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Vertical breast reduction with medial pedicle with breast implants increases upper-pole fullness
For patients that desire more upper-pole fullness a vertical breast reduction with a medial pedicle can be combined with breast implants, according to Eric Swanson, MD.
The study, published in Plastic and Reconstructive Surgery Global Open, had three parts: a clinical study of 80 consecutive women, breast measurements and an outcome study.
All patients underwent a vertical reduction with a medially based pedicle and intraoperative nipple siting, and all breast implants were inserted submuscularly.
Fifty-six women underwent breast reduction and 24 underwent reduction plus implants. Including appearance complications like, asymmetry, scars and persistent ptosis, the overall complication rate was approximately 50% with no significant difference between procedure groups.
The breast area in both breasts decreased for both procedure groups, but more so in those without implants.
Lower pole area also decreased for both groups.
Breast projection and upper-pole projection was increased in both groups.
In both groups, the upper-pole area increased in size but was greater for women who had implants.
Upper-pole projection was significantly increased and greater in those who received implants.
Both procedures effectively increased the breast parenchymal ratio, according to researchers.
Before surgery, 92.9% of patients were self-conscious of their breast appearance prior to surgery, after surgery, 26.8% were self-conscious.
All patients who opted for implants were pleased with their decision.
“Only breast implants are capable of providing a substantial boost in upper-pole projection,” Swanson wrote, and should be seriously considered for patients hoping for this type of augmentation. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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The concept of having a breast reduction and augmentation at the same time is counterintuitive: breast tissue is removed in order to relieve pain, only to replace that tissue with breast implants.
So, is a “breast reduction plus implants” a zero-sum game? The answer lies in the aesthetics. Breast implants are the only way to create fullness in the upper portion of the breast. Furthermore, breast reductions can result in a “boxy” or “deflated” appearing breast shape. So, a “breast reduction plus implants” actually does make sense. From an aesthetic standpoint, tissue is removed from the lower part of the breast and replaced with an implant to fill the upper part of the breast.
It sounds simple, but the surgery is quite the opposite. A reduction-augmentation is by definition unpredictable. Changes in breast tissue after either surgery can be difficult to predict; when the procedures are combined, asymmetry is likely. In this series, the reoperation rate was 20%. This does not include non-surgical complications, which were quoted at 25-50%, based on interpretation of results.
While there is indeed an aesthetic benefit to a “breast reduction plus implants,” a more predictable approach is attained with a two-stage procedure. Not only does this permit the patient to determine their true desire for maintaining larger (albeit more aesthetic) breasts, it also improves patient safety by reducing complications. Beauty is — and must always be — a secondary goal in plastic surgery.
Adam J. Oppenheimer, MD is a board certified plastic surgeon in Orlando, Fla. Follow him on Instagram: @OrlandoNipTuck