How is a breast reduction performed?
Breast reduction surgery is typically an outpatient procedure. The surgery commonly involves three incisions. Below are the general steps for a breast reduction, however these steps may vary depending on the technique you and your aesthetic plastic surgeon decide on.
- Your surgeon marks your skin to indicate where the incisions will be. These markings are especially important because your breasts change shape once you are lying on your back on the operating table.
- Most surgeons prefer general anesthesia for this procedure. A few may perform breast reduction with intravenous sedation.
- Your incision pattern will depend on the size of your breasts, how much your breasts sag, and where your nipple-areola is on your breast.
- With each technique, your surgeon can make your areolas smaller if they're too large. Your surgeon may use an areolatome, more commonly known as a "cookie cutter," as a circular template to make the new areola size. The “cookie cutter” diameter ranges from thirty-eight to forty-five millimeters.
- If your breasts are fatty (not fibrous) and not sagging, your surgeon may use an alternative, less invasive technique in which he or she makes micro incisions and uses liposuction to decrease the breast size.
- With the traditional method, your surgeon will remove excess breast skin and fat with a scalpel and cautery instrument. If your breasts are asymmetrical (or uneven), the surgeon may remove more tissue from one breast than the other. He or she will then reshape the remaining skin and fat to create a more youthful breast shape and move the nipple-areola complex to a higher position.
- Sometimes, your surgeon will place drains in your breasts to collect excess fluid.
- The surgeon then closes the breast incisions with sutures that go from the deep tissue layers to the more superficial layers (the skin).
- You may also receive liposuction to improve the contour under your arms.
Your aesthetic plastic surgeon’s goal is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.
What are my breast reduction options?
The size and shape of your breasts and how much reduction you desire will help your aesthetic plastic surgeon determine the best technique for you.
Incision-Based Breast Reduction
1. “Anchor” Incision
An “anchor” incision, the most common technique, and involves three distinct cuts. Your surgeon makes the first incision around the perimeter of the areola, the second vertically down from the areola to the breast crease and the third horizontally along the breast crease. If you desire a significant reduction or have a severe degree of sagging, your surgeon will likely recommend this approach. This technique can help you achieve the most dramatic results, but also leaves the most scarring.
IMAGE IMAGE CAPTION: An “anchor” incision is around the areola and then vertically down and under the breast crease.
2. “Keyhole” Incision (also known as a "lollipop" lift)
A “keyhole” incision, also known as a “lollipop” lift, involves two distinct cuts. Your surgeon makes the first incision around the perimeter of the areola and the second vertically down from the areola to the breast crease. If you desire a moderate reduction and have a moderate degree of sagging, your surgeon may recommend this approach. This technique produces moderate scarring.
IMAGE IMAGE CAPTION: A “keyhole” incision is around the areola and then vertically down to the breast crease.
3. “Donut” Incision (also known as a "periareolar” incision)
A “donut” incision involves one cut made solely around the border of the areolas. If you desire a minor reduction, your surgeon may recommend this approach. This technique produces the least amount of scarring, but is only appropriate for a minimal reduction
IMAGE IMAGE CAPTION: A “donut” incision is around the areola.
4. Significant Breast Reduction
If your breasts are extremely large, your surgeon may have to completely detach the nipples and areolas then shift them to a higher level. This technique is rare, and in such cases, you will lose nipple sensation and may not be able to breastfeed.
IMAGE IMAGE CAPTION: The incision pattern goes around the areola, vertically down from the areola to the breast crease with two incisions, then along the crease below the breast following the breast's natural contours and defining the new location for the nipple. Once your surgeon removes breast tissue, fat, and skin, your surgeon brings the skin together to tighten and reshape the breast.
For more detailed information, see Incisions and Scars.
Liposuction-Only Breast Reduction
For a select group of women, it is possible to avoid the vertical incision that runs from the bottom edge of the areolas to the breast crease or the horizontal incision underneath the breast (typical components of the “anchor” incision). If you have fatty breasts, need a minor-to-moderate reduction, and do not need to correct sagging, you may be able to have a breast reduction using liposuction alone.
Here are some breast liposuction considerations:
- With the onset of menopause, fat gradually replaces breast tissue, so postmenopausal women are among the best candidates for liposuction-only breast reduction.
- If you need a significant reduction but do not want the scars and loss of sensation and are willing to accept some breast sagging, you may find breast liposuction results acceptable.
- If you have fibrous tissue, minimal fat in their breasts, significant breast sagging, poor skin condition with little tissue elasticity, or a low nipple position, this technique may not be right for you.
- Liposuction alone may treat asymmetry up to one cup size.
- After breast liposuction, the skin’s elastic qualities cause it to contract, and subsequently, your breast contour may lift.