Cosmetic breast surgery that combines two or more procedures has become a common routine nowadays. In some situations, this is even a more preferable approach than having two separate surgeries in order to produce more natural results.
Today, the most common “combo” procedures are breast augmentation with lift, and breast reduction with lift, according to the California Surgical Institute website.
Breast augmentation with lift prevents a specific deformity called Snoopy due to its close resemblance to the profile of the classic cartoon dog.
When implants are used in sagging breasts without a simultaneous breast lift, their bottom edge might become visible beneath the lax skin, and thus there will be an appearance of two pairs of submammary fold.
But with a simultaneous breast lift, the implants will not “herniate” as the internal support and the actual breast tissues are reinforced with sutures. In addition, the south-pointing or low-lying nipple area is positioned higher to further achieve a proportionate result.
Breast lift is also commonly incorporated with breast reduction, a procedure that produces a smaller “cup size,” which in turn can provide instant relief from back pain, rounded shoulders, postural problems, and other ill effects of overlarge, heavy breasts.
Large breasts are susceptible to the effects of gravity (i.e., causing their skin to lose their elasticity), thus it always makes sense to incorporate some type of breast lift during the surgery.
Meanwhile, breast lift does not always entail a simultaneous breast reduction unless the patient specifically requests for a smaller cup size as well.
Cosmetic breast surgery involving combination procedures aim to produce a more natural-looking and youthful appearance—i.e., conical shaped, 45:55 breast ratio (i.e., most of the volume should be in the lower pole), proportionate nipple diameter relative to the breast size, and “ample” distance between the areola and the submammary fold.
A slight lateral bulge is also deemed ideal, although all efforts are made to prevent it from becoming excessive and thus giving an illusion that the breasts are too wide apart.
Also, it is ideal to produce a ski-slope appearance in the upper pole. In fact, one study has suggested that the ideal breast profile should have a 45:55 ratio, with the areolar complex serving as the delineating mark between the lower and upper breast poles.
Of course, good symmetry between the left and right breasts must be achieved during cosmetic breast surgery. For this reason, some patients may need different sized implants, or require more tissue removal or additional elevation on one side.
Breast reduction with breast lift is routinely performed together because they share the same incision sites.
In essence, breast reduction creates a smaller “cup size” to address symptoms associated with enlarged breasts such as painful bra strap grooves, rounded shoulders, postural problems, neck and back pain, and spinal curvature.
Breast lift, meanwhile, corrects the appearance of pendulous breasts by removing a small amount of loose skin and lifting and transposing the soft tissue.
Despite having different goals, the two breast surgeries are routinely combined because they share the same incision sites—around the nipple, within the submammary fold, and perpendicularly between the nipple and the breast fold. Furthermore, both involve removing a certain amount of loose skin from the lower breast pole.
(Note: Breast reduction almost always incorporates breast lift, although this is not always the case in breast lift unless the patient specifically requests for a smaller cup size. It is important to note that overlarge, heavy breasts are generally pendulous in appearance, according to California Surgical Institute website.)
When breast reduction is medically warranted, i.e., performed to improve the patient’s quality of life, health insurance coverage is possible. However, most issuers require trying first non-surgical treatments such as weight loss and therapy (in an attempt to improve posture and possibly reduce discomfort caused by overlarge breasts) before they cover its cost.
Breast lift, on the other hand, is always considered a cosmetic, elective procedure and thus precluding any chance of insurance coverage.
Whether performed separately or together, the results of these surgeries are expected to last a lifetime, provided that the patient maintains a healthy weight and avoids pregnancy in the future. For this reason, women of childbearing age and teenagers may have to postpone these procedures.
However, performing breast reduction with breast lift (or even without it) could be a good option for patients as young as 15 if their hugely disproportionately breasts are causing pain. This is particularly true for normal weight women who have tried non-surgical treatments to no avail.
But there is one caveat when breast reduction and/or breast lift is performed “sooner than ideal”—there is an increased risk of tissue regrowth, which may warrant some type of revision surgery down the road.
The ideal breast size for reduction surgery is primarily anchored to the patient’s level of comfort. It is important to note that a good number of patients seek the procedure to remove a huge weight off their back and ultimately improve their quality of life, as suggested by celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley.
In addition to back pain relief, many patients also seek the surgery to improve their posture, correct their rounded shoulders, and eliminate chronic headaches.
Before and After Photos of a Breast Reduction Surgery Patient
Aside from delivering the most comfortable breast size, other goals should include creating an optimal shape, hiding the surgical stigmata as much as possible (i.e., scars are placed at the border of areola and within the submammary fold), and minimizing risk of tissue regrowth.
Tissue regrowth may occur after significant weight gain and pregnancy, so it is in the best interest of patients that these factors are ruled out before the surgery is attempted. For this reason, women of childbearing age and those whose weight is not yet stable are advised to postpone the procedure.
The truth is, it is quite difficult to guarantee a cup size after a breast reduction surgery. First and foremost, cup size is not an accurate measurement as each bra company has its different interpretation.
The patient’s body largely determines the ideal breast size for reduction. For this reason petite women may want to have a slightly smaller size, while large-framed patients may have to choose a fuller, heavier breast if their goal is to preserve a more natural look and better proportion.
But if there is a high probability that tissue regrowth will occur, a scenario that may happen when breast reduction is performed in patients in their mid or late teens, they may have to choose a size that is smaller than their initial plan.
Some patients also choose to have a breast size smaller to their liking so their health insurance will cover the surgery’s cost (for instance, some companies require at least 500 grams of removed breast tissue per side in order to qualify for coverage).
While breast reduction is best reserved for women whose breasts have fully “stabilized” and they are done having children, teenagers whose overlarge breasts cause them undue discomfort can opt for it.
Dr. Smiley says that there are no limitations on how small the breasts can be made, although significant reduction is tied to increased risk of numbness or other sensation-related problems and poor scarring.
Breast reduction for men is a more straightforward procedure than the surgery performed in women. Nonetheless, it entails the surgeon to have a good eye for detail and “extensive” experience (i.e., performs it on a regular basis for at least five years) to achieve a highly predictable result.
Breast reduction for men is generally expected to produce near permanent results provided that the factors, which have been explained below, are present.
Before-and-after photos of a successful breast reduction for men
This is one of the most critical factors to achieve near permanent results from breast reduction for men. A highly qualified surgeon knows that each patient requires a unique approach. For instance, body builders may need complete removal of all breast gland tissue to eliminate or at least reduce tissue regrowth in the future.
According to some studies, body builders are susceptible to hypertrophy (excessive development) of breast tissue after surgery; hence, they require a more invasive approach compared to an “average” patient.
- Avoid anabolic steroids and other drugs and treatments known to cause gynecomastia
Another caveat with male breast reduction for body builders is that a good number of them continue their use of anabolic steroids and hormone-laden sports drinks and supplements despite warning from their surgeons that they could cause gynecomastia recurrence.
- Preoperative weight is stable for at least six months
Prior to surgery, the patient must be near his ideal weight, which he is able to maintain for a minimum of six months. Should male breast reduction for men is attempted despite weight fluctuations, the results are almost always less than optimal.
Also, significant weight gain and loss after surgery can affect if not completely reverse its results, according to experts at California Surgical Institute.
- Long-term weight management
Long-term weight management is only possible through regular exercise and proper diet. No diet trend or unsustainable or unrealistic exercise routine can accomplish this; they only serve as a temporary fix.
Some patients, particularly massive weight loss patients, will need medical supervision (i.e., nutritionists and bariatric doctors) to help them stick to their long-term weight management.
- Wait at least 2-3 years after the onset of gynecomastia
Gynecomastia is not uncommon during puberty stage and will most likely resolve on its own (about 90 percent). For this reason, the consensus is to wait at least 2-3 years before any surgery is attempted.
Performing breast reduction “too early” may result in tissue regrowth and possible revision in the future.
Oftentimes, breast reduction and areola reduction are performed simultaneously to achieve a more balanced appearance. This is particularly true for patients who require significant downsizing of her “cup size,” explains leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
While breast reduction surgery comes in various incision patterns, all of them share one thing: They use incisions around the areola’s perimeter.
Before-and-After Photos of a Satisfied Patient Who Have Had Breast Reduction and Areola Reduction
And with or without areola reduction, the resulting scar around the areola must precisely lie at the dark and light skin junction for its optimal concealment.
To ensure that both areolas would have the same dimension and size, Dr. Smiley says he uses a round “cookie cutter” to guide him during surgery.
In the past, breast reduction surgeries were only accomplished with the use of an anchor technique; it has a scar that runs around the areola’s perimeter, a vertical scar along the midline of the lower breast pole, and a horizontal scar adjacent to the submammary fold.
While the standard or anchor breast reduction technique is still used today, it is only reserved for patients who require a drastic downsize.
A modified form of breast lift eliminates the submammary fold incision, which takes the longest time to heal. Referred to as lollipop technique due to the shape of the resulting scar (i.e., around the areola’s perimeter and a vertical scar), it results in less scar and shorter downtime.
Aside from reducing the “cup size,” the lollipop lift is also noted for its narrowing effect, hence it is ideal for patients with markedly wide breasts.
Dr. Smiley says he always incorporates breast lift when performing breast reduction, both of which share the same incision patterns thus additional scars are avoided.
The final position of the areola (starting from its lower border) is ideally 2 cm above the submammary fold to achieve a perkier, more balanced appearance. Aside from proper placement, Dr. Smiley says that the actual tissue must be reshaped and lifted to achieve long-lasting results.
The results of breast reduction and areola reduction are near permanent provided that the patient maintains a stable healthy weight and avoids pregnancy after surgery, explains Dr. Smiley.
The breast reduction scars healing time is one of the most common concerns of patients. It is important to note that recovery varies from person to person, although most can expect that by three weeks their wound is mostly healed.
Scar is the body’s natural response to repair what has been injured, damaged, or cut; it serves as a glue that holds the tissue layers back together. Nonetheless, all efforts are made to prevent it from becoming raised and thick (keloids and hypertrophic scars).
Leading Orange County plastic surgery expert Dr. Tarick Smiley says that scar placement and wound closure would play a critical role on how visible or well concealed the scars are.
Most breast reduction scars are placed around the areola’s border and adjacent to the breast crease for their optimal concealment. However, the vertical scar between the nipple area and the natural fold has a more visible location, which expectedly concerns most patients.
Despite the more obvious location of the vertical scar, proper wound closure in which there is very little tension on the skin, allows it to heal and fade better, says Dr. Smiley.
Dr. Smiley highlights the importance of a proactive approach in scar management; hence, he recommends the use of silicone sheets and other similar modalities once the wound is completely healed, which happens around three weeks.
The use of medical-grade compression garments or supportive bra is also known to reduce tension on the wound, ultimately prompting the scar to remain thin and faded.
To further promote favorable scars, the renowned surgeon says any factors that contribute to increased risk of bleeding and infection must be eliminated or at least controlled prior to surgery. Smoking, aspirin and other drugs known to increase bleeding, and uncontrolled hypertension are closely tied to poor healing and unfavorable scarring.
However, avoiding tobacco products and aspirin (and other medications with similar effects) well in advance of the surgery can lower the risk of poor healing and aggressive scarring.
Should the scar remain thick and unsightly, Dr. Smiley recommends steroid injections, certain types of laser treatments, and scar revision, which is viewed as the last resort because it requires additional incisions (and of course, another risk of adverse scarring).
Breast reduction scars healing time (i.e., full maturity) can take 1-2 years, so they should not be exposed to the sun. Studies have shown that UV rays cause slow healing, hyperpigmentation (scars becoming permanently dark), and irritation.