[Case Review] Improving Sagging After Childbirth with Breast Reduction Liposuction

Today, while looking at front, left oblique, and right side photos of one actual case, I would like to explain that breast reduction liposuction is a surgery well worth considering for improving sagging (breast ptosis), even when the reduction in size is not very large. I will also explain how the skin contracts after liposuction, why the change in size can feel small compared with the amount of fat removed, and how the size keeps decreasing until about three months after surgery.

For this reason, at Venus Clinic we suction evenly not only in the deep layer but also in the layer close to the skin, using cannulas that reach that level. We remove the fat that needs to go as thoroughly as possible, and we smooth the line so that it is not bumpy or uneven. When the skin wraps around the area where the volume has decreased and contracts again, the lower edge of the breast moves upward, which helps improve sagging.

The amount of fat removed is a “volume,” while the size you see in the mirror or in photos is a “length,” such as diameter or circumference. When volume decreases while the overall shape stays similar, length decreases only by the cube root of the volume ratio. For example, if volume decreases by 30% and 70% remains, the length becomes about 0.888 times, the cube root of 0.7 — a decrease of only about 11%. Even if volume is cut in half, the length becomes about 0.794 times, the cube root of 0.5, decreasing by only about 21% [5].

Breasts that have grown larger after childbirth often have increased volume not only in the breast itself but also in the accessory breast toward the armpit and in the side of the chest next to the breast. Liposuction can remove fat from the breast together with the accessory breast, armpit, and side of the chest, so the transition to the surrounding areas is natural, and a neater line can be expected not only from the front but also from the side.

Suctioning evenly up to the superficial layer can encourage skin contraction, but not all sagging improves to the same degree. If skin elasticity was already greatly reduced before surgery or the sagging is severe, some sagging may remain or fine wrinkles may remain on the skin. Also, what liposuction can reduce is the fat inside the breast, so breasts with a high proportion of glandular tissue may show less size reduction.

The patient below had breast reduction liposuction at Venus Clinic for breasts that had grown larger and sagged after childbirth. We show front, left oblique, and right side photos of the same person in order. All after photos were taken one week after surgery. Swelling still remains at this stage, so this is not the final result; as the swelling subsides, the size decreases a little more until about three months after surgery.

This is the fat removed on the day of surgery. In the left (Lt) and right (Rt) containers, the red layer at the bottom is tumescent solution and the yellow layer on top is fat; together, both sides amount to about 2,700 cc of pure fat.

If you look closely at the containers, the fluid layer at the bottom is larger than the fat layer on top. I believe this is because this patient’s skin was very loose, so more tumescent solution was infused. Before liposuction, tumescent solution is infused to swell the fat layer firmly before suctioning, and when the skin is very loose, more solution is needed to swell the fat layer to the same degree. It is the same principle as needing to put more into a loose pouch to fill it tightly. That is why, in sagging breasts with very loose skin, the proportion of solution in the suctioned amount comes out relatively high.

The four stages in the illustration above follow the same order as the figure in the tumescent liposuction textbook (Tumescence and detumescence) [6].

A. Tumescent Infiltration — This is the stage where infusion of the solution begins. The textbook explains that the first infiltration should start in the deepest part of the fat layer, just above the muscle fascia. If infiltration starts too superficially, the boundary between the fat and the fascia becomes hard to feel by hand, making it more difficult to fill the deeper layers [6].

B. Progressing — Wherever the needle passes, the solution first collects in small pockets, then spreads through the tissue between the fat cells and gradually becomes evenly distributed. Because the nerves in the deeper layer are anesthetized first, the more superficial layer above can be filled with less discomfort, and as more nerves and blood vessels are reached by the solution, the anesthetic and vasoconstrictive effects become stronger [6].

C. Full Tumescence — The entire fat layer of the target area is filled with solution and is firmly swollen. If a little more solution is placed in the most superficial fat, the skin may take on an orange-peel appearance. According to the textbook, subcutaneous fat can hold an additional volume of fluid of about twice its own volume, so the fat usually becomes fully swollen only after infusing about twice the volume of the targeted fat [6]. Once swollen like this, the deeper fat layer is lifted away from the tissue beneath it, and any missed fat is easier to find, which helps in refining a smooth line [6].

The textbook also notes that once the skin and subcutaneous tissue have been stretched by obesity, they remain stretched and loose even after weight loss, so a greater volume of solution is required to reach this stage [6]. The same principle applies to breasts stretched after childbirth, and I believe this is why the proportion of fluid was high in this patient.

D. Detumescence — As the infused solution spreads out into the surrounding fat tissue, the swollen fat layer partially settles. The textbook explains that allowing time for this settling (20 to 30 minutes) before suction maximizes vasoconstriction and anesthesia, and also makes the tissue easier to grip, so liposuction becomes easier [6].

This is a case of breasts that were large and sagging after childbirth. Liposuction was performed on the breasts together with the accessory breasts, armpits, and side of the chest. Before surgery, the breasts sagged significantly and the nipples sat below the inframammary fold. After the fat was removed as shown above, the photos taken one week after surgery already show a decrease in size from the front, left oblique, and right side, and the lower edge of the breasts and the nipple position moved upward, improving the sagging as well. Swelling still remains at this stage and the size continues to decrease until about three months after surgery, so we expect the actual size reduction to be greater than in the photos. This is a case in which both size reduction and improvement in sagging can be seen.

With breast reduction liposuction, the change in size can look small compared with the volume removed. However, the improvement in sagging — as the breasts become lighter and the skin, suctioned evenly up to the superficial layer, contracts again — is as important a change as size reduction for those troubled by breasts that sag after childbirth. At Venus Clinic, we believe breast reduction liposuction is a surgery well worth considering for improving sagging even when the size reduction is not large, and we perform surgery that shapes the breasts and the surrounding areas into one line.

References: Breast Reduction Liposuction Size Reduction After Liposuction Sagging Breast Reduction After Childbirth