Breast Reduction and Liposuction
Liposuction has always been part of the breast reduction surgery by reducing fat around the arm pit or as an adjunct to the more standard breast reduction technique. Until 1991 it had not been used as the sole modality for breast reduction. It was experimental at the time, but the advantages are clear. Liposuction breast reduction is a safe procedure, significantly reducing the risk of scarring and complications, and possibly eliminates the risk of nipple-areola sensory changes. In addition, liposuction can significantly reduce the breast size with less pain, a shorter operation and faster recovery. However, the aesthetic value of the results after liposuction breast reduction is compromised. When the fat is removed the skin will contract to an extent then sag. The breast does not get the type of lift seen in a traditional breast reduction. Patient selection is critically important.
There are important issues with liposuction breast reduction and female breast cancer detection.
These are some of the statistics:
- Excluding cancers of the skin, breast cancer is the most common cancer diagnosed among U.S. women, accounting for more than 1 in 4 cancers.
- Breast cancer is the second leading cause of cancer death in women, after lung cancer.
- One out of eight American women who live to be 85 years of age will develop breast cancer, a risk that was one out of 14 in 1960.
- 2.4 million Women living in the U.S. have been diagnosed with and treated for breast cancer.
- An estimated 192,370 new cases of invasive breast cancer are expected to be diagnosed in American women during 2009. About 1,910 new cases of breast cancer are expected in men. In addition, an estimated 62,280 cases of in situ breast cancer (both DCIS and LCIS) are expected, with 85 percent being DCIS.
- An estimated 40,610 breast cancer deaths are anticipated this year.
One of the most important risk factors for cancer detection is breast density and the denser the breast the more difficult it is to detect cancer. This is an incontrovertible fact. There is no question that liposuction of the breast increases breast density by the removal of fat resulting more compacted breast tissue in a smaller breast. The consequence of a denser breast renders the mammographic imaging and interpretation more difficult. Current diagnostic tests rely on differentials in tissue density, which in turn depends on the presence of fat in the breast tissue. Another issue to consider would be the possibility that the liposuction could potentially spread the cancer cells.
Arguments to refute these claims of detection assert the problems are marginal at best and that calcifications, change in breast architecture, and scarring is no different than in traditional breast reduction procedures.
The question is whether the degree of change in the breast is significant enough to discard a useful procedure. There are currently ongoing studies with multispecialty disciplines to answer these questions. For the present, liposuction breast reduction is a widely used procedure.
WHO IS THE BEST CANDIDATE
The best candidates for liposuction breast reduction are younger women with normal skin elasticity, minimal to moderate breast enlargement, and with minimal ptosis or sagging. Candidates who have a history of forming keloid scars and any woman who is a poor candidate for the traditional breast reduction procedures would be included as a candidate for liposuction breast reduction. The breasts should have an adequate amount of fat-to-breast content to achieve a good reduction.
For the patient with large breasts and significant breast sagging wishing for a more predictable aesthetic outcome in shape, size, and position of the nipple, liposuction reduction alone will likely fall short. Nevertheless, due to the complexities of the alternative methods, this procedure does allow an option for patients who might otherwise refuse traditional breast reduction.
A personal consultation is the first step for every patient considering a breast reduction. This appointment can be scheduled at Dr. Delgado’s San Francisco or Marin County offices. During the appointment, Dr. Delgado will inquire as to the patient’s concerns about her appearance and the impact her breasts are having on her daily life. A detailed exam will be performed to determine the best breast reduction procedure. If liposuction breast reduction is desired, Dr. Delgado will discuss the pros and cons of this procedure as well as possible alternative procedures. A complete history will be taken and if the case is potentially covered by insurance, photos will be taken.
The patient is provided with a booklet that supplies detailed pre- and post-operative instructions, including the use of medications prior to surgery. For example, it is required that aspirin and aspirin-containing products be discontinued, including anti-inflammatory products, two weeks before and two weeks after surgery, as these products have a negative effect on the patient’s clotting ability. The pre-operative instructions include a complete list of medications that could pose hazards for the patient, and therefore should be avoided. However, the patient is reassured that Tylenol (acetaminophen) can be safely taken during this time. The booklet also provides a list of vitamins and homeopathic preparations that promote healing and limit bruising, which a patient can opt to use before and after her surgery. Dr. Delgado will provide a surgical healing package which includes all the necessary vitamins and healing derivatives.
Liposuction breast reduction surgery is performed under general anesthesia. At Marin Cosmetic Surgery Center, anesthesia is administered only by a physician who is board-certified by the American Board of Anesthesia. Dr. Randy Gaynor has worked with Dr. Delgado since 2001 and, working collaboratively, they evaluate each case to optimize the care of each patient. The anesthesiologist also calls the patient the evening before surgery to review the medical history, confirm last-minute instructions, and answer any questions the patient has regarding anesthesia. Dr. Delgado realizes that anesthesia can be a frightening event and takes great care to comfort patients.
DAY OF SURGERY
Liposuction breast reduction surgery is typically performed in an outpatient surgery center or a hospital. Sometimes the patient is kept overnight as a 23-hour stay, for comfort.
Dr. Delgado offers liposuction breast reduction surgery at Marin Cosmetic Surgery Center, an accredited outpatient surgery center. Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, is located in his Marin County office on the Sutter Novato Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before anesthesia is given, Dr. Delgado answers all questions the patient or family might ask. At this time detailed drawings are made on the breast using a surgical marking pen. This architectural plan enables the doctor to make precise adjustments to accommodate the changes that occur as the body moves from a lying position to a sitting position.
AFTER LIPOSUCTION BREAST REDUCTION SURGERY
The first few hours after surgery are spent in the recovery room. When the patient is fully alert, she will be able to go home with the assistance of a friend or family member. In order to decrease post-operative swelling, it is important that the patient sleep with her head and back elevated. Instructions are given in the preoperative booklet as to wound care of the liposuction sites. The sutures are removed approximately ten days after surgery.
The breasts will be uncomfortable for a day or two, but the pain should not be severe. Pain medications are prescribed for use the first few days in order to make movement and sleeping more comfortable. By the third day, the need for pain medication is less common. However, some patients have a low pain threshold and, therefore, may take pain medications up to five days.
The swelling and bruising will resolve after approximately one week, but a patient should allow two weeks for recovery. Once the bruising and tenderness are gone, the patient can return to normal activity. Most patients can drive a car and return to work or social activities after one week. Sexual activity should also be postponed until a week after surgery, since this can aggravate swelling and cause discomfort. Strenuous exercise should avoided for three to four weeks following surgery as this can cause swelling to recur.
RISKS AND COMPLICATIONS
Liposuction breast reduction carries the usual surgical risks of infection, bleeding, and complications of anesthesia. However, with Marin Cosmetic Surgery Center’s highly-trained surgical team, the risk of these complications is minimized. Liposuction breast reduction does leave small incisional scars, but they resolve very quickly. Most women who have liposuction breast reductions are able to successfully breastfeed since the breast tissue isn’t significantly altered. On rare occasions, there may be a slight difference in size from one breast to the other.
LIPOSUCTION BREAST REDUCTION RESULTS
Although a significant reduction in breast size can be enjoyed immediately after surgery, it takes a couple of months for the breasts to settle into their new shapes. A patient will experience better balance with her reduced breast size and she will also find that clothes fit better with trimmer proportions. As breast reduction reduces the weight of the breasts, the body adjusts to a lighter gravitational pull, reducing symptoms of back and neck pain and improving posture. Even though there are scars that result from this surgery, the resulting changes described above help explain why liposuction breast reduction patients are some of the happiest plastic surgery patients.