Breast Reduction

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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Contrary to popular belief, breast reduction is not always a vanity procedure. In fact, studies conducted in different parts of the world have suggested that overly endowed women who have had the procedure reported improved quality of life. Some researchers even went further by saying that it could increase the patients’ life expectancy by up to five years.


To further shed light on the issue, celebrity Los Angeles plastic surgeon Dr. Tarick Smiley explains the surprising health benefits of breast reduction that are backed by science.


health benefits of breast reduction

Before and after photos of breast reduction patient


  • Improved quality of life


A 2007 study conducted in US has shown that patients reported improved quality of life following surgery, which has given them relief from the debilitating effects of over-large breasts such as spinal curvature (which may lead to disc or nerve damage), postural problem, rounded shoulders, painful bra strap grooves, neck pain, lower back pain, skin breakdown, and decrease in physical performance.


  • Possible increase in life expectancy


In 2008, Scandinavian researchers have estimated that the cumulative damage caused by overlarge breasts may shorten a woman’s life by five years on average. They argue that because of nerve damage, physical discomfort that force some women to rely on daily use of painkillers, and difficulty to exercise that leads to higher BMI, women who are overly endowed face more health issues after factoring in other variables.


  • Smaller breasts allow women to increase their physical activities.


Several studies have shown that after breast reduction surgery a good number of patients lost weight naturally possibly due to inadvertent increase in their physical activities, as they no longer experience the disabling pain and discomfort.


However, it is a common practice among health insurance companies to require patients to be near their ideal weight before they agree to cover the surgery’s cost. This may seem like a paradox (or a haphazard requirement) since overlarge breasts can make it exceptionally difficult to keep a normal weight due to limited physical activities.

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Male chest reduction surgery corrects the woman-like breasts generally caused by excess fibrous tissue and fats of varying amounts. All efforts are made to conceal the scars by placing them at the edge of areola, allowing them to blend into the background once fully healed.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat showing a patient with overdeveloped breasts that looked incongruous with his athletic physique.


chest reduction surgery

Notice that the “after” photo of the breast profile looks more masculine and flatter.

Dr. Smiley started the procedure with tumescent liposuction in which a flexible hollowed tube was used to remove the excess fat. But prior to fat extraction, he injected the breasts with tumescent fluids so the fatty cells would swell thus paving way for quicker and gentler removal.


The tumescent liposuction technique is also known to promote smoother results.


A thin liposuction cannula was inserted into a tiny wound puncture that was positioned at the lower border of the areola to hide the scar. After removing the excess fat, Dr. Smiley extended the incision to perform the excision-based aspect of the surgery.


In the video, Dr. Smiley said the patient required the excision-based surgery because a liposuction-alone approach cannot remove the fibrous [breast] tissue.


Thin liposuction cannula is used to remove fats in smaller, more accurate bits.

In addition to liposuction, the patient also requires excision to remove the fibrous breast tissue.

“The fibrous tissue will not come out with liposuction or even exercise,” he said in the video.


After removing the excess fat and breast tissue, Dr. Smiley closed the wound in deep rows without “picking up the skin.”


“The trick between a perfect wound closure and an okay one is the use of deep sutures. The idea is to suture the dermis, which is the deeper layer of the skin, without including the actual skin surface whose edges are simply allowed to kiss each other. We should always respect the skin,” he further explained.


With very minimal tension on the skin, Dr. Smiley said the incision tends to heal quicker and the scar fades better into the background.

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Breast reduction consultation will play a critical role in patient satisfaction. This gives the patient the opportunity to describe her goals in precise detail, express her concerns, and assess the qualifications of her doctor.


On the other hand, breast reduction consultation allows the surgeon to explain the benefits, limitations, and potential risks of the surgery. Nonetheless, he must be able to allay the concerns of his patients by describing the preparation guidelines, surgical techniques, medications, and postop care that will reduce if not eliminate risk of complications.


breast reduction consultation

A good surgeon will make every effort to create a relaxed atmosphere, making it easier for his patients to express their goals, concerns, and medical history.

Oftentimes, the initial breast reduction consultation lasts 45 minutes to an hour, allowing the surgeon to listen to his patient’s input, goals, expectations, and medical information, particularly relating to current medications, family history, previous surgery, and medical condition, if there is any.


Afterwards, the surgeon may proceed with breast examination to determine its dimension, shape, nipple position, and skin quality, which will all determine the “best” incision pattern. To some extent these anatomical details will also dictate the final results and so the right patient should have realistic goals and expectations.


Then, the surgeon or his staff will take photographs of the breasts. This is particularly important when the patient is seeking insurance coverage. (Note: Many insurance issuers in Los Angeles plastic surgery require at least 500 gram of breast tissue removed from each side of the breast before they pay the surgery’s cost.)


It is not uncommon for patients to feel uncomfortable during breast exam. However, a good plastic surgeon will make every effort to create a more relaxed atmosphere.


The breast exam will allow the surgeon to determine the most helpful incision pattern. In general, patients with overlarge, pendulous breasts will need the standard anchor technique in which the scar goes around the areola, down to the midline, and across the base.


The anchor breast reduction is aptly called this way due to the resulting shape of its scar—i.e., like a nautical anchor. Over time, the scar is expected to fade into the background that most patients are not bothered by its appearance after 1-2 years.


Most surgeons will show the before-and-after photos of their actual patients to would-be patients to help the latter set realistic goals and to further improve the discussion.


At the end of consultation, surgeons typically provide a written material about breast reduction and possibly all the costs involved in the surgery.


Should the patient decide to go ahead with the surgery, a second consultation is scheduled so her doctor can tell her what medications to avoid and the lifestyle changes she needs to adopt to avoid or at least minimize risk of complications. Lab screening is also required to ensure that she is physically fit for the surgery.

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