Patients are frequently dissatisfied that their breasts are both too large and too droopy. The question they want answered is, should they have a breast reduction or a breast lift? The answer depends on many factors such as how big are a patient's breasts and how much smaller does she want them. Understanding the differences between the two surgeries will help.
The primary purpose of a breast reduction is to make a woman's breasts smaller. In doing so, most techniques also lift the breast while also elevating and reducing the size of the areola. Contrary to what most patients think, the nipple and areola are almost always left attached to the breast so sensation can be preserved as is the ability to breast-feed. How much smaller a breast gets depends on the wishes of the patient as well as their overall size. As a general role, for a breast reduction to be paid for by a health insurance company, about 500 grams of tissue need to be removed per breast. In rough volume terms, this is about 16 ounces, which is a substantial amount in most women. Since so much mass is removed, many women experience improvement in symptoms related to large breasts such as back, neck, and shoulder pain. Likewise, athletic activities are easy and clothing can fit better.
Breast reductions almost uniformly require incisions around the areola and down the front of the breast; frequently, there is also an incision in the fold underneath the breast, which is known as the "anchor" incision. In some cases, liposuction is used.
The primary purpose of a breast lift is to improve the shape of a droopy (ptotic) breast. The areola and the majority of the breast is elevated above the fold under the breast. Some reduction in size is necessary with a lift, and often a patient may decide to have a significant amount of breast tissue removed at the same time. I consider an operation a lift when less than 500 grams of tissue are removed and a reduction when more than 500 grams are removed. Breast lifts by definition are never paid for by insurance companies unless the patient is undergoing breast reconstruction.
Lifts involve a variety of incisions, depending on how much excess skin exists. A minimal lift involves an incision around the areola, a moderate lift adds an incision down the front of the breast, and significant lift also requires an incision in the fold under the breast. As with a reduction, the nipple-areola is left attached to the breast preserving nipple sensation and the ability to breast-feed.
A shortcoming of a breast lift is that it does not reliably restore fullness in the upper part of a woman's breast. Women who want this fullness may choose to have a breast implant placed either at the time of their lift or at a second operation.
Both breast reduction and breast lift are significant procedures that are usually done under general anesthesia. Depending on patient and doctor preferences, either operation can be done as an inpatient or as an outpatient. When carefully chosen to meet the individual patient's needs, each operation can result in significant patient satisfaction. Your plastic surgeon can help you decide which is best for you.
Paul G. Pin, M.D.
American Board of Plastic Surgery Dallas, Texas
Breast reduction and breast lift is real surgery and involves risks such as bleeding, infection, and scarring, Results vary. Dr. Pin will be happy to discuss these and other risks of breast reduction and breast lift.