Breast Reduction

Breast reduction with lift accomplishes two goals: shrink the breasts to make them more proportionate to the body, and improve their shape by elevating some of the tissue of the lower pole.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says breast reduction and breast lift have different goals, the former is often considered a medical necessity (to eliminate systemic discomfort that comes with overlarge, heavy breasts), while the other is viewed as a purely cosmetic procedure. Nonetheless, it always makes sense to combine them as they share the same incisions.


breast reduction with lift

Dr. Smiley works on one breast first before operating on the other side. The goal is to create a nice template so both sides will have a good level of symmetry.

In a recent Snapchat video, Dr. Smiley says large, heavy breasts are almost always pendulous.


Dr. Smiley has recently performed breast reduction with lift on a patient. He also did a simultaneous areolar reduction to further ensure more proportionate and natural results.


Due to the significant breast ptosis (droop), Dr. Smiley elevated the nipple area by around 7 cm. The goal was to create a decent distance between the areola and the submammary fold; of course, the ideal distance primarily depends on the final breast size.


But before he was able to elevate the nipple, he removed the epidermis of the skin, a process called de-epithelialization. He was careful not to go deeper (ensuring that the dermis remained relatively intact) to minimize bleeding and to prevent inadvertent injury to the blood vessels.


By preserving most of the blood supply, Dr. Smiley says the risk of infection and healing problems is significantly reduced. Of course, lab screening prior to surgery is also critical to ensure that the patient is “healthy enough” to tolerate the operation and its ensuing recovery, he further explained.


Thereafter, he removed some breast tissue to reduce its size before elevating some of the lower pole tissue to give the patient more upper pole fullness and to correct the drooping appearance.


Instead of relying on skin tightening, Dr. Smiley says his breast reduction with lift depends more on internal lifting to ensure that the results can resist the effects of gravity and progressive aging.


After reshaping the internal structure of the breast, he closed the anchor-shaped incisions with multiple rows of sutures. The actual skin, meanwhile, was not included in the process and instead its wound edges were just allowed to “kiss” each other, similar to a jigsaw puzzle, to promote the best scar possible.


Reducing tension on the skin is the key to thin, faded scars, says Dr. Smiley.

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Large breast reduction surgery, which entails removing at least 1 pound (or 454 gram) of tissue, typically involves patients whose disproportionately huge breasts are causing physical problems such as poor posture, chronic back and neck pain, rounded shoulders, and migraine headaches.


In extreme cases, some patients even experience shortness of breath and numbness in their fingers, a symptom stemming from the excessive weight pulling on the nerves around their shoulder and collarbone.


large breast reduction

Recently, leading Los Angeles plastic surgeon Dr. Tarick Smiley performed a surgery involving drastic “downsizing” to eliminate physical discomfort experienced by a patient.


The said patient requested for a smaller breast size not just for physical relief but also for improved body proportions. (She has a medium frame body.)


During surgery, which was recently posted on Dr. Smiley’s Snapchat, he created an anchor shaped incision—i.e., the incision went around the areola, down the midline, and across the base of the breast.


The resulting scar around the areola’s border and the one across the base of the breast will be inconspicuous due to their strategic placement. Even the vertical scar, despite its more visible position, is expected to fade into the background within 6-18 months.


One of the most notable benefits of anchor breast reduction technique is the pleasing contour because it allows surgeons to remove excess tissue, fat, and skin quite uniformly. Modified incision patterns, meanwhile, tend to provide less natural shape (i.e., boxy) particularly when the incision across the base of the breast is eliminated.


After reducing the breast size, Dr. Smiley incorporated some breast lift techniques to create a more pleasing contour and to provide additional fullness to the upper cleavage. After all, these two surgeries share the same incision pattern.


Breast lift in general involves suturing the tissue and transposing some of the lower breast pole tissue to the upper cleavage to create a more youthful result.


To further ensure cosmetically pleasing results, Dr. Smiley raised the drooping nipple about 8 cm. The goal was to create at least a 3 cm distance between the areolar complex and the breast crease. In addition, its size was reduced to complement the smaller breast size.

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Achieving a pleasing breast shape after breast reduction surgery is possible with deep tissue work and the creation of “appropriate” cup size, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


In the past, breast reduction surgeries were primarily concerned with the removal of excess tissue and redraping the skin over the smaller breast. However, the approach has a fundamental weakness: The skin stretches over time and so the initial perkiness is lost invariably.


breast shape after breast reduction surgery

To prevent breast sag, or at least prolong the perky appearance of the breast, Dr. Smiley says he performs deep tissue work alongside his breast reduction surgery.


His deep tissue work is the same with the breast lift technique in which internal sutures and breast tissue “elevation” are used to create a pleasing shape—i.e., some fullness in the upper breast pole.


With the suturing techniques, the breast shape is not dependent on the overlying skin, which is known for its inherent weakness, but rather on the deeper structures. This approach promotes longer lasting perkiness and more favorable scarring and healing since the skin receives no or very little tension.


When there is little tension on the skin, the scar tends to fade and heal much better, says Dr. Smiley.


“Sufficient reduction” is another critical element to promote a pleasing breast shape that can last for many years. It should be noted that one of the most common causes for “bottomed-out” breasts after surgery is that they are not made small enough.


Patients with overlarge breasts who want a conservative size reduction should realize that they remain susceptible to bottoming out or sagging due to the excessive weight that is causing the skin below the nipple area to stretch out.


It should be noted that the surgery does not change the quality of skin, although making the breast smaller and lighter can diminish the effects of gravity.


The breasts appear perky in the first few weeks postop until they gradually settle (i.e., lose some of the fullness in the upper breast pole) within 6-12 months.

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With meticulous patient selection and surgical execution, male chest liposuction can result in a more athletic appearance, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


But what constitutes the ideal male chest?

male breast reduction photo


As with any body contouring surgery, male chest liposuction demands a profound understanding of the established aesthetic guidelines. For instance, most cultures prefer a V-shaped male torso that exhibits broad shoulders and a defined chest that tapers to the flat waist.


Scientists recon that the athletic V-shaped male physique might serve as visible cue for health, virility, and good genes.


Knowing the aforementioned aesthetic guideline is one of the keys to achieve natural results from male chest liposuction. After all, men generally want an outcome that appears like they were born with it or at least work on their physique through good ol’ fashion exercise and healthy diet.


Dr. Smiley says one common mistake of inexperienced surgeons doing male chest liposuction is focusing only on the lower part of the chest wall, while ignoring other critical areas such as the lateral and outer aspect of the muscle. This results in “fullness” or indentation of the adjacent sites.


Due to the natural diffusion of superficial fat whose distribution is genetically predetermined rather than caused by poor lifestyle, male chest liposuction entails a larger surface area—i.e., the lower and lateral and outer areas of the muscle must be contoured as well to ensure smooth transition and natural results.


All efforts are made to promote natural results, as men are generally more reticent about their aesthetic plastic surgery than women.


To further ensure a more “cohesive” result, a good number of patients can also benefit from liposuction of their anterior abdomen and/or flanks. Compared to women, men in general require less fat volume removed due to the natural distribution of their fat and muscle composition.


It should be noted that male chest liposuction only works in normal weight men with pseudo-gynecomastia, which means that their overdeveloped breasts are caused by excess fat instead of glandular tissue, which does not come out with liposuction cannula (hollowed steel tube attached to a pump).


The only way to remove the excess glandular tissue is to create a short incision along the lower edge of the areola (dark pigmented part of skin). And over time, the scar is expected to fade into the background.

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Natural breast reduction results are primarily achieved with meticulous breast and chest analysis, and deep understanding of what constitutes a beautiful breast. Hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that breast surgery should be a “perfect marriage of art and science.”


While the vast majority of patients seek the procedure to find relief from physical symptoms arising from their heavy, overlarge breasts, correcting the sagging appearance and improving their overall shape and projection remain important to ensure high satisfaction rate.

natural breast reduction

A concomitant breast reduction is part of this patient’s mommy makeover surgery, leading to a holistic improvement of her physique.


Meanwhile, Dr. Smiley has explained the core principles that allow him to deliver natural breast reduction results and ultimately high patient satisfaction.


  • Entail a comprehensive consultation


The patient is given all the opportunity to share her input particularly relating to her “size goal,” which should result in the elimination or reduction of her physical symptoms as well as appear proportionate to her body.


Because health insurance issuers typically require large reductions (e.g., more than 500 gram of tissue on each breast must be removed before they agree to cover the surgery’s cost), some women are forced to choose a size that is significantly smaller for their liking. Dr. Smiley discourages this practice because the “new breast” should provide long-term satisfaction to patients.


  • Anatomical analysis


The success of any breast enhancement surgery boils down to careful analysis of not just the breast and chest anatomy, but as well as the patient’s height, weight, and “body shape.” The goal is to achieve the most proportionate results and possibly simulate the idealized feminine physique—i.e., the hourglass shape.


During breast analysis, Dr. Smiley says he pays closer attention to the placement of nipple area, the skin quality, the volume of tissue, and the extent of sag and [lack] of projection.


  • Combining breast lift


Dr. Smiley highlights the importance of performing a simultaneous breast lift, which is achieved by reshaping the internal tissue and elevating it higher on the chest wall with the use of appropriate suturing techniques. The goal is to reshape the breast that adheres to the idealized 45:55 ratio, meaning most of the volume is found in the lower breast pole, with the nipple serving as a demarcating line.


A concomitant breast lift also ensures additional fullness of the upper breast pole, which should ideally possess 45 percent of the breast total volume. While this may not always be possible particularly in patients with poor skin elasticity, a good surgeon should try every effort to go near this “aesthetic guideline.”


To further achieve a more feminine physique, Dr. Smiley says in his previous Snapchat video that there should be a mild lateral “bulge” that should not account for more 10 percent of the total breast volume.

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In body contouring plastic surgery, breast reduction has one of the highest patient satisfaction rates, as suggested by medical literature. This is not surprising since it can provide immediate relief from painful bra strap grooves, back pain, nerve and disc damage, postural problems, and other symptoms caused by being too “endowed.”


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who performs breast reduction on a regular basis, says that most complications are minor or “just nuisances,” as opposed to health-threatening problems.


The standard breast reduction incision technique favors women who require large downsizing, i.e., more than 600 gram of tissue per side.

Nonetheless, Dr. Smiley says he requires all his patients to pass lab screening to determine that they are fit for the surgery and its ensuing recovery. A careful preoperative evaluation, he adds, also allows him to identify breast reduction risk factors, many of which can be eliminated or at least controlled to minimize risk of complications.


A 2013 study, which involved more than 500 women who had bilateral breast reduction, has shown that infection at the surgical site (16 percent) and delayed wound healing (10) were the most common complications.


The study, along with other previous findings, was able to identify the risk factors or predictors of complications following breast reduction surgery.


  • Smoking


Smokers were twice more likely to experience infection and poor wound healing than non-smokers because of the nicotine’s constricting effect on blood vessels, preventing the efficient delivery of nutrient- and oxygen-rich blood to the wound.


However, complete smoking cessation for a minimum of two weeks prior to surgery and throughout the recovery is enough to reverse most of the detrimental effects of tobacco use.


  • Diabetes


Diabetic patients have compromised healing and so they face a higher risk of necrosis (death of tissue) of the areola. Hence, prior to surgery it is highly ideal to eliminate or at least control serious medical conditions through medications and/or lifestyle changes.


  • Large reduction


The risk of poor wound healing and infection is markedly different between a patient having a 500-gram reduction and someone requiring a 1,000-gram excision.


Large breast reduction entails more breast tissue and skin removal, which could lead to increased bleeding and higher risk of comprising the blood supply. Furthermore, a significant downsize could make it extra challenging to achieve a natural breast shape.

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