Lipoplasty-only Breast Reduction

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Lipoplasty-only Breast Reduction
Aesthetic Surgery Journal, May/June 2001

Lipoplasty-only breast reduction can result in an average reduction of 2 cup sizes. It is as effective as
traditional surgery for eliminating symptoms and significantly reduces scarring and complications. This procedure allows women to retain nipple sensation
and the ability to breast feed. The author, who uses this method of breast reduction exclusively, describes his technique and results over a 4-year period.
(Aesthetic Surg J 2001;21:273-276.)

Reduction mammaplasty, one of the most common plastic surgery procedures, is extremely effective in eliminating back, neck, and shoulder pain. Unfortunately,
the traditional method of breast reduction may lead to patient dissatisfaction. Complications including infection, hematoma, seroma, dehiscence, fat necrosis,
and skin loss may occur in as many as 50% of patients. Unacceptable scarring has also been reported. In addition, reduction mammoplasty may result in
diminished nipple sensation, poor shape, and the inability to breast feed.

Patients not only desire relief from symptoms but also want procedures with low risk, quick recovery, and minimal scarring. Recent meetings and papers have
focused on shortening the scar in reduction mammaplasty; lipoplasty-only breast reduction (LOBR) represents the ultimate in short scars.

Lipoplasty has been used successfully to treat gynecomastia and minor breast hypertrophy and has been used in conjunction with excisional techniques. Because
the breast is more than 70% fat in the lateral and preaxillary areas and 61% fat in the central breast area, significant reduction is possible with lipoplasty
alone. Previously, I reported on its use in 45 patients.

For patients older than 40 years, preoperative mammograms should be obtained before LOBR. Mammograms may also be helpful for estimating fat content in other
patients. Patients receive tumescent anesthesia with sedation; the tumescence provides maximum distention of the gland and connective tissue. One liter of
lactated Ringer’s solution is mixed with 400 mg of lidocaine and 1 ampule of 1:1000 epinephrine; the average breast requires 2 L.

Lipoplasty is then per formed through a medial and lateral stab incision along the inframammary fold (Figure 1). The entire breast and the subcutaneous fat
are treated with 2-, 3-, and 4-mm straight and angled cannulas. I have tried internal and external ultrasonography as well as oscillating cannulas without
any noticeable benefits. Because the entire procedure is usually performed in less than 1 hour and results in minimal blood loss, it is frequently performed
along with other procedures.

After the procedure, patients wear a surgical bra for the first week, followed by a sports bra for 1 month. Drains and taping are not used. Patients have
minimal restrictions, similar to those imposed after other Lipoplasty procedures, and usually return to normal activity within the week. After surgery,
firmness in the breasts is managed with massage.

From 1996 through 2000, I performed 475 LOBR procedures that resulted in 100% symptom relief without nipple numbness. More than 30% of my patients had
declined traditional reductions because of concerns about scarring and potential complications. Lipoplasty is the only method of reduction I perform,
and I have found it to be successful in all patients, young and old, including patients with diabetes, hypertension, mental or physical impairments,
keloids, and in patients who smoke (Figures 2, 3, and 4).

The average volume removed per breast is 800 mL (range 250 to 2650 mL). The average breast reduction is 2 cup sizes. The skin envelope has contracted
in all patients as a result of the volume removed and the superficial Lipoplasty of the skin.