Breast reduction surgery has long been a solution for women seeking relief from the physical and emotional burdens of disproportionately large breasts. Traditionally, this procedure has involved significant scarring and recovery time. However, in appropriately selected patients, the use of liposuction can provide a scarless alternative. In this article, I will explain the procedure of scarless breast reduction with liposuction, detailing the benefits, selection criteria, and what to expect during and after the surgery.

Benefits of Scarless Breast Reduction with Liposuction:

1. Minimal scarring: As the name suggests, one of the most significant advantages of this procedure is the absence of visible scars. The small incisions made during liposuction are strategically placed and often fade over time, leaving behind virtually no trace of surgery.
2. Reduced risk: Compared to traditional breast reduction surgery, scarless breast reduction with liposuction carries a lower risk of complications such as infection, bleeding, and poor wound healing.
3. Faster recovery: Because it’s a minimally invasive procedure, the recovery time associated with scarless breast reduction with liposuction is typically shorter than that of traditional surgery. Many patients can return to work and normal activities within a week or two.
4. Natural-looking results: By sculpting the breasts with liposuction, rather than removing glandular tissue, this procedure can achieve natural-looking results with minimal disruption to breast shape and sensation.
5. Future ability to breast feed: Although not guaranteed, a breast reduction with liposuction should not disrupt the connection of the breast to the nipple and should not therefore affect the ability to breast feed in the future, unlike traditional breast reductions with scars.
6. Maintenance of nipple sensation: In the majority of patients, the sensation to the nipple is not affected by this surgery. There is often a temporary reduction due to bruising and tissue swelling which settles after several weeks.

Selection Criteria for Scarless Breast Reduction with Liposuction:

While scarless breast reduction with liposuction offers numerous benefits, it’s essential to understand that not everyone is a suitable candidate for this procedure. Ideal candidates typically:

– Have good skin elasticity: Candidates with good skin elasticity are more likely to achieve optimal results, as the skin can contract and reshape effectively after fat removal. Factors that damage skin elasticity include advancing age, multiple pregnancies, smoking and significant weight loss.

– Desire moderate reduction: Scarless breast reduction with liposuction is best suited for individuals seeking moderate reduction in breast size rather than significant volume reduction.

– Have excess fat, not glandular tissue: Since this procedure targets excess fat rather than glandular tissue, candidates should primarily have fatty tissue contributing to their breast size.

– Are in good overall health: Candidates should be in good physical and emotional health, with realistic expectations about the outcome of the procedure.

In my practice, I have found that liposuction breast reduction is particularly useful in patients with fatty breasts and well-placed nipples. The other main group of patients is those suffering from breast asymmetry (noticeable difference between the breasts). These patients are usually younger and have very good skin elasticity. The breast size difference is also usually modest. A standard breast reduction leaves permanent scars so there will always be (a new) difference between the breasts because of these visible scars. An example of before and after liposuction breast reduction is shown below in a patient who has breast asymmetry and allowed her photographs to be shared.

The Procedure:

1. Consultation: The journey begins with a consultation with a plastic surgeon specialising in aesthetic breast surgery, as this procedure is not commonly undertaken by more general cosmetic surgeons. During the appointment, the surgeon should assess your medical history, examine your breasts, discuss your goals, and determine your candidacy for the procedure.
2. Pre-operative Preparation: Once you’re deemed a suitable candidate for scarless breast reduction with liposuction, you will be provided with pre-operative instructions. These may include refraining from smoking, avoiding certain medications, and arranging for someone to drive you home after the surgery.
3. Anaesthesia: Whilst it is possible to carry out this procedure under local anaesthetic with sedation, I still prefer a light general anaesthetic for my patients. Total intravenous anaesthetic (TIVA) provides good control of the patient’s vital systems during the operation and allows immediate recovery like sedation.
4. Liposuction: With anaesthesia in place, the surgeon will make small, inconspicuous incisions around the perimeter of the breast. Through these tiny openings, a thin tube called a cannula will be inserted, and excess fat will be gently suctioned out, sculpting the breasts to the desired size and shape. Different types of liposuction machines can be used and some may add an energy source such as ultrasound, radiofrequency or laser to help break up the fat particles. I prefer a machine known as PAL® by MicroAire which vibrates at the tip and reduces the trauma to the tissues. It allows multiplanar (all levels) liposuction to the whole breast, which is key to the success of this technique. The deeper layers are accessed to remove as much volume as possible and the superficial sub-dermal fat layers to stimulate post-operative skin contraction.
5. Closure: Once the liposuction is complete, the incisions are closed with sutures, which typically dissolve on their own over time.
6. Recovery: Following the procedure, you’ll be monitored in a recovery area before being discharged home with detailed post-operative instructions. While recovery experiences vary, most patients can return to light activities within a few days and resume regular exercise and more strenuous activities after a few weeks. In my practice, you will be provided with two post-operative surgical bras that you should wear for six weeks, day and night.
7. Results: the long-term results from this procedure do not become fully clear until around six months following surgery. Most patients notice a significant reduction in breast volume and an elevation of nipple position. This is associated with a very high level of satisfaction.
8. Complications: Although the complication rate overall is lower that traditional breast reduction surgery, it is important to understand all of the potential complications. These should be discussed with you before surgery so that you can make an informed decision to move forward. The specific complications include bleeding into the tissues (haematoma), potential skin necrosis around the canula insertion site, infection (which is usually treated with antibiotics), retracted nipples (temporary or permanent) and long-term reduced sensation to the nipple. The overall breast reduction cannot be guaranteed and there will always be a degree of natural asymmetry.

Recent advances in scarless breast reduction:

Some surgeons around the World have recently combined liposuction breast reduction with internal breast loops to act as an internal bra and re-shape the breast. I feel that we do not have enough longer-term data to routinely and safely offer this to patients yet, although it is a very promising development to potentially achieve a greater lift effect. Studies are on-going with the most recently published, combining PAL® – MicroAire and Loops, showing very low complication rates, high satisfaction and an average elevation of the nipple position of 7.3cm.

Summary

Scarless breast reduction with liposuction offers an innovative solution for women seeking to reduce breast size without the tell-tale scars associated with traditional surgery. By harnessing the power of liposuction, this minimally invasive procedure provides natural-looking results with minimal downtime and risk. However, it’s essential to consult with a qualified plastic surgeon to determine your candidacy and explore all available options before undergoing any cosmetic procedure.