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Background:  Breast reshaping surgery includes three basic manuevers, making the breast smaller (reduction), uprighting a saggy breast (lift) or adding volume.(implant vs. fat injections) They can be done alone or in almost any combination depending upon the patient’s aesthetic breast desires.

Breast reduction surgery is very common and extremely effective at not only reshaping the breasts but alleviating many of the musculoskeletal symptoms from their weight. Contrary to the concerns and perceptions of some patients, every breast reduction is also a full breast lift. It is simply not possible to do a satisfying reduction without elevating the nipple position and repositioning the breast mound  back up onto the chest wall at the same time. That is exactly why the breast is so measured and marked before surgery, that represents the pattern of skin removal to create the lift and the resultant inverted T or anchor scar pattern seen afterwards.

Conversely, breast lifts can and are often done without removing any breast tissue. If the patient’s breast volume is adequate, the excess skin is removed and tightened around the existing volume to reshape and lift the breast mound. But is some cases of breast lifts, there is a little too much volume to accomodate the amount of lifting needed. This is usually in the upper pole of the breast and it can prevent the ‘stuffing’ of the breast mound tissue into the reduced and tightened mound skin without causing undue tension on the wound closure.

Case Study: This 46 year-old female had saggy level III ptosis of her breasts that she felt were a little too big. She was not entirely displeased with their size (44 DD) but they had sagged a lot over the years after children and with age. She also had near constant pain in her back, neck and shoulders from what she thought had to be from her saggy breasts.

Right before surgery, the markings were made for an inferior pedicle type breast reduction. Under general anesthesia, the same areolar size was maintained and all skin within the keyhole pattern was de-epithelized. Skin flaps of 1 cm thickness were raised over the entire breast mound down to the pectoralis fascia. The skin flaps were wrapped around the breast mound and temporarily sutured together but it could be seen  that the closure was very tight. After taking the flaps apart, breast tissue was removed from the upper pole of 110 grams per side. The flaps were put back together, sutured closed and the nipple-areolar complex brought through a new site at the upper end of the vertical closure. Drains were not used.

Her recovery was typical for any breast reduction or lift patient. Swelling and bruising in the skin flaps persisted for just under 3 weeks after surgery. She did not have opening of the junction of the vertical and horizontal incision lines which many such patients do. Interestingly, even with very little breast reduction, her musculoskeletal pain was relieved.

Breast lift surgery can include a bit of a breast reduction if for no other reason than  to reduce the tension on the wound closure if necessary. Such reduction will not significantly reduce the final breast size.

Case Highlights:

1) Breast lifts can incorporate varying amounts of reduction (removal of breast tissue) at the same time if desired.

2) Breast reduction surgery, however, can not be performed without doing a full breast lift at the same time

3) Both breast reduction and full breast lifts use the same incisional pattern and resultant scars. (anchor pattern)

Dr. Barry Eppley

Indianapolis, Indiana

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