Ideas and Innovations
Update on Experience with Liposuction Breast Reduction
Lawrence N. Gray, M.D.
Over the course of my 3-year experience, liposuction breast reduction has proven to be safe, effective, and a better choice than the traditional method of
breast reduction, for numerous reasons. Patients want relief from symptoms with minimal scarring, low risk, few complications, and low cost. Conventional
reduction results in keloid or hypertrophic scars in 60 percent of breasts. This method meets those requirements with greater success than the traditional
Traditional reduction mammaplasty does provide relief of symptoms of oversized breasts, but often results in a high complication rate, poor shape,
numbness of the nipple, prolonged recovery, and high costs for the patient. An earlier report of mine from my first 453 patients showed no complications.
This study focuses on 204 patients from 1996 to 1998, including the first 45.
I considered using liposuction after observing that a lower complication rate is noted with liposuction of the abdomen compared with abdominoplasty.
The successful use of liposuction for male gynecomastia offers a logical strategy for treating the female breast. Since the breast is over 70 percent
fat, significant volume reduction is only possible using liposuction. The key to relief of symptoms is weight removal.
MATERIALS AND METHODS
A preoperative mammogram is helpful to evaluate the fat content of the breast and to screen for breast cancer. The procedure is per formed under local
anesthesia with sedation on an outpatient basis. The breasts are infiltrated through a stab incision along the infra mammary fold. Using 2 to 3 liters
of fluid per breast, infiltration is performed until the breasts are tumesced. The fluid is a mixture of 1 liter of lactated Ringer’s with 30 ml of 1
percent lidocaine and 1 ampule of epinephrine (1:1000). Liposuction is accomplished through medial and lateral stab incision along the fold using 3- and
4-mm straight and angled blunt cannulas. The entire breast and subcutaneous fat is treated. Suctioning generally takes 25 minutes per breast. Patients
are placed in a surgical bra for 1 week, followed by a sports bra for 1 month. Most return to work within a few days, similar to other liposuction patients.
Mastopexies, which are offered to all patients at 3 months, are rarely requested.
From 1996 through 1998, I performed 204 breast reductions using liposuction on women ranging in age from 15 to 74 years old (Figs. 1 through 4). Volumes
ranged from 300 to 2250 cc per breast, with an average of 850 cc per breast. The average improvement in nipple position in relationship to the sternal notch
was 6 cm, with a range from 2 to 12 cm at 6 weeks. All enlarged areolas were contracted to a more normal size and there was no numbness. There was complete
resolution of symptoms in all patients, with an average reduction of 2 cup sizes. The breast size and shape at 6 weeks has been unchanged at 6 months. There
were no infections or skin loss. Mammograms show smaller breasts with increased density and with out any troublesome microcalcification (Figs. 5 and 6).
Patients have been able to breast-feed.
There was one seroma, which responded to aspiration. There was one hematoma in a patient with an undiagnosed familial coagulopathy. Three unilatera