Liposuction Only Breast Reduction Treatment & Management

No medical therapy is available for breast hypertrophy.^[13] 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.

• 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

Surgical details

• Make a stab incision just above the lateral aspect of the inframammary fold.The skin is pierced 2 cm above the inframammary fold, in the mid line.
• 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. The right breast is infiltrated up to tumescence with solution; the left breast already has been infiltrated.
• 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.
• The material suctioned from the breast appears as a yellow, fatty, bloodless fluid and is removed easily.The material suctioned from the breast appears as a yellow, fatty, bloodless fluid.
• Stop the suction when the goal aspirate is reached or an unacceptably bloody aspirate is obtained.Appearance of the right breast after a liposuction of 700 mL. Appearance of both breasts at the end of the procedure. The liposuction of the right breast is 700 mL; the liposuction of the left breast is 600 mL.
• 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.
• The procedure ends with a moulding dressing using elastic foam tape.At the end of the procedure, elastic tape is used to mould the breast in the new shape and position.

• 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.

• 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.

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.^{[14, 13]}

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.

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.^[15]

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.^[16] Moskovitz answered this criticism with the observation that a change in breast density is a common finding after any reduction mammaplasty.^[17]

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.^[18] 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.