Gupta
 

MRCGP Diploma in Aesthetic Medicine
 

One of the UK’s leading aesthetic physicians and an expert in non-invasive cosmetic treatments.
 

Breast Reduction London

Request A Fee Estimate

Reduce the size of your breasts and get a lift with liposuction

What Is Tumescent Liposuction Of The Female Breast?

You can both reduce the size of your breasts and achieve a significant and attractive breast lift through the use of tumescent liposuction.
 

The procedure can be done with local anaesthesia and microcannulas for minimal postoperative pain, a rapid recovery and return to normal activities. There is also virtually no scaring.
 

Liposuction can reduce the female breast by more than half, and removing this much weight produces the lift. The process also allows the natural elastic properties of the female breasts to contract and create elevation.
 

Your breasts won’t change shape but will be smaller and lifted somewhat.

Will I have Surgical Scars?

Most patients have no visible surgical scars after breast reduction by tumescent liposuction using microcannulas. Any evidence of micro-incisions will usually go after a few months.
 

Using microcannulas means the incisions are very small round - around a millimetre in diameter - and so virtually invisible. If you have darkly pigmented skin you may see some small spots of increased pigmentation at the incision sites. This is post-inflammatory hyperpig-mentation and will usually fade away after a year or two.
 

Traditional breast reduction does produce larger and more visible scars. But we don’t use those techniques.

Does Tumescent Liposuction lift the breasts?

As well as reducing the size of you breasts, the tumescent liposuction procedure will also lift them.
 

By removing weight the liposuction allows the natural elastic tissue in the breast to retract and produce a visible lift. Generally, the more fat you remove, the greater the lift.

What are the older techniques for breast reduction?

There is a older and now out-dated technique for reducing the size of breasts. It is called surgical-excision breast reduction and involves using a scalpel to cut the breast and remove large amounts of tissue.
 

This can create a range of risks, including keloids or excessively large scars, unevenly sized breasts, impaired nipple sensation and damage to the nipple. The skin near the nipple could take on an abnormal appearance. There are also risks of bleeding and blood clots as well as seromas, which is when fluid collects in the breast. In addition there is the dangers of fat necrosis with cyst formation in the breast, and the scarring of the deep breast tissue. This could lead to mammogram abnormalities.
 

The process requires general anaesthesia, and recovery may be prolonged. The procedure is also painful.
 

We do not perform surgical-excision breast reduction, instead using more modern techniques.

What are the advantages of breast reduction with Microcannulas?

There are many advantages to be gained by reducing the size of your breasts using tumescent liposuction with microcannulas. These include:
 

  • Fast recovery - you can usually go back to work and normal social life activity within two to three days
     
  • Almost no scaring
     
  • Reduce the size of your breasts by around 20 to 50 per cent.
     
  • Low risks - there are few dangers of postoperative complications.
     

What problems do excessively large breasts cause?

Any woman with excessively large breasts may find they cause pain, physical impairment and even psychological challenges. It can be very hard to play many sports. Your posture may be compromised to compensate for the excessive weight and this can cause pain in the neck, shoulders and back. The pressure of bra straps can hurt the shoulders and even mark the skin.
 

Areas where the skin rubs together, such as between and beneath the breasts, can be susceptible to candida yeast infections.
 

You may find clothing doesn’t fit properly, it’s hard to find the right bra. And large breasts can often be cosmetically undesirable.
 

Breast reduction by tumescent liposuction is most successful for women whose breasts have a large proportion of fat. Typically this is women who have gone through the menopause as they are likely to have breasts with a larger proportion of fat than teenagers.
 

It is also important to have realistic expectations.
 

For the right candidates, however, the results are usually excellent and most patients are very pleased with the results. We will be happy to discuss your suitability in depth.

What if my breasts have a lot of fat?

Women who have gone through menopause will have much of the glandular tissue in the breasts replaced by fatty tissue. Older women with large breasts are therefore often good candidates for tumescent liposuction of the breasts.
 

Younger women who still have menstrual periods but are overweight may also be suitable candidates since they are likely to have breasts with large amounts of fat.
 

It is possible to accurately identify the proportion of fat in the female breast with a mammogram.

What are realistic expectations?

Liposuction will make your breasts smaller, provide lift, and should produce no scarring. The shape of your breasts, however, will not be changed by the liposuction procedure.
 

Liposuction is not usually capable of producing “perky” young breasts. The lift that is achieved comes about by reducing the weight being carried, and the elastic properties of the ligaments do the rest.

Who is not a good candidate?

Some women are not good candidates for liposuction breast reduction, and we do not recommend the procedure for them.
 

If you would need traditional breast reduction surgery - with its associated large excisions and scars - then we do not perform those procedures, and we would urge you to reconsider.
 

Additionally, if your breasts contain more glandular tissue than fat, then you are not likely to be a good candidates for breast reduction by liposuction.

What are unrealistic expectations?

If you hope that liposuction can have some miraculous effect, and that simply by reducing them in size you will achieve 'perfect' breasts, then this is a sign of unrealistic expectations.
 

If you have had a baby, then breast reduction through liposuction cannot return the looks of virgin. And there is no other surgery or procedure that can do this either. We urge you to consider all your options and set realistic expectations of what can and cannot be achieved by breast reduction with liposuction.

Can you help with excessively pendulous breasts?

If you have particularly pendulous breasts, they are likely to contain only a small amount of fat. Similarly, breasts that sag or droop are also likely to contain small amounts of fatty tissue.
 

This means liposuction will have little effect and in fact will not deliver a good cosmetic improvement. Indeed, the opposite is probably true. The problem here, with “empty” breasts, is that they have too little fat rather than too much.
 

Cosmetic improvement is more likely to be achieved through breast implants or excision of skin.

Does it work for thin young women?

If you are young and thin, then you are likely to be the envy of many around you. However, it means your breasts will be made up mainly of glandular breast tissue with little fat. This means you are not a good candidate for breast reduction by liposuction.
 

Even if you have relatively large breasts, if you are young and thin then there is likely to be very little fat in your breasts. Liposuction therefore cannot help and will not deliver a reduction in size.

Does it work for excessively large breasts?

Tumescent liposuction using microcannulas will usually achieve no more than a 55 per cent reduction in breast size. If you are looking for a reduction greater than this, then you may need to consider opting for the older, more traditional surgery.
 

These older techniques do carry risks, including the possibility of unsightly scars caused by the excision of skin and breast tissue. But it's something you might want to consider. We'll be happy to discuss the issues with you.

What if my breast tissue is excessively dense?

If you have breasts with a large amount of glandular tissue, and relatively little fatty tissue, the process may not deliver satisfactory results for you. This is because liposuction removes fat, but not glandular breast tissue.
 

In addition, fibrocystic disease of the breast can make liposuction more difficult. If the fibrocystic disease is only mild to moderate, however, then you may be able to achieve good results.

What if I have A breast lump?

If you have any significant breast mass, we would urge you to get this investigated and evaluate with a mammogram and possibly a breast biopsy before going ahead with breast reduction.
 

You should not consider cosmetic breast surgery unless your doctor has established that there is a minimal likelihood of breast cancer. If you have a significant family history of breast cancer then breast surgery requires very careful consideration and detailed informed consent.

Can I still produce milk after breast reduction?

If you have breast reduction liposuction treatment and subsequently become pregnant, there is every possibility that you will be able to breast feed, although it is not guaranteed. Tumescent liposuction using microcannulas does very little damage to the milk producing glands and ducts.
 

With the kind of breast reduction techniques that use scalpels, on the other hand, where large amounts of breast tissue are cut away, the glands and ducts are often damaged. They are sometimes blocked by excessive scar tissue and this can completely prevent milk production and breast feeding.

Should I get preoperative mammogram?

It makes sense to consider getting a mammogram performed before the operation, both in order to rule out the possibility of existing malignancies, and so you establish an up-to-date baseline mammogram. This is useful for comparison with which future mammograms.
 

You should also aim to have a mammogram carried out within 3 to 6 months after your breast reduction liposuction treatment. This will give you a new base-line for future mammograms.
 

Traditional breast reduction where surgical excision techniques are used often create postoperative inflammatory nodules, and lipid filled pseudocysts. It can be hard to interpret future mammograms under these conditions without good baselines for comparison. It is, however, very rare for these inflammatory nodules and pseudocysts to be present following tumescent liposuction.

Will there be trauma to my breast tissue?

Tumescent Liposuction creates very little trauma to the breast tissue - so much so that mammograms (an x-ray examination of the breast) usually look completely normal after microcannula liposuction.
 

This contrasts sharply with the results achieved by the traditional excisional breast reduction process, where mammograms show significant changes in appearance as well as calcification.

Is it better before or after menopause?

Before you go through menopause, your breasts will have a higher proportion of fibrous glandular breast tissue. This is much more challenging to remove by liposuction. After your menopause, your breasts will have a significantly higher percentage of fat, and this is much more easily removed by liposuction. Indeed, after menopause, breast reduction by liposuction becomes relatively straight forward.
 

All this means that breast reduction through liposuction is easier for women who have gone through menopause.
 

This doesn’t mean younger women can’t benefit from breast reduction through liposuction. But the process will require greater effort, compared to older women.

Is it true that there are virtually no scars?

When we perform breast reduction through liposuction using micro cannulas, we make extremely small holes in the skin - around one millimetre in diameter, which is smaller than a toothpick. These small holes are known as ‘adits’, and are made with a skin biopsy punch. They perform a range of useful functions.
 

These adits are so tiny they heal with almost no visible scar. The skin of the breast is naturally elastic and stretchy so the 1mm opening can be stretched quite easily to allow access for the liposuction cannulas with diameters from 1.5mm to 2.8 mm. We would typically place 8 to 12 adits randomly on each breast. The use of these tiny adits means we don’t need to make any larger incisions and so there are no big scars.

How do Adits work?

Adits are tiny holes in the skin, less than one millimetre in diameter, which we use for a variety of functions during breast reduction through liposuction. First of all, we use them to insert a needle and inject the solution of tumescent local anaesthesia. Then we use the adit to insert the microcannulas (very small liposuction cannulas). These suck-out the fat. And finally we use the adit to drain any residual blood-tinged local anaesthetic solution. Doing this reduces any swelling and bruising.

Which is best - local or general anesthesia?

Most of the time we are able to perform your breast reduction by tumescent liposuction using microcannulas using local anaesthesia. Liposuction can be carried out safely with either local or general anaesthesia, but there are significant advantages to using local anaesthesia.
 

It is generally considered safer than general anaesthesia - and this is why other health care professionals such as dentists prefer to use local anaesthesia. You will experience virtually no pain at all using local anaesthesia, providing your doctor is well trained and experienced at doing liposuction.
 

Less experience surgeons may need to depend on heavy IV sedation or general anaesthesia if they are relatively new to tumescent liposuction.
 

We nearly always recommend local anaesthesia, although we are happy to discuss all the options with you.

How do you measure breast volume?

The best way to measure the volume of a breast is with the method of water-displacement.
 

To do this, we immerse the breast in a beaker or similar vessel of water filled to the brim. The water is comfortably warm so there’s no discomfort. Then we take the breast out of the water, and measure how much water is needed to refill beaker. We do this several times and take an average for improved accuracy.
 

We need to do this so we can plan the amount of fat to be removed during the breast reduction by liposuction procedure. If your breasts are unequal in size, then we may be able to remove more fat from the larger breast and so improve the symmetry of your breasts.

What are the steps for performing Liposuction breast reduction by local anesthesia?

To perform breast reduction through liposuction, we follow these steps:
 

  • Step 1 - we measure the volume of each breast using the water displacement method.
     
  • Step 2 - we draw lines on your breasts using indelible ink. This helps us during the infiltration process, and when performing the operation.
     
  • Step 3 - We use the tiniest needle possible to inject a small amount of local anaesthetic into the skin. This is painless.
     
  • Step 4 - we make tiny 1mm adits in the skin with a biopsy punch.
     
  • Step 5 - we complete the infiltration of the tumescent local anaesthesia. This will generally be equal in volume to the original preoperative volume of the breast.
     
  • Step 6 - we carry out liposuction of the breast using microcannulas. These range in diameter from 0.9 mm to 1.8 mm.
     
  • Step 7 - once the liposuction is completed, we put super-absorbent HK Pads on your breasts. These absorb the blood-tinged tumescent fluid that drains from the adits.
     
  • Step 8 - We apply a breast compression garment to keep the pads in place.
     
  • Step 9 - We put additional adjustable elastic binders on top of the breast compression garment to increase the amount of compression and encourage drainage of the blood-tinged tumescent fluid.
     
  • Step 10 - You can shower and change the Pads twice a day for the next few days. After three to six days you’ll probably be able to discontinue using the pads.

Can I breast - feed after breast reduction?

You are far more likely to be able to breast feed your baby following a breast reduction process that uses microcannulas compared to the more traditional surgical excision method. This is because breast reduction using microcannulas causes minimal trauma to glandular breast tissue. In addition, the it is unlikely that the process will interfere with future lactation - and we can predict this because of the normal appearance of post-liposuction mammograms (X-rays of the breast).
 

It is less likely that you will be able to breast feed following traditional surgical-excision breast reduction. The excisions and scaring often severs and blocks the milk ducts.

Why do I need mammograms before and after breast surgery?

Any operation you have performed on your breasts may produce postoperative calcifications and this could hinder the detection of breast cancer by a mammogram.
 

Mammograms (X-ray of the breast) work by revealing tiny white specks (calcifications) within the breast tissue. Clearly the presence of the calcifications from the operation can confuse the results. This is why it is important to compare mammograms done before and 6 months after your breast reduction. This enables the detection of any new calcifications caused by the breast surgery.
 

The calcifications caused by surgery usually have a different appearance from those due to cancer. But it is still important to go through this checking process so that calcifications from your breast reduction process are nor confused with cancer.
 

In point of fact, calcifications are actually quite unusual following breast reduction by tumescent liposuction. It is more of an issue with the traditional surgical-excision process. But it makes sense to have the checks all the same.

What's the normal healing process?

Following your tumescent liposuction of your breast, you’ll experience a gradual decrease in swelling over the next 8 to 16 weeks. You’ll also experience very little bruising thanks to the use of open-drainage and proper compression garments.
 

You may detect breast lumps after liposuction but this is temporary. It may last for several weeks after the operation to reduce your breasts. You may be able to find these lumps with your fingers but they won’t be visible, and they are part of the normal healing processes.

Is there a need for post - operative breast compression?

Compression of your breasts following the breast reduction process will help to speed up the healing process and reduce any post-operative lumpiness. It will also reduce any pain you might experience, and any swelling and bruising.
 

We use open draining - tiny holes not closed with sutures - together with external breast compression immediately after your liposuction to reduce any risk of bleeding, bruising, or hematomas.

What kind of breast compression garments will I need?

You’ll need to wear special Adjustable Breast Compression Garments. These have been designed to allow easily adjustable compression.
 

If compression is too slight, subcutaneous bleeding could occur. If, on the other hand, the compression is too tight, you may feel pain or even have problems breathing.
 

By using a garment that you can easily adjust, you can get the compression to a comfortable level at any time.

What are the stages of breast compression?

There are three stages of breast compression required following breast reduction by liposuction.
 

Day 1 - for the first day 12 to 18 hours you’ll need the maximum compression you can take comfortably. This helps reduce any risk of postoperative hematomas. It also reduces any bruising.
 

Day 2 - on the day after surgery, you’ll be able to adjust the compression to a more moderate level, and then keep this up for at least two days. You should also wait until 24 hours after all drainage of fluid has stopped.
 

Compression for comfort - once all drainage has stopped, you’ll be able to reduce the compression level once more, so that the garment still gives support and comfort.

What is the HK Breast garment?

The HK Breast Garment is designed to be easily adjusted. You’ll be able to do this yourself. It’s comfortable, secure and provides high pressure compression for breasts following tumescent liposuction.
 

If you find that compression causes pain or difficulty breathing, then it is too tight and you can loosen it by yourself, without help.
 

The local anaesthetic we use has a prolonged effect so you are unlikely to feel any localised pain in your breast. You will probably need only over-the-counter pain killers.

Are there any complications associated with Liposuction breast reduction?

There can, of course, be complications with any kind of surgery. One that can occur with tumescent liposuction is excessive bruising. This is usually down to the use of a poorly designed elastic compression garment. Or it can be caused by inadequate post-operative compression. The bruising will usually fade and resolve without any permanent issues.
 

Traditional breast reduction by excision carries greater risks of complications compared to breast reduction by liposuction.

What are the complications of traditional surgical - excision reduction?

Traditional breast reduction by excision carries greater risks of complications compared to breast reduction by liposuction. These include impaired sensation to the nipple and the pigmented skin around it (the areola).
 

The breast reduction by surgical excision process can also produce scars. These may be painful, can be become enlarged and are sometimes disfiguring.
 

Traditional surgical excisions for breast reduction can also, in some extreme cases, lead to the necrosis and loss of a nipple. This can be cause by a surgical injury to the nipple’s blood supply.

Are there complications with any breast surgery?

It is true that any surgery to the breast carries some risk of complications. For example: if a needle or cannulas punctured the lining of the lung this could lead to pneumothorax - where air leaks from the lung cavity in the chest. This makes breathing more difficult.
 

A pneumothorax is more dangerous if it happens when using general anaesthesia. This is because of the high pressures of mechanical ventilation cause a more rapid air leak.