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Case Study: Post-Operative Mammography Findings One Year After Cosmetic Breast Reduction Using Liposuction Technique

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Mullen, Kevin P., MS, PA-C, Yoho, Robert A., MD

Breast cancer is a major health care concern for women as they age. More precise and accurate mammography testing is becoming available as the technology advances, but there are various breast tissue characteristics that make it difficult to identify and treat the earliest stages of breast cancer. Among these characteristics are distorted architecture, parenchymal bands, tissue redistribution, microcalcifications, and various other postsurgical changes. These characteristics are sometimes seen after a breast reduction procedure. The traditional procedure is the reduction mammoplasty, which decreases the breast size by surgically excising the breast tissue. However, surgical excision involves the cutting of skin and tissue of the breast, with a resulting scar that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. This scar is so distinctive that it has been termed an "anchor" scar , and is the mark of a woman who has undergone the typical reduction mammoplasty.

Cosmetic appearance after surgery is an important consideration, especially surgery of the breasts. For women who would prefer not to have such a noticeable scar, an alternative is available which involves the use of liposuction to remove breast fat and reduce breast size, leaving minimal scarring, both on the skin, and in the breast tissue. Though some women might not mind the scar left from reduction mammoplasty, those that prefer not to have such a large scar are comforted in the fact that breast liposuction typically requires no more than 4-6 small incisions. The incisions are usually no more than 3-4mm in diameter, just large enough to allow the liposuction cannula to pass through the skin and into the breast tissue. More importantly, breast liposuction does not involve excision of breast tissue or skin, therefore, the native breast architecture is not as disrupted and often the typical postsurgical changes are absent.

This can be demonstrated in the case of M.D., a healthy, 55 year-old woman who presented to our office requesting breast liposuction. She had large, pendulous breasts, which had caused her back and shoulder discomfort, while limiting her physical activities for most of her life. She had considered reduction mammoplasty, but, after further consideration, opted for breast liposuction. M.D. tolerated the procedure well, and, after removal of just over 1.2 liters of fat from each breast, she achieved a significant decrease in her breast size. She followed up at 1-week, 1-month, and 3-month intervals post-operatively, and her recovery was without incident.

Approximately 11 months after her breast liposuction, she obtained a routine screening mammogram as part of her annual physical exam. To her physician’s surprise, the radiologist found no evidence of typical postsurgical changes in the breast tissues. The report stated:

Before breast lipo after breast lipo
Before breast lipo After breast lipo
before breast lipo 2 after breast lipo 2

"The breasts are heterogeneously dense and nodular with no evidence of mass. There are discrete nodules consistent with normal intramammary lymph nodes in both breasts….The skin and nipples appear normal and there are no suspicious calcifications noted."

The radiologist also noted that "Comparison with the patient's previous films from 3/22/02 [prior to breast liposuction] shows interval decreased breast size, otherwise no change."

In summary, breast liposuction provides women with a safe, minimally invasive alternative to reduction mammoplasty. The benefits include, 1) a procedure that leaves little to no scarring, 2) a significant decrease in breast volume while maintaining the native shape of the breasts, and 3) a drastically reduced incidence of the typical postsurgical changes in the breast tissue often seen after reduction mammoplasty.

Other Notable Photographs From Breast Liposuction

Before breast lipo 3 breast lipo after 1 week
Before breast lipo After 1 week
Before breast lipo 4 breast lipo after 6 weeks
Before breast lipo After 6 weeks
Before breast lipo 5 breast lipo after 2 months
Before breast lipo After 2 months

 

Procedure

The breast liposuction was done using the "super wet" tumescent technique in which each breast was infiltrated with approximately 1 1/2 liters of 0.1% concentration lidocaine and 1:1,000,000 epinephrine concentration per liter of normal saline solution. After waiting approximately 10 minutes for the tumescent solution to infiltrate the breast fat, the liposuction was done using 3-4.2mm candycane KMI liposuction cannulas. The anesthesia was administered using the modified propofol-ketamine technique , and the surgery was performed in our accredited outpatient surgicenter.

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