THE DERMATOLOGY
COSMETIC CLINIC
and
SOUTHERN LIPOSUCTION CLINIC

"Non-Scarring" Breast Reduction - Female

Breast reduction using Tumescent Liposuction is now available at our Wellington Clinic, Wakefield Hospital, Newtown, as well as at our Christchurch Clinic

Background
Breast reduction has traditionally been performed with surgical intervention called mammoplasty. The procedure involves cutting out sections of the breast and usually cutting around the nipple/areola area and elevating the nipple and loose skin.

Mammoplasty is an effective and well-proven procedure. However, it does have a high reported rate of complications (10-50%) and involves a number of hours in theatre under general anaesthetic. Complications can include unsatisfactory scarring, altered sensation of the nipple, difficulty or inability to breast-feed as well as others. Recovery from this procedure is slow compared with the now available option of Tumescent Liposuction, which has a reported low complication rate (about 1%).

Liposuction underwent a dramatic change in 1987 when an American Dermatologist discovered the tumescent technique. This involves filling the fat with a very dilute form of local anaesthetic and adrenalin, which numbs, softens and prepares the fat. The adrenalin causes temporary shrinkage of small blood vessels so there is minimal bleeding.

Using very small and thin microcannulae, the fat can be removed smoothly and evenly through tiny 1-2mm incisions. These heal with no, or at most minimal scars.

This woman would be a good candidate for breast reduction by Tumescent Liposuction

Dr. Bellaney believes that Tumescent Liposuction should be the procedure of choice for most women seeking a breast reduction. There is a minority of women for whom Tumescent Liposuction may not be suitable, e.g. those with poor skin elasticity. In this situation Mammoplasty would likely result in more breast elevation than could be achieved with Tumescent Liposuction

Procedure
Pre-operatively patients require mammograms to see where the fat lies within the breast and also to assist long-term follow-up.

Following the procedure, a compression garment is applied and worn for the next 2-4 weeks. Post-operatively there may be some tenderness and bruising and there may be weeping of fluid through the small incisions during the next 24 hours. Most patients can return to ordinary duties after 48 hours; however, there may be variation between patients.

Results
Between a third and a half of the breast can usually be reduced in size with this technique. The amount that is removed may vary from 200ml to 2,000ml of fat from each breast and it is important that pre-operatively some guidance is given to Dr. Bellaney as to what would be the ideal size the patient wishes to obtain. Women can expect a bra size reduction of about 2-3 sizes, e.g. size 40E to 38C, or 36DD to 36C. These are examples only and individual results will vary.

Often large breasts are associated with a breast tail, where fat continues around the side of the chest and under the armpit area. This area and others can be removed at the same time with Tumescent Liposuction. Breast asymmetry can also be helped.

Breast asymmetry such as shown here can also be helped.

Most people having Liposuction are surprised at the extent of the skin contraction. Nipple elevation varies from 3cm-10cm. By using the "superficial technique" of removing the fat layers immediately under the skin, maximum skin contraction and breast elevation occurs. There is usually more lift of the nipples when breast reduction is performed with the surgical alternative.

Dermatologists proficient at the procedure of Tumescent Liposuction for Breast Reduction believe it should be the procedure of choice for most women considering Breast Reduction - indeed a number of Plastic Surgeons feel the same way.

Complications
Some bruising, swelling and pain can be expected in most patients. the pain is almost always only mild to moderate and controlled with pain relief. Infection is also possible. The Tumescent technique reduces the infection rate, due to the fact that the fluid is antibacterial. The procedure is performed under high sterility with pre-operative antibiotics.

Significant scarring does not occur with Tumescent Liposuction, as there are only lmm-2mm necks on the skin, which normally heal exceptionally well with minimal to no marking.

There have been no long-term studies to ascertain the effect of liposuction on the ability to breast feed, although groups overseas report that patients can.

A major Issue with all forms of breast reduction Is whether changes will occur in the breast that would be Identified on the mammogram at a later date and confuse a mammographer as to whether they are marks from previous surgery or, in fact, breast cancer developing. Dr Bellaney's routine is to perform a pre-operative mammogram and to have It repeated at six months, to see if there are any changes which will then be used as a reference for mammograms later in life Hopefully this will avoid any confusion and requirements for unnecessary biopsies

It is important to understand that cosmetic surgery is not an exact science and no guarantees can be given as to the exact outcome Individual results will vary. No long-term studies directly comparing Tumescent Liposuction with Mammoplasty are available. However, this information attempts to present the main body of medical opinion. For further information see www.asds-net.org or www.drlanzer.com or www.dermnet.org

	Surgery - Mammoplasty	Liposuction
Surgical procedure	Long and complicated (2-5 hours)	Rapid and relatively simple (1-1/2 hours)
Risks of procedure	Potentially high and significant All have scarring - occasionally severe Blood Loss Risk of Infection Loss of nipple sensation up to 25%	Low and rare Minimal or no scarring Minimal or no blood loss Infections are very rare Usually no loss
Pain	Post-op pain can be prolonged	Little pain and tenderness
Recovery	Prolonged - Regularly 2 weeks or more	Rapid - Back to work In 1-3 days
Elevation	Significant	Mild - Moderate
Type of Anaesthesia	General Anaesthesia	Local Anaesthesia

Individual results will vary. Medical, diagnostic and surgical procedures have benefits and risks. Talk to Dr Bellaney or your GP about your individual situation in advance of Tumescent Liposuction.