There are several techniques that Dr. Smith will use to perform a breast reduction. Each of the following breast reduction techniques is aimed at removing excess breast tissue, adding contour to the breasts, and repositioning the nipple and areola on the chest wall.  The standard breast reduction technique uses a “keyhole” or Wise pattern shaped incision.  This incision technique is best for large pendulous breasts.  Another technique is called a Vertical or “lollipop” breast reduction.  This technique involves an incision around the areola and vertically from the areola down to the infra-mammary fold (Lollipop Incision). This technique is ideal for breasts that are large but are not as ptotic, sagging, or pendulous.  The final technique that is occasionally used is a scarless breast reduction.  This operation involves a small incision and is mainly performed using liposuction to remove excess fatty tissue.  Each of these techniques is described in more detail below.

Standard Breast Reduction

This breast reduction procedure is generally performed in our state-of-the-art outpatient surgical facility (Ascent Surgery Center) under general anesthesia as an outpatient procedure.  A typical standard breast reduction will take approximately two hours.   Prior to the procedure, Dr. Smith will meet with you and go over any last minute quests that you may have.  Next, while standing, the planned incision lines, new nipple/areola location and remainder of the surgical incisions are drawn on your breasts.  You will also meet with the anesthesiologist to discuss the anesthesia to be used during the procedure.  Dr. Smith only uses a Board Certified Anesthesiologist for his operations.

The standard breast reduction procedure uses a “keyhole” (Also known as an Anchor, or Wise pattern) shaped incision.  The incisions/scars for this procedure extend in three different directions.  First, they are around the entire areola (pigmented skin around the nipple).  Second, from the areola in a vertical direction down to the crease under the breast and third, horizontally along the fold or crease under the breast.  Frequently, liposuction will also be performed laterally on the chest wall to help improve contour and overall chest/breast shape.

Skin and breast tissue are removed and sculpted from the inner and outer quadrants of the breast and from the area above the nipple.  The nipple and areola are preserved on a pedicle or “mound” of breast tissue that also adds to the volume of the upper pole of the breast.  The remaining breast tissue and nipple are relocated in this keyhole pattern and the incisions are closed.  Dr. Smith does not use clips or staples.  All the incisions are closed with multiple layers of absorbable sutures.  Every effort will be made to keep scars as inconspicuous as possible, however, scars are an inevitable result of surgery.  Scars will usually fade but may take up to 6-12 months to completely resolve.  Typically, no drains are required for the operation.  Dermabond or steri-strips are then applied over the incisions and a supportive bra and dressings are placed.

Vertical or “Lollipop” Reduction

A vertical breast reduction procedure is aimed at reducing the breast scars while still achieving the desired result.  The procedure is typically performed in our state-of-the-art outpatient facility (Ascent Surgery Center) under general anesthesia and as an outpatient procedure.  A typical vertical breast reduction will take approximately two hours to perform.  Prior to the procedure, Dr. Smith will meet with you and go over any last minute quests that you may have.  This technique is ideal for medium to large shaped breasts that are not overly pendulous or “sagging”.

The vertical technique consists of removal of excess breast tissue with both excision of breast tissue and liposuction.  The incisions are typically located around the areola (the pigmented area around the nipple) and vertically down to the crease under the breast.  Every effort will be made to keep scars as inconspicuous as possible, however, scars are an inevitable result of surgery.  Scars will usually fade but may take up to 6-12 months to completely resolve.  Typically, no drains are required for the operation.  Dermabond or steri-strips are then applied over the incisions and a supportive bra and dressings are placed.

Before:

After:

Scarless Breast Reduction

A scarless breast reduction is another technique Dr. Smith will occasionally utilize for the appropriate breast.  The ideal breast shape for a scarless breast reduction is one that is large but has little to no sagging/ptosis.  The procedure is performed with multiple small incisions that are hidden and very inconspicuous.   Liposuction or liposculpting is then performed to reduce the volume of the breasts.  This technique will reduce the volume of the breasts but will result in a less dramatic change in size and shape.

Following breast reduction surgery, patients generally report mild to moderate discomfort, which is usually controlled with prescribed pain medications.  Varying degrees of swelling, bruising, and firmness will subside over the first several weeks.  Bruising and swelling in the lateral aspect of the chest wall is common, especially when liposuction is performed.  The incisions around the areola and under the breast often result in varying degrees of “pleats” or rippling.

These will resolve over the weeks to months after surgery.  Dr. Smith uses sutures (stitches) that are dissolvable but may take up to 6-8 weeks to be fully absorbed by the body.  Light exercise may begin after four to six weeks.  Dr. Smith will place a surgical bra on you immediately after surgery.  A non-underwire bra should be worn for at least 6-8 weeks following surgery.  A supportive bra is generally worn until the swelling resolves and an underwire can be worn without discomfort.  Recovery and healing will vary from patient to patient and depend on the extent of surgery.  Dr. Smith does recommend using a silicone gel scar cream on the incisions after surgery. (Link to Scar therapy)

It must also be remembered that complete healing takes time and patience, taking up to one year or longer before realizing the final results of breast reduction surgery.  It can take this amount of time for scars to soften, lighten, and fade.  It can also take this same amount of time for the breast tissue to relax and remodel itself.  As the swelling and bruising resolve, the breasts will become slightly smaller and descend into their final location.  Most patients find that their breasts will relax and look more natural over time.

As with most cosmetic surgical procedures, complications following breast reduction surgery are unlikely when performed by a skilled and competent surgeon.  Complications include but are not limited to allergic reactions, bleeding/hematoma formation, infection, tissue necrosis/loss, delayed wound healing with obvious/wide scars, numbness, altered nipple sensation, asymmetry in breasts or areola, and need for revisional surgery. Also, rare but possible risks include blood clots/DVT or pulmonary emboli (blood clots which dislodge and travel in the bloodstream to distant sites).

Wound healing complications can be increased with smoking.  All smokers must quit smoking for at least 6 weeks before and after surgery.  Smoking seriously decreases blood circulation in the skin, which increases the risks of complications and poor healing.

When choosing Dr. Smith for your cosmetic surgery, you are choosing a plastic surgeon who will stand by you throughout the surgical process.  This starts at the consultation and does not end until you are completely healed.  Although complications are a part of any surgical procedure, Dr. Smith will be with you along your surgical journey.

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