Surg. 2005 Aug. 116(2):646-53; discussion 654-5. [Medline].
Rohrich RJ, Ha RY, Kenkel JM. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003 Feb. 111(2):909-23; discussion 924-5. [Medline].
Samdal F, Kleppe G, Amland PF, Abyholm F. Surgical treatment of gynaecomastia. Five years' experience with liposuction. Scand J Plast Reconstr Surg Hand Surg. 1994 Jun. 28(2):123-30. [Medline].
Stark GB, Grandel S, Spilker G. Tissue suction of the male and female breast. Aesthetic Plast Surg. 1992 Fall. 16(4):317-24. [Medline].
Song YN, Wang YB, Huang R, et al. Surgical treatment of gynecomastia: mastectomy compared to liposuction technique. Ann Plast Surg. 2014 Sep. 73 (3):275-8. [Medline].
Matarasso A, Courtiss EH. Suction mammaplasty: the use of suction lipectomy to reduce large breasts. Plast Reconstr Surg. 1991 Apr. 87(4):709-17. [Medline].
Rohrich RJ, Gosman AA, Brown SA. Current preferences for breast reduction techniques: a survey of board-certified plastic surgeons 2002. Plast Reconstr Surg. 2004 Dec. 114(7):1724-33; discussion 1734-6. [Medline].
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.
Abboud MH, Dibo SA. Power-Assisted Liposuction Mammaplasty (PALM): A New Technique for Breast Reduction. Aesthet Surg J. 2015 Jul 24. [Medline].
Wong KY, Malata CM. Conventional versus ultrasound-assisted liposuction in gynaecomastia surgery: a 13-year review. J Plast Reconstr Aesthet Surg. 2014 Jul. 67 (7):921-6. [Medline].
Sadove R. New Observations in Liposuction-Only Breast Reduction. Aesthetic Plast Surg. 2005 Mar 9. [Medline].
McMahan JD, Wolfe JA, Cromer BA, Ruberg RL. Lasting success in teenage reduction mammaplasty. Ann Plast Surg. 1995 Sep. 35(3):227-31. [Medline].
Di Giuseppe A. Breast reduction with ultrasound-assisted lipoplasty. Plast Reconstr Surg. 2003 Jul. 112(1):71-82. [Medline].
Brauman D. Liposuction breast reduction. Plast Reconstr Surg. 2005 Oct. 116(5):1558-9; author reply 1559-61. [Medline].
Moskovitz MJ, Muskin E, Baxt SA. Outcome study in liposuction breast reduction. Plast Reconstr Surg. 2004 Jul. 114(1):55-60; discussion 61. [Medline].
Jakubietz RG, Jakubietz DF, Gruenert JG, et al. Breast reduction by liposuction in females. Aesthetic Plast Surg. 2011 Jun. 35(3):402-7. [Medline].
Moskovitz MJ. Liposuction breast reduction: reply. Plast Reconstr Surg. 2005. 116(5):1559-1561.