Breast of Burden; Jodi Theissen investigates three different surgical techniques for reducing breast volume.

Home » Doctor Article » Breast of Burden; Jodi Theissen investigates three different surgical techniques for reducing breast volume.

Women who want to reduce the size of cumbersome, heavy and often pain-causing breasts are usually concerned with the resulting size and shape more than anything else. Here are three common techniques, which, depending on the individual’s original shape and size, will allow adequate reduction with the most minimal surgery.


Liposuction is one of the newest methods for reducing breast volume. Fatty tissue of the breast is removed using fine tube-like instruments called cannulae. The fat is extracted leaving the glands intact. “This is not a perfect operation because the shape is not as good as what you can get with a more traditional technique,” says plastic surgeon Sherwood Baxt, M.D. “But I can call it the ‘Scarless Reduction’ and it takes about half an hour under twilight sleep; the patient is home within an hour of surgery and there is virtually no pain afterwards and there are no incisions to heal,” He says. “People put on a good sports bra and they can be back at work in three days. The only restriction on physical activity is their own discomfort level.”

Once the weight has been removed the skin and the areola (dark part surrounding the nipple) shrink dramatically which gives some elevation of the nipple. A good candidate according to Dr. Baxt is: “Someone who wants to remove up to four cup sizes and isn’t obsessed with an absolutely classical shape. Rather, their main desire is to get the weight off the breast so they can be athletic.”

Peri-Areola Incision:

Peri-areola literally means around the areola. This incision type may be recommended for a reduction that needs some nipple elevation. Plastic surgeon Nicholas Nikolov, M.D. explains this process: “By taking the skin off around the areola, reshaping what’s inside.. the actual breast tissue.. then letting the skin redrape over the top gives a reasonable amount of reduction and achieves a lift.”

Often larger breasts also have a degree of sag. To lift the nipple, creating a nice shape, as well as a reduction for the sagging breast, an incision is made around the areola as well as

vertically down. This allows greater reduction of fatty tissue; a small amount of skin is
removed as well to reduce sagging and creates a nipple lift. This method results in a well supported, naturally shaped breast.

Inverted T-incision:

“If it’s a medically necessary reduction, which is a much larger reduction, then the inverted T-incision may be required,” explains Dr. Nikolov. The inverted T-incision is an incision placed around the areola running vertically down as well as horizontally hidden in the breast crease. This allows for large amounts of fatty tissue and skin to be removed in such a way as to preserve the blood supply to the remaining breast tissue and nipple.

“the most reliable method for performing a breast reduction has been the inferior pedicel technique.” The pedicel method refers to the location of the blood and nerve supply, not where the incisions are placed. “There are ways to handle the scars to shorten them so you don’t have to have the large scars,” says Dr. Nikolov. “But it’s usually still in an inverted T-position.”

This is the method that the majority of women have had or will have. The pedicel method of breast reduction reduces breast appearance, volume, and contour.