Breast Reduction TechniquesDr. John Q. Cook performs breast reduction surgery employing several different surgical techniques.
Breast Reduction Techniques
PERIAREOLAR BREAST REDUCTION
Patients love the periareolar approach to breast reduction surgery because the scar from the surgery is limited to the border of the areola.
The ideal patient for this operation is someone who is seeking a modest reduction in size of breasts that are not very large to begin with. Most patients who choose this operation are interested in breast reduction for artistic reasons rather than a major reduction in size.
During this operation I make an incision around the border of the areola, diminish the excess breast structure, and remove an outer circle of skin that surrounds the areola. When I bring the edge of the outer circle to the border of the areola, this tightens the skin of the breast and provides a modest lift.
Consider this operation if you want a relatively small reduction with a modest degree of breast lift and place a high priority on limiting breast scars.
STRUCTURAL BREAST REDUCTION
The structural breast reduction technique offers three key advantages: a restructuring of breast volume to fill out the upper portion of the breast, deep structural anchoring of breast tissue to reduce the stretching out that occurs after skin level breast lifts, and a limited scar.
The development of the structural technique has been one of my major breast surgery projects in recent years. The technique addresses some of the limitations of other breast reduction techniques.
With this technique I shift a portion of the breast structure to fill out the upper pole of the breast. This is important because a lack of fullness in the upper portion of the breast is one of the most common problems that breast reduction patients encounter over the long term.
With many enlarged breasts, the structure becomes spread out and lacks a good tone. With the structural technique it is possible to tighten the base of the breast and firm up the breast structure as part of the reduction process.
Many breast reduction and breast lift techniques rely on the skin to lift and tighten the breast. Unfortunately, for many patients the skin will stretch out again. This leads to a settling of the lower breast structure in a process that is known as “bottoming out.” This is accompanied by a hollowing out of the upper portions of the breast. With structural breast surgery the breast is anchored at a deeper level, so that the skin doesn’t have to do all the work.
I make use of the structural technique for a wide variety of breast reductions. In patients with massive breast enlargement or who have a great degree of extra skin in the lower portions of the breast I make use of the classic reduction pattern.
Consider structural reduction if it is important for you to maintain a degree of fullness in the upper portion of the breast, you want a firm breast structure, and you want to avoid the scar of the classic technique, especially the part at the inner part of the breast along the fold.
CLASSIC (ANCHOR) BREAST REDUCTION
The classic reduction technique produces scars that run around the areolar border, straight down from the lower edge of the areola, and along the fold under the breast. This forms a pattern that resembles an anchor, so some people refer to this as the anchor technique.
This is a tried-and-true technique that has produced many wonderful results and happy patients, and it is still the most commonly performed breast reduction technique in the United States.
For some patients, the scars from the surgery are a problem, especially along the fold at the inner portion of the breast. This is also a technique that essentially relies on the skin to hold the breast in its new position. In general, skin tends to stretch over time, and the breast tends to settle.
Although the scars may look the same, not all breast reductions with the classic scar pattern treat the breast structure the same way. Some surgeons carry out breast reduction by removing wedges that include the skin and underlying breast tissue and then bringing the edges back together by sewing the skin. This is the fastest method of reduction, but it is not, in my opinion, an approach that is well-suited to all breasts. For many breasts, the wedge approach produces a breast that has a boxy appearance. When I carry out a classic breast reduction I separate the two key variables of the surgery: skin reduction and breast structure reduction. I feel that this gives me more control over breast shape.
Many, but not all, patients who come to me for breast reduction surgery can take advantage of the structural reduction technique. For this reason I do fewer classic breast reduction surgeries than I did in the past.
There are still patients for whom the classic reduction technique is my best recommendation. Patients who are massively enlarged or who have a great degree of stretching out of the skin of the lower portions of the breast are often best served by a variation of the classic technique.
During your consultation I perform a careful dimensional analysis of your breasts, so that we can determine which breast reduction technique is best suited to your needs.
Consider breast reduction with a classic (anchor) scar pattern if you have massive breast enlargement or if you have very stretched out skin in the lower portion of the breast.
BREAST REDUCTION BY OTHER TECHNIQUES
Vertical Reduction and Liposuction Reduction
Vertical Breast Reduction was developed by pioneering surgeons in France and Brazil, and was resisted for many years in the United States. The main advantage is the limited scar when compared to classic breast reduction surgery. The main disadvantages are that it sometimes produces a strange breast shape until the breasts “settle in” and that there can be a “puckering” where the scar ends at the bottom edge of the breast.
In my practice the vertical reduction technique has been replaced by the structural reduction technique.
Breast Reduction by Liposuction certainly sounds appealing. If only one could reduce a breast without any noticeable scars! The technique has two major limitations. First, it doesn’t work well in breasts that have a glandular (as opposed to fatty) structure. In a breast that is largely made up of fatty tissue, it is certainly possible to reduce the heaviness of the breast with liposuction, but, in my opinion, it is difficult to produce a breast that will have a beautiful shape and position. Also, breasts that are reduced by this technique tend to take on a dense appearance on mammography, which can make them more difficult to evaluate. I would recommend discussing these issues in detail with your surgeon if you are considering this type of breast reduction surgery.
Contact Dr. John Q. Cook
As founder of The Whole Beauty® Breast Center, Dr. John Q. Cook is a leading provider of breast surgery in Chicago, including breast reduction and revision breast reduction. If you are considering breast reduction surgery, we encourage you to consult with Dr. Cook. Contact his practice today at 312-751-2112 or 847-446-7562 to schedule a consultation.