Lipoplasty-only Breast Reduction: ASAPS Position

This position statement was released in July, 2002. Position statements are subject to change as further information becomes available.

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.

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