Breast Reduction

breast reduction before and after photo

Breast reduction is the perfect plastic surgery operation in the sense that it relieves discomfort, improves lifestyle, and enhances appearance.  A standard breast reduction is the time honored way of reducing breast size, because it allows for an unlimited amount of breast tissue removal.  It also provides maximal control for breast mound reshaping and lifting. 

But the scars can be significant. If the skin is good and does not need to be lifted, then a "scarless" reduction can be done (though there are actually two very small incisions underneath the breast.)  Only fat can be removed and this technique does not offer the surgeon the ability to reshape, tighten, or lift the breast.  But for the appropriate patient the result is gorgeous and very satisfying.

breast reduction before and after photo

Dr. Teitelbaum is thrilled to perform breast reduction surgery because breast reduction patients are among the happiest in all of plastic surgery. This is because breast reduction is the perfect marriage of a “medically necessary” procedure with an aesthetic procedure.

Many women have significant symptoms from their large breasts: neck and back pain, breast pain, rashes under their breasts, grooving and pain from their bra strap, and much more. Large breasts restrict many women from exercising, jogging, or playing certain sports.  They feel their breasts are stared at; they face difficulty finding nice fitting clothing; and find that they look heavier and more short-waisted than they actually are.

It is very important for a patient to convey the symptoms they are having and the size they wish to be to create the ideal surgical plan.

Types of Breast Reduction

Anchor Scar, the Inverted-T Scar, or the Wise-Pattern Scar

The gold standard for breast reduction is known as either the anchor scar, the inverted-t scar, or the Wise-pattern scar. This requires an incision around the areola, then straight down from the 6 o’clock position on the areola to the crease under the breast, and then along the crease. Though this method has the longest scars, it still remains the most common method for breast reduction because it is able to remove skin in both the vertical and horizontal dimensions, which thereby gives the greatest control of shape and balance of the breast, and the results are durable over time. It also gives the surgeon the ability to remove excess breast volume in any part of the breast, thereby furthering the surgeon’s ability to shape the breast.

“Vertical” or “Lollipop” Breast Reduction

The “vertical” or “lollipop” breast reduction eliminates the scar across the bottom of the breast and is an excellent method for some breasts. The addition of the horizontal scar on the bottom, however, does give more control over the shape of the breast by allowing skin to be removed in an additional axis. And since it is along the crease of the bottom of the breast, that scar is usually barely noticed. A vertical breast reduction also requires some “bunching” of skin.  Though this flattens over time, the scar invariably ends up wider as a result of this. In all published case series of vertical style breast reductions, there is a significant need to add at least a short horizontal scar on the bottom or to do a scar revision.

“Donut” or “Benelli” Breast Reduction

The “donut” or “Benelli” breast reduction has a scar that is only around the perimeter of the areola. This is effective only for breasts that are small and light to begin with. American patients with breasts sufficiently small rarely consider a breast reduction. If this method is attempted for larger breasts, the areola ends up stretching and flattening, the scars widen, and the shape is typically unattractive. So while this scar works for very small breast lifts, there is rarely a place for it in breast reduction surgery, particularly given the desires of breast reduction patients in the United States.

Considering Breast Reduction Scars

A patient considering breast reduction surgery has to determine on her own that the improvement in shape, droop, and weight, is worth the trade-off of a scar, even if the scar is not inconspicuous.  In general, darker skinned, thicker skinned, and oilier skinned individuals make worse scars than patients with thinner skin and paler complexions, but this rule is not absolute.  

Scars are the inescapable trade-off with breast reduction.  There is simply no way around them.  Usually the benefit is worth the scar, but that is a decision a patient must make for herself.  While the scars fade in most people, they never go away.  And there are some women in whom the scars of a breast reduction remain thick or red.  Dr. Teitelbaum carefully puts in tiny sutures made of a fine material in order to maximize the chances that the scars will heal well.

Despite this warning about scars, studies have shown breast reduction patients to be among the happiest of plastic surgery patients. Even when scars are not faint, most patients will report that they are happier with how they look and feel after surgery.

"Standard" breast reduction

The term “standard reduction” implies that some type of an incision is used to remove tissue as well as to remove breast skin in an effort to retighten the breast after the tissue removal. 

All of the scar types mentioned above allow for removal of tissue as well as skin.  A standard reduction procedure removing both skin and “fill” of the breast achieves the ideal result in the greatest number of circumstances.
before and after standard breast reduction

Before and after standard breast reduction surgery. 
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Every breast reduction patient and surgeon wants the shortest possible scars that are faint and barely perceptible.  All desire the best elevation and shape of the breast possible.  Sometimes these objectives can be achieved with a single method, but frequently there is some trade-off between scar length and scar quality, or between scar length and shape.

"Scarless" breast reduction

The gold standard for breast reduction both reduces and lifts the breasts.  A predictable amount of tissue is removed, a lift is done, but it does come with significant scars.  For women with significant excess volume or much droopiness, there is not much of an alternative. However, for women with less droopiness and who need a more limited amount of weight removed, the scars can be a difficult trade-off to accept.  While the scar often fades, it never fully goes away, and in some cases the scar remains quite visible.

For the patient with a full and high breast, liposuction only (or “scar-free”) breast reduction is a fabulous procedure.  It is a way to make the breasts smaller and lighter without any scars.  One or two tiny incisions are made that are hidden in the crease under the breasts, and fat is removed from the breasts.  Recovery is quick and very easy.

There are two shortcomings to this technique:  First, it can only remove the fat in the breast; it cannot remove the firm glandular breast tissue. Every woman has some fat in her breasts, but surgeons cannot reliably predict before surgery how much of the breast size is due to fat or to glandular tissue.  Surgeons cannot always predict ahead of time which problem a woman has.  So it is possible that a breast reduction with liposuction will not remove as much as would be ideal. 

Nevertheless, usually enough can be removed to make a significant change in symptoms, how bras fit, and overall body proportions. Of those who did not get as much of a reduction as they would have ideally wanted, most everyone still says that they prefer having the more modest reduction without scars to a more complete reduction with scars.

The second shortcoming of liposuction breast reduction is that it does not lift breasts.  With less weight in them the breasts typically recoil upwards.  The extent to which this will happen is not predictable, and that recoil is in no way comparable to the lift that is achieved with a breast lift procedure.  Liposuction-only breast reduction is best reserved for women who do not need or who do not want a breast lift.

scarless breast reduction before and after photo

Before and after "scarless" or "liposuction-only" breast reduction surgery. 
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Teenage breast reduction

For women who have suffered with large breasts for many years, the decision to have a breast reduction often comes easy and brings with it a sense of emotional relief.  But for the many teenage girls who consider breast reduction, trying to decide whether to have a breast reduction can be more emotionally charged. Dr. Teitelbaum’s manner is slow and particularly delicate when meeting together with a young breast reduction surgery patient. Frequently mothers accompany their daughters to these visits, and occasionally fathers do as well. Parental support and understanding for their daughters considering breast reduction surgery is very important.

VIDEO: Breast Reduction Surgery

Breast reduction surgery expertise 

Dr. Teitelbaum has performed breast reduction for over twenty years. He gained his initial experience in breast reduction while a general surgery resident at Harvard with famed breast reduction surgeons Robert Goldwyn, MD and Sumner Slavin, MD.  Over the years, he has been influenced by other experts and has developed an approach that enables him to achieve magnificent and beautiful results. 

Breast reductions are a procedure that he performs with great regularity and his many breast reduction patients express relief and joy over their more beautiful bodies and more comfortable state of living.

For more information about breast reduction surgery in the Los Angeles area, contact plastic surgeon Dr. Steven Teitelbaum at 310-315-1121