Small breasts may cause many women to be psychologically unhappy with their appearance; however, breasts that are too large (Macromastia) can cause not only negative physiological effects, but also physical discomfort.
The weight of large breasts can often cause backache, as well as embarrassment to the sufferers, due to their appearance. Successfully treated, these patients are often amongst the most grateful patients within medical aesthetics.
There are different ways by which breast can be reduced in size, the most popular techniques being: the open-surgical and liposuction breast reduction.
Now we have the latest revolutionary technique using an advanced laser to fracture the tissue after which the liquefied tissue will be sucked out with skin tightening effect due to the laser energy, which is targeting the skin tissue.
Even though breast reduction by liposuction is a procedure that was first introduced more than 20 years ago, many surgeons are still sceptical and prefer to perform breast reduction through open surgery.
The main advantage of performing breast reduction (reduction mammoplasty) by open-surgery over liposuction is that the final shape and size of the breasts can be better predetermined.
This is because a skilled surgeon using open-surgery can shape the breasts by removing the right amount of both skin and fat, whereas liposuction can only remove the fat, not the skin.
However, this does not mean that after laser liposuction the breasts will be left looking like an empty sac as, after laser procedure, the skin will contract and cause the breasts to be uplifted.
Also, breast reduction by laser liposuction has many advantages over open-surgery, including lower risk of infection and skin necrosis; far less scarring (The scars left by laser liposuction are very small and almost undetectable)
The recovery after laser liposuction is very fast and patients can usually go back to work after just a few days with minimum discomfort, painkillers are rarely needed after Laser liposuction.
Also, the nipple sensation after the laser procedure remains normal, as the laser liposuction tends to only remove the adipose tissue and not the glandular tissue, and, thus, the ability to breastfeed after the laser procedure is usually maintained.
The laser liposuction is a day procedure, mainly performed under local anaesthetic only with no need for the hospital stay overnight.
Dr Ayham Al-Ayoubi explains that patient selection for laser breast reduction liposuction is very important.
The ideal patients for laser beast reduction liposuction are healthy females, who are aged 40 or above, who have realistic expectation of the outcome. Older female’s breasts have more fat than glandular tissues and this makes it much easier to perform the liposuction.
Glandular tissues are fibrous and make it difficult for the liposuction cannula to penetrate, but this not the case in laser liposuction, hence the laser energy can cut through the fibrous tissue.
The results will also be better in the fatty breasts, as a larger volume of fat can removed. It is important that before the procedure, the surgeon should estimates how much fat is to be taken out, or otherwise too much fat might be removed.
Surgical reduction mammoplasty, on the other hand, is less suitable for older females. Compared to laser liposuction, the more invasive surgical procedure has an increased risk of poor wound healing and infection after surgery.
Laser breast reduction liposuction can reduce the appearance of ptotic breasts, but the main function of this procedure is for reducing breast volume.
Patients who need a breast uplift are not suitable for liposuction or laser liposuction and should be referred for breast uplift surgery.
Concerns of reduction mammoplasty there are differing opinions as to whether a mammogram is needed prior to a reduction mammoplasty treatment.
The result of a recent survey showed that UK breast surgeons tend to be pro-mammogram prior to the treatment, but plastic surgeons seemed to be less inclined to do so.
Breast cancer is the most common cancer in women and occult cancer cells have been found in the histological specimens obtained from surgical reduction mammoplasty.
The risk of finding occult malignant cells is believed to increase with advancing age, so it is therefore prudent to encourage patients to have a mammogram done prior to either method of reduction mammoplasty procedures, especially those in the 50 and above age group.
There is evidence that indicates that the risk of developing breast cancer is correlated to the size of the breast, as larger breasts have more breast tissues and, therefore, there are more cells that are potentially capable of becoming malignant.
Surgical reduction mammoplasty has been shown to reduce the incidence of breasts cancer and has even been suggested as a prophylactic procedure.
So far, there was no evidence that breast reduction by liposuction causes breast cancer. Neverthless, some practitioners are concerned that either method of reduction mammoplasty will make it difficult to detect breast cancer in the future. The worry is that the scar tissue and fibrosis after the procedure will somehow make it more difficult for a radiologist to spot the breast changes.
Dr Ayham Al-Ayoubi explains that, the liposuction cannula will need to be maneuvered to go round the glandular tissues that are normally placed just under the areolar. Avoid performing liposuction on an area of about 10cm wide under the clavicles, as this area is more vascular. Also avoid putting the incision site in the keloid-prone area around the sternum. After the procedure, compress and bind the area tightly to avoid bruising. Personally, I do not stich the small incision sites needed for microcannula access, as this will allow the tumescent fluid and blood to leak out, and, thus, reducing haematoma. I advise my patients to remove all compression after 24 hours and to wear a brassiere that they are used to wearing, and not to change them for smaller brassieres until at least four weeks post treatment. I found that excessive pressure only delays the healing and does not lead to better results. Potential Complications Breast reduction by liposuction, if done properly, is generally very safe. The complications are not different liposuction used in other areas of the body. These include: haematoma, pseudo-cysts formation, infection, bruising, swelling, mild pain and tenderness. Patients need to be advised that, as with all liposuction, the best results can only be seen six to 12 months after the surgery. Conclusion Reduction mammoplasty by liposuction can offer a lot of advantages over the open-surgical method. This is a procedure that has been safe and effective. For the sake of our patients, this simple procedure should be recommended more often, especially to those who are older and are at a higher risk of complications from open surgery.