A Breast Reduction using Liposuction?

Yesterday I performed a Breast Reduction using Liposuction only. To my surprise, the OR nursing staff was unaware this was possible. So I figured if they were unaware it was possible, most people probably are. So lets talk about it.

Why it works: Well, breasts are normally made up of glandular milk producing breast tissue AND fat. In fact, for many women, the breast is a preferred fat storage site. So, we are able to use liposuction to remove the fatty component of the breast. This can be done with one or two very small incisions instead of the typical larger more noticeable breast incisions.

Limitations: There are limitations to the procedure being done this way. First, you cannot get as much skin tightening this way and you cannot lift the breast as well as with a traditional reduction. Secondly, you cannot suction out the glandular breast tissue component, only the fat component. So gauging final breast size is more challenging.

In the end, it is a very effective technique that replaces the significant scaring of a traditional reduction with almost no scars yet still effectively can reduce the breast.

To learn more contact our East Louisville office at 502-721-0330

Lee E Corbett MD

Medical Director Corbett Cosmetic Aesthetic Surgery and Med Spa

 

“Do you have to detach my nipple?”

In my 19 years of practice I have heard this question a lot and I always wonder where this information comes from. At our consultations my patients tell me that they heard or usually read when they consulted Dr. Google, that during a breast lift or a breast reduction the nipples have to be removed from the breasts.

This is unequivocally WRONG. Totally False. Untrue!!

I know you are never supposed to use “always” and “never”, but in this case I’m gonna break that rule and then comes my disclaimer. I “never” detach a nipple during a breast lift and I “never” detach a nipple during a breast reduction. I “always” leave them attached. There, I just broke both rules.

Disclaimer time: There actually is a time when we DO have to detach the nipple. The operation is called a Free Nipple Graft, but we ONLY do this when the breasts are EXTREMELY droopy. What does ‘extremely droopy’ mean. Well, get a tape measure and measure from the top of your breast bone diagonally down to the nipple. That distance should ideally be between 19 and 21 cm. For most patients who need a lift or a reduction the number will be more in the 27-30 cm range. It is only when the number exceeds the 41-42 cm mark that we even discuss detaching the nipple. The other measurement to look at is from the crease under the breast back up to the nipple. Lift the breast and place the tape measure at the crease and then measure back up to the nipple. Ideally that number is 5-7 cm. It’s not until 21-23 cm we that we even start to discuss detaching the nipple.

So, for 99% of women considering a lift or a reduction, detaching the nipples isn’t even remotely a consideration. It just never happens. When we see the kind of numbers I mentioned above, then, and only then, do we discuss the need to detach. Stated another way, in 19 years of practice and having done literally thousands of these procedures, I have never, ever detached a nipple that I didn’t plan on detaching from the get go to extreme breast size and extreme droop.

Lee E Corbett, MD

Corbett Cosmetic Aesthetic Surgery and Med Spa

 

Herbal Supplements: Helpful or Harmful?

In a Study published in the journal of my society, the American Society of Plastic Surgeons, it was shown that almost 50% of patients who were planning to undergo some type of facial cosmetic procedure (facelifts, blepharoplasty, rhinoplasty) were taking some from of herbal supplement. The problem is that many of these supplements can have adverse effects for a surgical patient.

In the study, it was found that 49% of patients were using at least one supplement, usually vitamins. In all there were about 53 different supplements that were used and the average number of supplements used was about 3.

The problems we see as surgeons that are supplement related are that many patients don’t really know what is in these things and they can cause problems. Bleeding is probably the most common problem and is related to bilberry bromelain, fish oil, garlic, MSM, selenium and Vit E.

What I recommend to my patients is to stop taking all supplement 2 weeks before surgery. And, don’t be tricked into thinking that these supplements are always safe. A lot of my patients, when they fill out their intake paperwork, will omit their supplements because they are not prescriptions. This is a mistake and can lead to post operative complications.

Lee Corbett, MD

Nipple Sensation after breast augmentation

I saw a new patient just yesterday who is going to have a breast augmentation and she had a good question. Her nipples are overly sensitive and she was hoping that after her breast implants were placed her nipples might be less sensitive. She asked if this was likely.

The answer is that it is possible but not likely. With any breast surgery, whether we are doing a lift, a reduction, or an implant, the nerve that give the nipple are its feeling is at risk. As a rule the ‘deeper’ into the breast we go the more this becomes a possibility because the nerve in question enters the breast from its under surface and then branches come up to the skin level. So, if we are just on the surface, as in a lift, yes some of the tiny nerve branches will be cut resulting in some temporary sensory loss but the dominant nerve supply is intact and full sensation should return within a few weeks. That’s why when we make a circular incision around the nipple it doesn’t mean you will be numb afterwards. With a breast reduction, as this is a bit more invasive than a lift, the chances for sensory changes are higher and thus more common. It’s simply a matter of the surgeon being deeper into the breast to remove the excess tissue. Now with implants the risk is highest as we are placing the implant right at the level of the nerve, which is called the 4th Intercostal nerve. This nerve enters the breast from the side and moves towards the midline (your breast bone). Now as your surgeon, I know where this nerve lives and so when I get into that area I change how I develop the pocket for the implant in an effort to preserve full sensation. That being said, if you look at the implant manufacturers data, the rate of sensory disturbance after an augmentation is about 8% and when this happens it tends to be an all or none deal. So, my answer to the patient referenced above is that “No, your nipple sensation probably wont change and if it does lessen I have no way to control how much or how little.

Lee E. Corbett, MD

Medical Director, Corbett Cosmetic Aesthetic Surgery and MediSpa