Breast Reduction /Liposuction

Breast Reduction
/Liposuction

Women who undergo breast reduction surgery are often looking for symptomatic relief of neck and shoulder pain and/or skin fold irritation and rashes.

What is Breast
Reduction Surgery?

Women who undergo breast reduction surgery are often looking for symptomatic relief of neck and shoulder pain and/or skin fold irritation and rashes. There are many types of breast reduction procedures that have been developed to lighten and lift the breast through the surgical excision of excess breast fat, glandular tissue and skin. Most of these procedures are excellent at addressing the physical symptoms, but the aesthetic outcomes often leave much to be desired. With each surgical reduction technique the breast shape, contour and scars can vary widely. Most of these procedures were developed before the advent of liposuction, and by surgical necessity, have extensive incisions and subsequent scars as their end result.

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The anchor technique, as one example, is a very reliable and commonly used technique for breast reduction. Nevertheless, Dr vanVliet stopped using this technique about 6 years ago because she found the final result was often not pleasing to the eye. She found that the scarring was extensive and the breast contour was often left flat with poor projection. In addition, the breast contour and lift often did not hold up over time. Dr vanVliet now revises many of these anchor technique breasts to help improve their shape after they have bottomed out. This issue led her to take on more current, innovative procedures that are better able to address the aesthetics as well as the weight of the breast.

Today, Dr vanVliet uses a vertical reduction technique or lollipop technique of breast reduction surgery because she finds it to be a more aesthetically appealing technique of reducing the breast. This technique significantly reduces the amount of scar left on the breasts. More importantly, it creates a very pleasing conical projection of the breasts, one that most women desire.

For women with very wide breasts, or those wishing more extensive reductions, Dr vanVliet often combines the vertical reduction procedure with adjunctive liposuction of the upper chest (under the armpits and to the sides of the breasts) to improve the power of the reduction and to help refine and shape the breasts.

In some cases, liposuction alone can be used to reduce the breast, if the skin elasticity of the breasts is good, and if there is minimal descent. This is virtually a scar-less procedure.

Occasionally, women get recurrent breast growth in the years following their breast reduction. There are many causes such as pregnancy, lactation, menopause and weight gain. They also may have lost some of their shape, lift and contouring over time and come in for revision surgery. Traditionally, repeat breast reduction was considered a high-risk procedure for nipple death and poor quality scarring. Most revisionary breast reductions that Dr vanVliet conducts are done extensively with liposuction alone, with or without a small wedge excision. This allows her to reliably revise scars, reshape and reduce breasts with minimal risk and often with improved breast aesthetics.

Dr vanVliet believes that breast reduction can provide a wonderful opportunity to lighten and lift the breasts and also improve on the breast aesthetics.

Most women who request breast reduction surgery have physical discomfort related to their heavy, pendulous breasts. Often the complaint is neck and shoulder girdle pain, painful bra strap markings, or rashes in the breast folds. The ideal surgical candidate is: – a nonsmoker older than 17 years of age with fully developed, stable breast size – close to ideal body weight (BMI <35) – realistic about potential loss of breast-feeding potential – realistic about scars on the breast mounds – in good physical and mental health with no existing breast disease.

Your initial office consult will allow you to meet with Dr. vanVliet and discuss your specific concerns and your expectations of surgery. It is a time to explore whether breast reduction surgery is the right procedure for you and if there are any co-existing health issues or risk factors that need to be addressed in preparation for your surgery. Dr. vanVliet will make specific recommendations based on a thorough examination of your breasts and your discussions with her. If you wish to discuss options for adjunctive liposuction to further contour the breast and to reduce fullness under the arms, or to correct nipple contour (nipple inversion, over-projection), this will occur during this initial consultation. Adjunctive liposuction can significantly increase the power of your reduction procedure to reduce and sculpt your breasts. If you decide to move forward with surgery, Dr. vanVliet will again re-assess you during a pre-operative visit closer to your scheduled operative date. Dr vanVliet believes a well informed, prepared patient is a more relaxed and happier patient.

Your surgery will be conducted at Southlake Regional Health Centre. Please ensure that you follow Dr. vanVliet’s pre-operative instructions regarding when to arrive for surgery and when to stop eating and drinking. Also, aspirin, anti-inflammatories and other blood thinners can significantly increase your chances of operative bleeding, so you need to avoid taking these medications at least one week prior to your scheduled operative date. A relative or friend should accompany you to the hospital. Dr. vanVliet will meet you in the operative suite and she will do pre-operative breast markings and photos before you go off to sleep. You will then be administered your anesthetic by a board certified anesthetist. After about 1.5-2.5 hours you will wake up in the recovery room where you will be closely monitored until you are fully awake. You will have a light dressing on and be wearing a protective compression bra. Drains are rarely required. Before you are discharged, Dr. vanVliet will assess you and provide you with post-operative instructions and a script for pain medication. You will then be released to the care of a relative or friend for the next 24 hours.

Dr. vanVliet continues to perfect her vertical reduction or “lollipop” reduction and she conducts over 200 reductions a year. The vertical scar technique has 2 scar components: around the areola, and then a vertical extension from the areola down to the breast fold. The length and extent of the vertical scar is directly proportional to the degree of lift that is required. The nipple areolar complexes are often reduced in size in order to be proportional to the newly reduced breast and, in most cases, they remain attached to their blood vessel and nerve supply. For the wider breast, additional liposuction is often employed to further contour the breast and to reduce fullness under the arms. Occasionally, if there is minimal breast descent, breast liposuction as a sole procedure can be done, further minimizing the need for breast scars. Nipple contour corrections, whether it be for inversion or too much projection can also be combined with the breast reduction procedure. The best choice of procedure can be tailored to best fit your needs at the time of your initial consultation with Dr. vanVliet.

The good news is that breast reduction is a minimally painful operative procedure. Dr. vanVliet will write you a prescription for pain medications but often anti-inflammatories suffice, with minimal narcotic requirements. You will have a light dressing on with an overlying protective compression bra during your first week. You will be in sponge bath mode during this time, not touching your dressings until we see you. Your first and often your only dressing change occurs on your first post-operative visit to the office. After that you can go home to shower. Initially you will notice that your incisions are puckered, raised and red and that you may have some bruising. With rest and compression of your chest, the bruising will quickly settle and the scars will begin to soften and become less raised. Wearing your compression bra 24/7 during the first month will greatly enhance your wound healing and, ultimately, your final scar quality and breast contour. You will be quite functional during your first post-operative month but we will ask you to refrain from exertional activity and sports, as well as friction and touch of the breasts. Most people return to work within two-to-three weeks and to the gym in a month.

Overall, operative risks are minimal in young, healthy patients. However, as with any surgical procedure, there is always the possibility of complications related to surgery or to your anesthetic. Bleeding and infection rates approximate 1-2% and may necessitate further corrective surgery. It is highly unlikely you would require a blood transfusion if you were to have post-operative bleeding. There is a 5% chance of poor quality scarring, or poor breast contour and/or permanent loss of nipple areolar complex sensitivity. Dr. vanVliet tracks her results closely and has not found liposuction to increase any of the operative risks observed above. As well, revision procedures are rarely required. Young patients are made aware that they will have a significant reduction in breast feeding potential as a result of the surgery.

Most often the procedure is funded by OHIP. If adjunctive liposuction or nipple contour correction is conducted, this will need to be privately funded. Dr. vanVliet will be able to give you a sense of the cost based on the work to be done at the time of your initial consultation. If you would like to learn more, please refer to our fees & financing section or contact us by phone or email to schedule your consultation with Dr. vanVliet.

Although liposuction is not an OHIP funded procedure, it can be combined with an OHIP funded breast reduction, which makes it more affordable. It can also be used on its own as a sole procedure. Liposuction is a safe and powerful tool. Dr. vanVliet often combines it with her vertical reduction procedures, allowing her to maximize the reduction and breast shaping, while reducing the amount of breast scarring. If you would like to learn more, please refer to our fees & financing section or contact us by phone or email to schedule your consultation with Dr. vanVliet.