Cosmetic Breast Reduction - You've got to Break Some Eggs

There is no argument that women who suffer significant neck and back pain because of the weight of their breasts benefit from a surgical breast reduction.  The varying techniques available to plastic surgeons in the performance of the operation, however, can produce a wide range of results.

The principle purpose of breast reduction is to solve the three problems that plague the overly large breast.  First, the design of the surgery must decrease breast volume. This is readily accomplished by any one of a number of techniques.  It is in the management of the  other two problems where most of the post operative dissatisfaction with breast reduction results lies.  The nipple areolar complex must be reduced and moved to a cosmetically ideal location, and the loose and fatty tissue beneath the armpit must be eliminated.  The breast’s base is narrowed and rounded with thoughtful attention to each of these preoperative flaws.

The chief cosmetic complaints after breast reduction include inadequate volume reduction, and the persistence of the fat roll along the side of the chest.  This problem is typically caused by a misunderstanding of classic breast aesthetics and under-treatment during the operation. 

At a recent meeting of the American Society of Plastic Surgeons, I was impressed to hear discussion about a return to focus on surgical techniques that produce this youthful athletic breast.  The pendulum is swinging away from techniques that are consumed with the effort to minimize scar length while sacrificing adequate shape.  It has always been my contention that, as the old proverb says,”In order to make an omelet, you have to break some eggs.”  My approach to breast reduction employs techniques which derive from such diverse disciplines as tailoring, sculpture, and plastic surgery.  The breast is dis-assembled and then reassembled in an orderly process that creates an idealized shape and size.

From sculpture, we borrow the concept of removal of the excess while maintaining the volume that will compose the corrected form.  Great sculptors can actually demonstrate their subjects emerging from solid rock. The description of this process should be sketched out during the consultation. The patient should become familiar with how much tissue will be removed and from where it is being excised.

From tailoring comes the control of the skin envelope of the breast.  This is, perhaps, the most important part of the intervention.  It is this process that controls the ultimate shape of the breast, lifts the nipple areolar complex, and avoids the dreaded “batwing”.  The greatest tailors make their craft appear effortless and create garments that can transform the bodies of those who wear them.    

Finally, from plastic surgery comes the depth of training required to combine these concepts into a living sculptural surgical technique. Not all breast reductions are the same; but with the ideas I have outlined firmly in mind, your breast reduction should be a safe and ultimately satisfying experience.