FEMALE BREAST REDUCTION

By Tumescent Liposuction
"Surgical procedure to reduce the size of the breast, as an over generous size can often be distressing or uncomfortable. Reduction can be performed for aesthetic reasons (to improve the look of an overly voluminous and/or sagging breast) and for physical reasons, such as the relief of symptoms such as pain in the breast, shoulder, neck and upper spinal problems."

Introduction

Dr Lanzer was featured on "Good Medicine" (TV& Magazine), "A Current Affair", "Woman's Day" and "New Idea" magazines with his world pioneering "new" technique.

Breast reduction until now, has been performed with surgical intervention called mammoplasty. The procedure involves cutting out sections of the breast and usually cutting around the nipple and elevating the nipple and loose skin. This is performed by surgeons under general anesthesia. Liposuction underwent a dramatic change in 1987 when an American Dermatologist discovered the tumescent technique. This involves filling the fat with a very dilute form of local anaesthetic which numbs, softens and prepares the fat. Dr Lanzer has helped pioneer the "new" technique of reduction by liposuction alone. He is an accepted world pioneer in this area and has presented his work at the American Academy of Cosmetic Surgeons - San Diego 2001 the Surgical Symposium of the American Academy of Dermatologists in Washington 2001 and at the annual meeting of the Australian College of Dermotoligst. Dr Lanzer has performed the proceedure on over 1000 patients.

Why

The breast is undoubtedly the characteristic most associated with the idea of femininity. A full, firm breast is associated with the idea of youth and health, and exerts a powerful sexual attraction. On the other hand, an overly voluminous breast (hyperplasia or gigantomasty) is not just an aesthetic problem, but can often be the cause of psychological distress and physical discomfort for the woman concerned (bad posture, back and joint pain, scoliosis). On the other hand, others talk of their sheer embarassment about having a very big bust, and the effect that has on their selfconfidence and even their personal relationships. Breast reduction provides a speedy aesthetic, psychological and useful remedy, and is a procedure that can be carried out even during the late teens.

Between 1/3 and 1/2 of the breast can be reduced in size with this technique. Generally older patients have more fatty breasts and therefore more can be removed. The amount that is removed may vary from 200ml to 2000ml of fat from each breast and it is important that preoperatively, some guidance is given to Dr Lanzer as to what would be the ideal size the patient wishes to obtain. Often large breasts are associated with a breast tail, where the fat continues around the side of the chest and under the axillae. This area and others can be removed at the same time with liposuction. Most people having liposuction are surprised at the extent of the skin contraction. Nipple elevation varies from 3-10cm. By using the “superficial technique” of removing the fat layers immediately under the skin, maximum skin contraction and breast elevation occurs. There is more lift of the nipples when breast reduction is performed through the surgical alternative.

Advantages of the Tumescent Method

• Numbs the area so that the procedure does not necessarily require a general anaesthetic, and post surgery discomfort is reduced.
• Seals the blood vessels so that there is little or no bleeding, resulting in safer liposuction and less bruising.There is no need for intravenous ‘drips’ or blood transfusions.
• Softens the fat so that it comes out smoothly and evenly, allowing much greater amounts of fat to be removed safely.
• The fluid used is anti-bacterial, so that infection is extremely rare.
• Safer liposuction techniques have resulted in many more patients requesting this treatment.

Procedure Technique

First Dr Lanzer will mark out the areas on your body to be suctioned. This allows for an accurate targeting of fat. Next a large amount of fluid is infused into the target treatment areas, before the suction is performed. This fluid consists of saline solution, local anaesthetic (lidocaine) and adrenalin (a vasoconstrictor); the term “tumescent” actually refers to the “turgid” state of the tissues into which the solution has been infiltrated.

This technique makes for much easier fat drainage, less or no blood loss, better anaesthesia during the procedure and afterwards, and fewer post-operative bruises. The excess fatty tissue is then removed. This is achieved by means of a cannula connected to a suction device (vacuum or large syringe); the cannula is introduced into the fat situated under the skin through small incisions (2-3 mm) made close to the target treatment area; it is then pushed through the fat until it reaches the area in question. The cannula is then moved about so that the fat is broken up and suctioned simultaneously.

Pre-operative patients require mammograms of the breast to see where the fat lies within the breast and also to assist in long-term follow-up of the breast. Routine pre-operative blood tests and antibiotics are arranged and a full history to exclude breast cancer including an awareness of high risk patients who would need closer monitoring in the future are identified. Patients with a direct family history of breast cancer such as mothers and sisters, will require an examination by a specialist breast surgeon, which will be arranged by Dr Lanzer. The procedure time is approximately 1 hour and a compression garment is applied afterwards and worn for the ensuing 2-4 weeks. Post operatively there may be some tenderness and bruising and there may be weeping of fluid through the small nicks during the first 24 hours. Most patients can return to ordinary duties after 1 to 3 days, however there may be variation between patients.

Recovery

Patients should wear a compression garment continuously for 2 weeks and then part time for 2 weeks. Physical activity can be resumed 5-6 days after surgery. Work can generally be resumed within days of the surgery. Sporting activities such as jogging, dance and yoga can be resumed after 2 weeks, but it is advisable to wait at least 4 weeks before taking up more strenuous sports again (skiing, tennis, football, basketball, sailing, swimming, scuba diving...)

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Commonly asked questions

How much smaller can my breasts be reduced?
Each individual case is different, during the medical consultation Dr Lanzer will examine you and discuss the achievable reduction in size. The most common size sought after is a C.

Who is a good candidate for breast reduction?
A breast reduction is usually performed for physical relief helping the client reduce the discomfort and embarassment caused by very large or saggy breasts rather than for purely cosmetic reasons.

What will I look like after surgery?
All surgery is associated with bruising, so you should expect this for 7-10 days after your operation. Some patients remain bruised for longer and in rare cases for up to a month or more. You may start to see the results quickly but you will not see the final benefits of your surgery for many months.

Dr Lanzers Residential Results

• Virtually all noted significant improvement in symptoms such as back pain and dents on shoulders • Virtually all extremely happy with the result • All mild deep bruising • No or minimal scarring • No infection, necrosis or excessive loose skin • No permanent sensation change • Average reduction DD to C • Maximum 2.7 Litres removed G to C

BREAST REDUCTION
(note natural elevation of nipple 10cm up to level of small mole-note no scarring)

Complications

Ordinary surgical complications include bruising, pain,swelling and infection. The tumescent technique reduces the infection rate, due to the fact that the fluid is anti-bacterial. The procedure is performed under a highly sterile environment. Pre-operative antibiotics are given to each patient. No guarantees can be made to the extent of nipple elevation or skin retraction.

In the first 100 patients treated, there was no loose skin but Dr Lanzer still warns that a second surgical procedure may be required in very droopy breasts. Significant scarring does not occur with liposuction, as there are only 3mm - 5mm nicks on the skin, which normally heal nicely.

The risk of skin necrosis and skin loss is significant with the mammoplasty surgical option but extremely rare with liposuction. In Dr Lanzers study there was no permanent altered sensation to the nipple. There have been no long term studies to ascertain the effect of liposuction on the ability to breast feed, although groups overseas report that patients can breastfeed.

A major issue with all forms of breast reduction is whether changes will occur in the breast that would be identified on the mammogram at a later day and confuse a mammographer as to whether they are marks from previous surgery or in fact, breast cancer developing. This area is under investigation and in early studies there were no long-term effects seen on the mammogram after six months in all patients. (This is based on 8 years follow up and 1000 patients).

Dr Lanzers routine is to perform a pre-operative mammogram and to have it repeated at six months to see if there are any changes which will then be used as a reference for mammograms later in life. This hopefully will avoid any confusion and requirements for unnecessary biopsies. If you do not understand this issue, please speak to your local doctor or breast surgeon. Dr Lanzer has not had any issues with this since he began this surgery eight years ago. It is important to understand that cosmetic surgery is not an exact science and no guarantees can be given as to the exact outcome. Also, all patients react differently and liposuction of the breast tissue is still considered a new procedure in its development stages.

Summary

Three breakthroughs have allowed liposuction alone to be the first-line treatment for breast reduction. These are the tumescent technique, Micro-cannulae and superficial Liposuction. Dr Lanzer has been recognised throughout the world as a major contributor to this new and exciting procedure. His pioneering work was published in the International Journal of Cosmetic Surgery and Aesthetic Dermatology. (See page 29-31 & 67)

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