Lipoplasty-only Breast Reduction: ASAPS Position

Background

Lipoplasty (liposuction)
continues to be the most popular cosmetic
surgical procedure performed in the United
States, according to statistics from the
American Society for Aesthetic Plastic Surgery
(ASAPS). Common sites for improvement with
lipoplasty include the thighs, hips, flanks,
abdomen, back, knees, arms, calves and neck.
Lipoplasty has been used successfully in
men to treat gynecomastia (enlarged male
breasts), a condition affecting an estimated
40% to 60% of all males at some point in
their lives. More recently, surgeons have
gained favorable experience in performing
breast reduction in a select group of women
using lipoplasty alone. Using lipoplasty
to significantly reduce the size of the
female breast is a relatively new concept,
and this technique has not yet been widely
adopted.

Benefits and
Patient Selection

Interest in lipoplasty-only breast reduction
is growing due to a number of

potential benefits:

  • Uses minimal incisions
    inconspicuously placed
  • Operating time is shorter,
    requiring the patient to spend less time
    under anesthesia
  • Some aspects of
    recovery are more rapid

While lipoplasty-only breast reduction
offers an alternative to traditional breast
reduction techniques, proper patient selection
is critical to achieving aesthetic results
comparable to traditional techniques.

Following lipoplasty of the breast, the
elastic qualities of the skin cause it to
contract, and subsequent uplifting of the
breast contour should occur to some extent.
However, in patients with poor skin elasticity
or when a large amount of fat is removed,
the degree of uplifting is unpredictable
and, in some cases, may not meet patient
expectations. Therefore, lipoplasty-only
breast reduction may not be the best choice
for patients requiring more than minimal
or, in some cases, moderate reduction, or
in women with low nipple position. Some
patients who have undergone lipoplasty of
the breast may benefit from further surgery
such as a lifting operation; however, a
breast lift (mastopexy) requires incisions
that result in additional scarring, so that
many of the benefits that were originally
sought from the lipoplasty-only technique
will be lost.



The fat component of the breast varies from
patient to patient, and within the same
patient, it varies over time. With the onset
of menopause, the breast tissue is gradually
replaced by fat, making postmenopausal women
among the best candidates for lipoplasty-only
breast reduction. Patients with fibrous
tissue and minimal fat in their breasts
may not be optimal candidates for lipoplasty-only
reduction.

Traditional Breast
Reduction

Traditional breast reduction procedures
in women remove both excess tissue and skin,
reposition the nipples and areolas (the
pigmented skin surrounding the nipple) and
reshape the breast. One commonly performed
technique uses incisions that encircle the
areola and then extend vertically down the
breast and horizontally along the crease
underneath the breast. There are other techniques
that may eliminate the horizontal incision,
the vertical incision or both.

Lipoplasty-only
Technique

The procedure for lipoplasty-only breast
reduction is similar to the technique for
lipoplasty performed elsewhere in the body.
It requires one or more small incisions
around the periphery of the breast to allow
the infusion of fluids, or wetting solution,
to reduce bleeding and facilitate fat removal.
Using traditional suction-assisted lipoplasty
(SAL), fat is dislodged by the surgeon using
a blunt-tipped instrument, called a cannula.
Next, the fat is vacuumed out through a
long, hollow tube connected to a suction
device.

Patient Advisory

Because of the possibility for any woman
to develop breast cancer, it is advised
that women undergoing lipoplasty of the
breast continue with mammographic examinations
according to the guidelines of the American
Cancer Society. There is no evidence that
the use of SAL for breast reduction either
causes or interferes with the detection
of breast cancer.

It is ASAPS' position that the patient's
most important consideration should be surgeon
selection, not the specific technique being
used. The surgeon's judgment in patient
selection and application of the appropriate
technique in each individual case is essential
to obtaining an aesthetic outcome from breast
reduction. Prospective patients should choose
a plastic surgeon certified by the American
Board of Plastic Surgery (ABPS) and, preferably,
a surgeon who has met the additional requirements
for membership in the American Society for
Aesthetic Plastic Surgery (ASAPS).

If lipoplasty-only breast reduction is
being considered, the surgeon should have
wide experience in both traditional breast
reduction techniques and lipoplasty surgery.
If the procedure is done in an office-based
surgical facility, patients should make
certain that the doctor has hospital privileges
to perform the same procedure in an acute
care hospital. In addition, the office-based
facility should be accredited by a national
or state-recognized agency such as the American
Association for Accreditation of Ambulatory
Surgery Facilities (AAAASF), or should be
state licensed or Medicare certified.

Ultrasound-Assisted
Lipoplasty

The use of ultrasound-assisted lipoplasty
(UAL) for reduction of the female breast
appears to offer no significant advantages
to traditional SAL. While there are theoretical
concerns, experimental data show no evidence
that the use of UAL for breast reduction
would increase the risk of breast cancer;
however, there are no clinical data to substantiate
long-term safety. It is the position of
the American Society for Aesthetic Plastic
Surgery (ASAPS) that patients considering
this treatment be adequately informed of
the theoretical concerns.

About ASAPS
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

WE ARE AESTHETICS.

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