There are currently several techniques for breast reduction. Each of the following breast reduction techniques aims to remove excess breast tissue, add contour to the breasts, and reposition the nipple. The standard breast reduction technique uses a "keyhole" pattern or "anchor" shaped incision. The incisions/scars for this procedure extend in three basic areas:



1. Entirely around the areola (the pigmented area around the nipple)

2. From the areola in a vertical direction down to the fold or crease under the breast

3. Horizontally along the area of the fold or crease under the breast extending for a variable length.

Minimal scar breast reduction encompasses several newer techniques, which are aimed at reducing scars. These techniques consist of removal of excess breast tissue either by excision or liposculpture and may result in scars only around the areola, or around the areola and vertically down to the crease under the breast. Although every effort will be made to keep scars inconspicuous, they are the inevitable result of the surgery. Scars usually fade in the course of six to twelve months.

Breast Reduction with Auto Augmentation

Plastic and cosmetic surgeons often combine breast reduction with "Auto" augmentation, a new technique that helps maintain fullness in the upper portion of the breast. One of the problems common to most breast reduction surgeries is a flatness or lack of fullness in the upper area of the breast. This deficiency in the upper breast area occurs gradually in several months as the repositioned breast tissue settles and succumbs to gravity.

Some surgeons refer to this as "bottoming out" of the breast. "Auto" augmentation is a procedure where a portion of the internal breast tissue, which would normally be discarded, is left connected to the chest wall and its blood supply. This segment of tissue is passed up and under a two-inch bridge of pectoralis muscle and secured. This keeps fullness in the upper breast as a "natural" breast implant.

Scarless Breast Reduction

There is also the "scarless" breast reduction technique, which can reduce breast size with no visible scars. This liposculpture-only breast reduction technique is meant for patients who are unwilling to accept the scars associated with standard breast reduction surgery, but are willing to accept a less dramatic change in size and shape.

Breast Reduction Surgery Procedure

This surgical procedure is performed in our state-of-the-art out patient facility under general anesthesia. Local anesthesia, with intravenous sedation, may also be used in some circumstances. Depending on which technique is used, the actual surgical procedure may take anywhere from two to six hours. While standing, lines of incisions, new nipple/areola location and the remainder of the surgical plan is outlined on the breasts.

After speaking with the anesthetist/anesthesiologist the patient is brought to the operating room. After asleep, local nerve blocks are combined with a medication that shrinks blood vessels and capillaries to reduce any bleeding.

The standard breast reduction used a "keyhole" pattern or "anchor" shaped incision. The incisions/scars for this procedure extend in three different directions. First, entirely around the areola (the pigmented area around the nipple). Second from the areola in a vertical direction down to the crease under the breast and third, horizontally along the fold or crease under the breast extending for a variable length.

The greater the amount of the reduction and lifting, the longer will be the horizontal portion of the scar. Skin and breast tissue are removed and sculpted from the inner and outer quadrants of the breast and from the area above the nipple. The nipple and areola are preserved on a pedicle (or mound) of breast tissue that also adds volume to the breast. The remaining breast tissue and nipple are relocated in this keyhole pattern and the incisions closed.

Your surgeon may not use clips or staples to close the skin. All incisions are closed with sutures predominantly below the surface of the skin to avoid cross- hatching and suture marks, optimizing the chances for the finest scars. "Auto" augmentation to preserve fullness in the upper portion of the breast may also be performed with the standard breast reduction.

This additional procedure utilizes a portion of breast tissue left connected to the chest wall and its blood supply, which is passed up and under a two-inch bridge of pectoralis muscle and secured.

Other minimal scar techniques exist. With a periareolar-vertical or "lollipop" technique, excess breast tissue is removed by excision and/or liposuction. The skin is elevated and the excess is then removed from around and under the areola. The resulting scar extends completely around the areola and vertically down to the crease under the breast. An "auto" augmentation technique may also be performed to enhance the fullness in the upper portion of the breast.