>IMPROVED LIPOSUCTION SEEN AS LESS TRAUMATIC METHOD OF BREAST REDUCTION
>Breast reduction by modern liposuction techniques can achieve good
>results without the morbidity of surgery, dermatologist Dr. Daniel
>Lanzer of Toorak, Australia, reported at the American Academy of
>Dermatology's annual meeting.
>Reuters Health Information 2002
>http://www.medscape.com/viewarticle/429039?srcmp=wh-030102
>It will be interesting to see how this impacts the possibility and course
>of future breastfeeding after liposuction.
Yes, in my analysis of reduction mammoplasty surgical techniques in my
research about BFAR, I concluded that even reduction by liposuction using
the common cannula instrument rather than the micro-cannula referenced in
Dr. Lanzer's study was likely to yield the most positive lactation
outcome. In addition to the article cited above, I see now that a study by
Lawrence Gray, MD, of Atlantic Plastic Surgery Center in Portsmouth, N.H.,
in the September 2001 issue of Plastic and Reconstructive SurgeryŽ, the
journal of the American Society of Plastic Surgeons (ASPS), has concluded
that this technique is consistently effective in achieving the desired
contour, and, because it is considerably less invasive, results in less
scarring and neurological impairments, which bodes well for lactation.
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.21432077&rendertype=pre
It should be noted, however, that while the liposuction technique is far
more likely to result in a greater lactation capability, it is nonetheless
possible for this technique to result in damage to the parenchyma,
especially when a sharp cannula is used. The extent of the damage would
depend, of course, upon the extent of the invasion with the sharp
cannula. Even so, the neural network (most importantly the fourth
intercostal nerve) would remain intact, increasing the probability of
significant lactation capability. It seems likely that Dr. Lanzer's
technique using the micro-cannula would be much more kind to the parenchyma
in its precision.
The plastic surgeon who reviewed my book for accuracy prior to publication,
while not disagreeing that breast reduction by liposuction was advantageous
from the perspective of lactation, expressed to me that this technique is
highly controversial among plastic surgeons because the liposuction can
result in extensive, prominent scarring (where the cannula extends into the
breast tissue). If I recall correctly, I believe he also said that adipose
necrosis was a significant risk. It may be, though, that the use of the
micro-cannula has minimized these risks.
Not all breasts are appropriate for liposuction (specifically those with
less adipose tissue and those of older women) and, even among those who do
receive it, not all breasts achieve the desired contour or areolar
reduction with this technique. Frequently, it is used in conjunction with
the more traditional inferior pedicle and vertical scar techniques, which
would clearly negate the benefit of liposuction by virtue of the damage to
neural and parenchymal tissues caused by the aspect of the surgery
involving the traditional invasive technique.
In practical terms, this means that this surgical technique is not
available to all women desiring breast reductions. The best candidates are
younger women with exceptionally large breasts (and hence more adipose
tissue). Although they may be young and more likely to be concerned with
retaining lactation capability, young women with only moderately large
breasts may not be offered this technique as an option. Further, few
surgeons worldwide are currently offering this technique, especially
employing the micro-cannula, although it does seem to be gaining acceptance.
Diana West
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