Lipoplasty-only breast reduction can result in an aver¬age 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 1-year period. (Aesthetic Surg.12001 ;Z1:273-Z76.)
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 necro¬sis, 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 mini mal scarring.
Recent meetings and papers have focused on shortening the scar in reduction mammaplasry; lipoplasty-only breast reduction (LOBR)
represents the ultimate in short scars.
Lipoplasty has been used successfully to treat gynecomas tia 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 preaxillar} 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 mammo¬grams should be obtained before LOBR. Mammograms may also be helpful for
estimating fat content in other patients. Patients receive tumescent anesthesia with seda¬tion; 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 epineph¬rine; the average breast requires 2 L.
Lipoplasty is then per¬formed through a medial and lateral stab incision along the inframammary fold. 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 fre¬quently performed along with other procedures.
After the procedure, patients wear a surgical bra for the first week, followed by a sports bra for I month. Drains and taping are
not used. Patients have minimal restric¬tions, similar to those imposed after other lipoplasty pro¬cedures, 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 proce¬dures that resulted in 100% symptom relief without nip¬ple 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 lipoplas¬ty of the skin.
The average nipple retraction in relation to the sternal notch is 6 cm (range 2 to 13 cm). All enlarged areolas were noted to
contract. Among 92 women who had simultaneous procedures, most commonly lipoplasty of the abdomen, no associated complications
occurred.
Women have been able to breast feed after having this procedure. Mammogram results are improved, com¬pared with those after
traditional breast reductions, showing increased density without any worrisome microcalcifications. Six patients who had previous
tra¬ditional breast reductions noted that lipoplasty resulted in an easier recovery.
Complications have been rare, and when they occurred, minimal: 3 seromas responded to aspiration, and I hematoma and a minor
skin loss healed without further surgery. Two patients required additional reduction. One of the early patients underwent a
secondary lipoplasty, and the other patient had a unilateral tradi¬tional breast reduction when her mammogram and magnetic
resonance imaging scan showed virtually no fat. Five bilateral mastopexies were performed subsequently.
LOBR has proven to be as effective as traditional surgery for eliminating symptoms and has significantly reduced scars and
complications. It results in moderate skin tightening, and patients rarely request a mastopexy. Most patients are not concerned
with achieving ideal nipple position. They appreciate signifi¬cant financial savings from a brief outpatient procedure that is
covered by most insurance policies and allows a quick return to normal activity. Both Patients and surgeons will appreciate that
additional procedures can be performed at the time of LOBR without an increase in the risk of complications.