Breast Reduction Plus Implants

Abstract

Unfortunately, many women after a breast reduction resemble candidates for an augmentation mastopexy because the Wise pattern can leave breasts looking deflated and boxy. A vertical reduction provides a modest boost in breast projection and upper pole projection, and tighter, more circular lower poles than a Wise pattern. Patients prefer the aesthetic result and scars of the vertical technique. In patients who wish to restore upper pole volume, breast implants are most effective.

Originally, a breast reduction was considered a purely functional procedure. Today, expectations are higher and include aesthetic considerations. Numerous studies document the physical benefits of a breast reduction. Fewer publications evaluate the patient’s perception of the aesthetic result. Patients readily understand that the goal is still to make their breasts smaller and relieve symptoms. Breast implants can help to restore a more ideal shape to a breast that has been distorted by hypertrophy and gravity.

The surgical approach for a breast reduction plus implants is the same as for an augmentation mastopexy. The procedures are arbitrarily differentiated only by the weight of breast tissue removed (≥300 g from 1 breast). A vertical mammaplasty is performed using a medially based pedicle and intraoperative nipple siting. Breast implants are inserted subpectorally. An inverted-T modification is used when the vertical scar extends below the level of the new inframammary fold.

Upper pole projection is increased approximately 2 cm when implants are used, compared with <1 cm for women who do not have implants. The most common complication is delayed wound healing (25%). After surgery, symptoms of back, shoulder, or neck pain are reported by only 21% of women undergoing breast reduction alone versus 19% of women who also receive implants (difference nonsignificant). The data suggest that implants do not undermine the functional benefit of reduction mammaplasty.