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Many, but not all people, with enlarged breasts are eligible to undergo liposuction-only surgery for this condition with several advantages over conventional breast reduction techniques.

Here are the major benefits of liposuction alone, as compared with the standard, open procedure:

• Less scarring. The 12-inch incisions from standard breast-reduction surgery discourage many people who otherwise might seek help for undesirably large breasts. Liposuction requires a single, half-inch incision in the crease under each breast.
• Faster recovery. Less postoperative pain and bruising makes recovery easier.
• No changes in nipple sensation.
• No breast-feeding problems later.
• No chance that there will be difficulty in reading future mammograms.
• Simpler method of correcting previous reduction surgery that has resulted in breasts of different sizes.

This liposuction-only breast reduction procedure is not appropriate for women whose breasts have:

• Less than 35 percent fatty tissue as indicated by a screening mammogram.
• Thin skin and stretch marks (called striae).
• Significant breast drooping, also called ptosis.

On average, at least half the breast is made up of fatty tissue. The rest is glandular tissue. Reduction is achieved by removing the fatty tissue via liposuction. The ratio of fatty tissue to glandular tissue in your breast determines how much reduction can be accomplished. In my opinion, all patients should have a screening mammogram before breast liposuction for an exact determination of the volume of fat. Just feeling the breast (called palpation) is a poor substitute for a mammogram. It is not advisable to perform liposuction for breast reduction if your breast is primarily glandular tissue, with little fat in it, because the ratio of fat-to-gland tissue limits the degree of reduction possible. This situation, however, is unusual and probably limited to less than 1 percent of patients.

When a doctor offers liposuction-only breast reduction surgery, you should make sure he or she has experience and success with the procedure. The operation is technically and aesthetically demanding and requires considerable training for the doctor to become comfortable with this approach.
The remarkable elasticity of the skin and its impressive ability to shrink toward the center of the breast, moves the nipple upward. This, along with the removal of the weight of the fat, makes liposuction-only reduction the preferred choice for most people. We first thought that women beyond their 30s would not have sufficiently elastic skin to produce a good result with liposuction of the breast. However, our results from performing liposuction on men of various ages with enlarged breasts (gynecomastia) showed that the skin shrinks well, the skin contracted nicely and conformed to the new shape. Equally important, the shrinking process repositions the nipple and its surrounding areola upward toward the center of the breast by as much as two and one-half inches. In fact, the areola itself, which has grown larger as the breast gets more pendulous, shrinks back toward a normal size.

If your enlarged breasts have extreme ptosis, conventional surgery may be required. Another option may be to undergo liposuction and to determine later if a conventional reduction is also necessary. Yet another option is to undergo liposuction in conjunction with conventional treatment. A reduction of breast volume with initial liposuction allows the use of smaller-than-usual incisions in the standard surgery that might follow.

Older Women

Because of these observations about elasticity and centripetal shrinking, we began offering liposuction-only breast reduction to older women, 60 years old and above. Older women, even in their 60s and, at times, even older, tend to be more realistic about their expectations of breast reduction surgery. If you are older, you likely will not expect to return to your teenage anatomy and can tolerate some degree of ptosis, or drooping. Older women are more focused on decreasing their breast volume than with the exact position of their areola-nipple complex, and are satisfied if this can be done with a much less invasive operation and a much shorter recovery.

Older patients tell us that they like the results of the procedure. They look thinner and feel much less matronly just from the reduction in breast volume. The liposuction-only approach also helps many patients with enlargement particularly on the side toward the armpit, called the lateral side. This condition causes their breasts to seem to float out of their bras, making the patient look very squarish. Sometimes this is one of the main reasons these patients seek surgical help. Because correctly performed breast liposuction always should be performed more aggressively on the lateral breast than the opposite or medial side, the floating breast problem often disappears with the procedure.

After liposuction-only reduction surgery, women in the older age group wear a supportive bra for three months, and the younger women wear one for one month. (A new baseline mammogram, at least six months after surgery, is also recommended.)

Potential Complications

We have not seen any complications from the liposuction-only procedure, although theoretically complications would be the same as for any type of liposuction. Infection is extremely rare. Problems of symmetry are possible. A temporary decrease in the breast’s sensitivity to stimulation is a possible side effect, as is the appearance of small bruise spots (ecchymosis).

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