[Case Review] Liposuction for Asymmetric Breasts

Today, through two cases in which liposuction was performed on only one breast, either the left or the right, I will explain how asymmetric breasts are corrected by liposuction on the larger side only. I will also show how the limit on the amount of reduction that breast liposuction can achieve appears in actual surgical results.

There are broadly two ways to even out asymmetric breasts: enlarge the smaller side or reduce the larger side. At Venus Clinic, we use liposuction to reduce the fat in the larger breast so that its size comes closer to the other side. The opposite breast is left untouched, so when only one breast is larger, surgery is performed on that one breast only.

For common areas such as the thighs, buttocks, and arms, Venus Clinic does not suction the left and right sides differently; our basic approach is to leave the remaining fat layer at the same thickness on both sides, because treating the sides differently could actually create asymmetry. The exception is when the two breasts differ in size: the larger side is suctioned more so that the two come closer in size. Both of these cases fall under that exception, so surgery was performed on only the larger breast (the left or the right).

What liposuction can reduce is the fat within the breast. The liposuction literature reports that tumescent liposuction with microcannulas can reduce breast volume by 30–50%, and by up to 60% in breasts with a high proportion of fat [1]. Reports of breast reduction by liposuction alone have also described a reduction of about two cup sizes on average (Gray, 2001) and volume reductions of about 51% and 43% (Habbema, 2009) [3].

The breast also contains glandular tissue, which liposuction cannot reduce. So even when the same amount is suctioned, a breast with a high proportion of fat shrinks considerably, while a breast with a high proportion of glandular tissue shrinks less [1]. Please keep this limit in mind when you look at how much the size changed in the cases below.

A thin suction tube (cannula) is inserted through a small incision a few millimeters long, and the fat inside the larger breast is suctioned. Because breast tissue is not cut away, no long incision line is left around the breast or the areola, and because the nipple is not moved, patients can consider this option without worrying about nipple sensation or breastfeeding function.

Before surgery, the area to be suctioned is marked with a pen on the breast to be treated and the surrounding area, with the patient standing. The photos below show the pre-operative design of the patient in the second case that appears later (surgery on the right breast alone).

On the operating table, the positions of the small incisions are marked together with the design lines. The white dots in the photos are those marks.

It is known that when the weight of the breast decreases, the tissue that was pulled downward becomes lighter and the nipple may rise [2]. As a reference, I will show how much the size actually decreases after breast reduction liposuction. Below are the pre-operative design drawn on a patient who had liposuction on both breasts, her photo 1 month after surgery, and the measurements written on the photos.

A clavicle-to-nipple length that is about 2–3 cm shorter means the nipple rose by that amount, and a navel-to-inframammary line length that is about 2.5 cm longer means the lower breast line rose by that amount. As a result, this patient's breasts appear reduced by about 2.5 cm. However, these figures were read from the photo design of a single patient, and not everyone will show the same degree of change.

Even when only one side is treated, it is very difficult to make both breasts exactly the same size after surgery. The shape and glandular tissue of the untreated breast remain as they were, and the amount the treated side shrinks also depends on its proportion of glandular tissue. So it is more accurate to understand this surgery not as making both sides completely identical, but as reducing a noticeable size difference so the two sides look similar. If you gain weight after surgery, the remaining fat cells can enlarge again and the breast size may change, so it is a good idea to manage your weight steadily.

The side of similar size is left alone and only the larger side is treated, so there is no need to operate on both sides unnecessarily.

Only the fat inside the breast is suctioned and the glandular tissue is not cut away, so patients can consider this option without worrying about breastfeeding function. Because the nipple is not moved, nipple sensation is also maintained.

If needed, fat in the accessory breast tissue, the armpit, and the flank beside the breast can be contoured in the same session, so the treated side blends naturally into the surrounding area.

Both of the cases below are patients who had liposuction on one breast only, and all of the after photos were taken 1 week after surgery. One week after surgery is a time when swelling remains, so these are not final results, and the shape may change a little more as the swelling subsides.

This is a case in which the left breast is larger. Before surgery, the left breast was larger than the right, so the size difference between the two sides was noticeable, and liposuction was performed on the left breast only. In the photos taken 1 week after surgery, the left breast has become smaller and is similar in size to the right. As mentioned earlier, breast reduction liposuction has a limit on how much size it can reduce, but in this case the left side was reduced sufficiently and the asymmetry appears well corrected. The yellowish discoloration visible on the left breast in the after photos is the bruising from just after surgery fading, and it becomes lighter over time.

This is a case in which the right breast is larger. Before surgery, the right breast was larger than the left and sagged downward, so the two sides clearly differed in size and height. Liposuction was performed only on the right breast and its surrounding areas (accessory breast tissue, the side of the breast, and the armpit), and in the photos taken 1 week after surgery, the right breast has become smaller and is similar in size to the left.

When only one breast is larger, liposuction on that larger side alone can reduce the difference between the two. Breast reduction liposuction has a limit on how much size it can reduce, but in both of these cases the larger breast (the left or the right) was reduced enough to become similar in size to the opposite side. At Venus Clinic, we examine each patient's breasts and plan the treatment around reducing the larger side.

References: Correcting Asymmetric Breasts After Breast Cancer Surgery Liposuction for Correcting Asymmetric Breasts