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Breast Reduction, Breast Lift or Both?

“Location, location, location” is not just a saying in real estate, it can also apply to cosmetic breast surgery. In particular, it is the location of the nipple (further south) that often brings a woman in to see a cosmetic surgeon. As women age, nurse babies, gain and lose weight etc… their breasts change. This is all normal, but some women are unhappy with the stretched skin and sagging that may occur.

This can be true for women with large or small breasts and helps determine whether she chooses a breast lift, either alone or in combination with another cosmetic procedure like an augmentation or a reduction. In our article, Augmentation, Lift or Both?, we discuss breast lifts in the context of breast enlargement. In this article we will discuss breast lifts and breast reductions and why they are often combined.

Breast Lift (Mastopexy)

A breast lift, or mastopexy, is usually done for someone whose nipple is below the breast fold or who has a significant amount of skin below the breast fold. It may also be done to reduce nipple size or for issues with skin irritation under the breast fold.

The procedure involves the removal of excess skin from around the nipple and lower part of the breasts. The nipple may be reduced in size and moved up to a higher position. This can slightly reduce the size of the breast while also decreasing sagging, improving firmness, and giving a more youthful appearance.

Breast Reduction

A breast reduction, or reduction mammaplasty, is a procedure done for women (and men, in fact) who want to reduce the size of their breasts. This may be for cosmetic reasons – perhaps they don’t feel their breasts are in proportion to the rest of their body, or, in the case of men, they want a less feminine appearance. People also pursue breast reduction surgery to alleviate physical symptoms like neck, shoulder, and back pain, headaches, and painful bra strap grooving.

During a breast reduction, breast tissue, including excess fat, skin, and glandular tissue, is removed. The extent of tissue removed depends on the original breast size and the goals of the patient. The surgery includes lifting the breast and repositioning the nipple unless the reduction is done by liposuction alone.

Breast Reduction with Lift

Because larger, heavier breasts are prone to droopiness, a reduction almost always includes a breast lift. According to Dr. Slack, “With any reduction technique, except liposuction-only, the breast is lifted, meaning the droopy lower pole of the breast is elevated so that the breast starts at the breast fold and moves up from there. The nipple/areola complex is elevated along with the breast and is typically made smaller.”

The lift is done for aesthetics, but it is also done for women whose primary complaints are physical symptoms like neck and shoulder pain. This is because the lift and subsequent higher positioning of the breasts significantly improves posture and takes stress off muscles in the neck and shoulders.

While Dr. Slack usually performs a lift with a breast reduction, every case is unique and must be handled individually. You might be looking to downsize but are quite happy with the location of things, or perhaps the reverse. Only a consultation with a highly trained and experienced plastic surgeon like Dr. Slack, will help you understand whether a reduction, lift, or both is right for you. Call and schedule an appointment today.

What if My Teenager Wants to get a Breast Reduction?

Whether you think it is OK or not, the fact remains that adolescents (age 13-19) in the United States are having plastic surgery. More than 200,000 cosmetic procedures are performed on teens per year. Many of these are minimally invasive procedures like laser hair removal or treatments for acne scars, but nearly 70,000 are surgical procedures including breast lifts and breast reductions.

Behind these statistics, though, are the individuals and their parents or guardians involved in making the decision to go forward. No plastic surgery should be taken lightly, but when a teen is involved, there are further considerations. The American Society of Plastic Surgeons gives the following advice:

“As with any surgery, parental consent is required for all plastic surgery procedures performed on teens younger than 18 years old. The ASPS advises parents to evaluate the teenager’s physical and emotional maturity and believes that individual cases merit careful evaluation under the guidance of a plastic surgeon certified by The American Board of Plastic Surgery.”

For breast reductions, called reduction mammaplasty, physical maturity is important in particular. Breast development during adolescence varies greatly and most plastic surgeons recommend waiting until an age when the breasts are fully developed.

Having overly large breasts, or macromastia, can be difficult physically and emotionally. The physical symptoms may include neck and back pain, chronic headaches, rashes, poor posture, and numbness and tingling in the hands. This research study found a significant negative effect on quality of life and eating behaviors in adolescents with macromastia.

The treatment for macromastia is a breast reduction. Depending on breast size, this procedure involves the removal of a variable amount of skin, excess fat and glandular tissue as well as lifting of the breasts so that they do not hang down below the breast fold. This repositioning of the breast may help as much as the actual reduction of the weight of the breasts. 

A 2017 study on the effect of breast reduction on the quality of life in adolescents showed a positive impact. About a hundred teens with macromastia were followed from six months to five years after breast reduction surgery. Along the way they gave the teenagers a self-esteem rating scale, a breast-related symptoms questionnaire, and an eating attitudes test. They found a significant improvement in all three areas that were still demonstrable after 5-years.

According to the American Society of Plastic Surgeons, the best results will occur if the following are true:

  • The teenager initiates the request.
  • The teenager has realistic goals.
  • The teenager has sufficient maturity.

It is important to note that breast reductions are not limited to teenage girls. More than 7,000 breast reductions in boys (age 13-19) with gynecomastia were performed in 2016 alone. Gynecomastia is a term used to describe enlarged breast tissue in men. You can learn more in our post on the surgical treatment for gynecomastia.

You can also learn more about breast reduction surgery in the posts below:

If you or your teenager are unhappy with your breast size, or you simply want to find out if a breast reduction is the right choice, call our office today and schedule a consultation.

What Exactly is a Breast Reduction?

No two breasts are alike–even the ones side by side on the same chest. Some are big and some are small. Some stand at attention and some hang low. If you want to even yours out or make them both smaller, a breast reduction can get the job done.

And just as no two breast are alike, neither are any two breast reductions. A breast reduction, also called a reduction mammaplasty, can involve a number of different procedures, depending on the needs of each patient.

There are many reasons people have breast reductions, including physical symptoms like headaches and back pain and cosmetic issues like uneven breasts, enlarged areolas, or stretching from weight loss or breastfeeding.

The right procedures depend on the goals of the patient: how much of a change in size and shape is desired; whether they are looking for a more feminine or masculine result (Breast reductions are the fastest growing plastic surgery procedures among men in the US); or whether a woman wants to be able to breastfeed.

Depending on these goals and on the initial size, shape and position of the breasts, the surgical approaches will vary. 

Here are the surgical terms to know:

Reduction Mammaplasty
This is an umbrella term used to describe the surgical removal of breast tissue that can include excess fat, skin, and/or glandular tissue. This may be accomplished by surgical excision (cutting out) of breast tissue or with liposuction. mastopexy (breast lift) is a part of most breast reductions.

Mastopexy
This procedure is also called a breast lift, and it is usually a component of a breast reduction. The procedure can also be done on its own. The surgery entails removing excess skin around the nipple and lower aspect of the breast to decrease droopiness.

Liposuction
This is a minimally invasive procedure used to reduce the breast by removing fat. Liposuction alone does not lift the breast however. 

Some patients with smaller breasts may only need a little liposuction to reduce their breasts. Others will need more tissue removed and a lift (mastopexy).

Dr. Slack explains, “With any reduction technique, except liposuction-only, the breast is lifted, meaning the droopy lower pole of the breast is elevated so that the breast starts at the breast fold and moves up from there. The nipple/Areola complex is elevated along with the breast and is typically made smaller.

The extent of the breast lift and scar pattern varies depending on the location of the nipple, the elasticity of the skin, and the amount of tissue to be removed.

Here are the three general types of breast lifts used during a breast reduction:

Periareolar “doughnut” mastopexy
An incision is made around the areola and excess skin is removed. With this technique the areola is repositioned and reduced in size. 

Circumvertical “lollipop” or “keyhole” mastopexy
A keyhole incision is made around the areola and then vertically down to the crease of the breast. Excess skin, fat and glandular tissue are removed. The areola can be reduced in size as well.

Extended circumvertical  “wise-pattern” or “anchor” mastopexy
Using an inverted “T” incision pattern, this procedure does all of the above but skin is also removed horizontally leaving a scar along the breast fold. This allows for the removal of more skin, fat, and glandular tissue and relocation of the areola. The horizontal incision along the breast fold is extended out toward the armpit.

During a breast reduction, the nipple is usually left attached to the breast tissue below. With extremely low placed nipples or larger breasts, the nipple may need to be completely removed and replaced as a skin graft after the reduction is complete. This possibility should be discussed with your surgeon before hand, particularly if you are concerned about breast feeding. 

All breast reductions are performed under general anesthesia or conscious sedation. Because of this and the many choices that go into any breast reduction, it is important to choose a qualified plastic surgeon. Preferably one with special training in surgery of the breast, like Dr. Slack. Take a look at his breast reduction before and after photo gallery of patients seen in Collin County, Texas.

As with all plastic surgery, there will be some scarring, the extent of which depends on the procedure performed: there is little scarring with liposuction alone and more if extra tissue needs to be removed. In most cases, your surgeon will do his best to hide incisions within the areola and in the breast crease. Some scarring is likely to remain visible but will fade over time. Most patients report it is a worthwhile tradeoff for all the benefits of the breast reduction.

Recovery time after a breast reduction will also vary depending on the amount of tissue removed and the extent of the incisions. Your results will be apparent immediately after surgery. You will need to take it easy for at least a week and it is important to follow your doctors instructions. These instructions will help minimize scarring and lead to the best possible results. It may take a few months for all the swelling to subside and your final results to be fully realized.

If you are interested in a breast reduction, and you want to learn more about the options available to you, call Dr. Slack’s office and schedule your consultation today.

Mastopexy in Men: Say Goodbye to Gynecomastia

You might be surprised to learn that one of the fastest growing plastic surgery procedures performed on men in America is… the breast reduction. In 2016, almost 30,000 surgeries of this type were performed on men for a condition called gynecomastia or it’s relative pseudogynecomastia.

Gynecomastia comes from a combination of the Greek words for woman (gynae) and breast (mastos), and it is a term used to describe enlarged breast tissue in men. True gynecomastia is characterized by an overgrowth of glandular tissue. This usually manifests as a small tender lump of glandular breast tissue beneath the nipple/areola. It is not uncommon to see this problem in adolescent males, but in most it will resolve as they get older. Pseudo– (Greek for false) gynecomastia is characterized by increased fat deposits in the breast area.

Both conditions (which for convenience are often both referred to as gynecomastia) are common, affecting up to a third of all men. The problem is benign but can cause social and psychological discomfort.

According to the American Society of Plastic Surgeons, gynecomastia is characterized by the following signs:

  • Excess localized fat
  • Excess glandular tissue development
  • Sometimes excess breast skin
  • Presence unilaterally (one breast) or bilaterally (both breasts)

Though for most cases of gynecomastia there is no identifiable reason for its occurrence, it can be the result of a hormone imbalance: either the presence of too much estrogen or too little testosterone. Drugs including anabolic steroids, certain antidepressants, and alcohol have been linked to this condition as have certain medical conditions, a few of which are listed below:

  • Kidney disease and dialysis
  • Tumor
  • Obesity
  • Extreme stress
  • Hyperthyroidism
  • Liver disease

Depending on the level of physical or social discomfort that accompanies the condition, with the help of a qualified plastic surgeon, the problem can be fixed. Excess skin, fat, and glandular tissue can be removed with a breast reduction, also called reduction mammaplasty.

In many cases this surgery involves a small incision at the border of the areola to remove the offending glandular tissue with any excess fat addressed as needed with liposuction. When the condition is more advanced, it can be corrected with a chest lift, or mastopexy, similar to a breast lift in women.

The severity of the condition, the elasticity of the skin, and the amount of sagging all help to determine the type of mastopexy needed to restore a firmer and more masculine appearance to the chest. The location and extent of the incision depend on the amount of tissue removed and include the following types of mastopexy:

Periareolar or doughnut mastopexy

An incision is made around the areola. Excess skin, fat and glandular tissue are removed. With this technique the areola can be made smaller.

Circumvertical mastopexy

A keyhole incision is made around the areola and down to the crease of the breast in order to remove more excess skin, fat and glandular tissue. The areola can be reduced in size as well.

Extended circumvertical mastopexy

An inverted “T” incision pattern allows the removal of more skin, fat, and glandular tissue and relocation of the areola. In some cases, the vertical scar below the areola is extended out toward the armpit.

To learn how plastic surgeons like Dr. Slack minimize the appearance of scars see our post: Best Practices for Minimizing Scars. You can also look through this male breast reduction before and after photo gallery to see how discrete the scarring can be.

In addition to years of experience, Dr. Slack has completed a fellowship and extensive training in cosmetic and reconstructive surgery of the breast. He says the best candidate for the surgery:

If you are a man suffering from a sagging chest or gynecomastia and want to know if you are a candidate for surgery, contact us today and schedule your consultation.