In an age when minimal plastic surgery seems to produce maximal results, why is it that reducing a breast seems to be lagging so far behind? The scars seem to be so long! You can shrink clothes by leaving them in the dryer too long. Why can’t something similar be done with breast reduction surgery?
This question is a good one. An attempt was made in this direction with the use of liposuction some years ago. The idea was that as women age, fat becomes a major component of their breasts. Liposuction is done with minimal scars since the skin shrinks down after fat removal. By doing liposuction only, why won’t the breast size decrease and the skin shrink down like it seems to do in other parts of the body? Liposuction was tried for breast reduction, but the problem was that for many women, the long years of excessively large breasts had resulted in the stretching out of the skin as gravity pulled down on the breasts and as the women went through pregnancy and weight fluctuations. The stretched out skin simply did not have the elasticity to contract, so the women who underwent liposuction for breast reduction were left with smaller but droopier breasts.
This, in a nutshell, is the reason for the long scars in breast reduction. One must remove the excess skin and doing this produces long scars. Although Thermage and other skin tightening procedures exist, the amount of skin tightening that they produce is far too limited.
How long must a scar be in a breast reduction procedure? It really depends on how lax the skin is.
For a woman with extremely lax skin, the removal of breast tissue needs to be followed by a large amount of skin removal, necessitating the scar around the areola, another vertical scar traveling down from the areola, and another in the fold beneath the breasts. The vertical scar allows for removal of skin in the horizontal direction which produces a lifting of the breasts. The scar in the fold beneath allows for removal of a strip of skin that will prevent the breast tissue from hanging down too low. The scar around the areola allows one to reposition the areola and nipple at a higher level. This is termed an “Anchor Scar.”
In cases where the skin is not so lax, it may be possible to use only the vertical scar plus the scar around the areola since the skin elasticity may be sufficient to shrink adequately. This is termed a “Lollipop Scar.”
Rarely, a limited breast reduction can be done with only a scar around the areola, termed a “Donut Scar.”
In some cases where the nipple is in the correct position and the skin elasticity is good, one can make an incision in the fold beneath the breast and use this to excise a “disc-shaped” portion of breast tissue on the undersurface of the breast and so achieve a reduction in size. No skin removal is necessary in such a case.
Despite the length of the scars required for most breast reductions, the good news is that the scars tend to heal to the point that they really don’t matter to the patient. We have our patients using silicone tape or paper tape on their scars for the first three months which helps to flatten the scar. In the end, it’s the rare patient who feels that the dramatic improvement in their shoulder and neck pain isn’t worth the final appearance of the scars. As methods of nonsurgical skin shrinkage improve, however, the length of breast reduction scars should decrease.
Should you have any further questions, please contact my office.
George Sanders, M.D.