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Ask anyone who has considered a breast reduction and lift why they would consider getting an implant and, most likely, their response will be that an implant can guarantee a round shape. For double board-certified New York plastic surgeon Brad Gandolfi, MD it’s a conversation he has often with patients considering a breast reduction as the general fear is that you cannot manipulate the breasts into a round shape when removing breast tissue and lifting. However, Dr. Gandolfi says with his specific breast-reduction technique he can get that beautiful round shape.
Why is it difficult to get a rounder, fuller breast shape with a reduction?
“My goal with every breast reduction is not just to improve back and neck pain, it’s also to improve the look of the breast which is possible in about 95 percent of patients. Many people that have large breasts often have them coming off the side of the body, in the armpit area, and it’s something that’s overlooked by a vast majority of plastic surgeons. I trained in three states and failed to see the side of the breast addressed effectively.
I went back to the beginning and started studying ideals. It is interesting that if you simply Google ‘attractive breast shape’ you will see a huge variety of shapes, sizes, and colors. However, most share a few similarities which include fullness, a round shape, and a nipple in the central position. As simple as this sounds, this can be hard to accomplish, especially if you are removing pounds of tissue, as is often the case with a breast reduction. There is a balancing act between what is removed and where it is removed, and it is this interplay that determines a good vs a great result.”
What does your approach entail?
“Larger breasts often appear very wide, so the key is narrowing the breast on the torso and making sure that it fits within the chest. That alone reshapes the torso, making it look longer and you appear thinner. Then, I’m taking the breast tissue and the parts of the breasts that I want to keep and moving them into a more central position. I’m centralizing the nipples while getting rid of all the sagging or excessive parts of the breast. The other important thing that I’m doing is securing the breast in position with sutures to ensure longevity.
For me, it’s important I recreate the ligaments of the breast that hold it in place. At the end of the procedure, you’re going to have breasts that are significantly less heavy but have more projection. I tell my patients they are going to feel better and look better in and out of clothes. Unfortunately, traditional breast-reduction methods often leave the breasts flat like pancakes. When I use these techniques, the final outcome is a pair of round beautiful breasts, not breakfast food.”
How do you determine the right proportions?
“Proportions are generally not determined by me. Everyone has a different framework. In breast surgery this framework is determined by the width and height of the chest. The breasts are then shaped to enhance that framework. Excess skin fat and breast tissue is removed, and the ideal parts are kept. This allows me to preserve and even enhance my client’s curves while decreasing back pain. This is an important point: Most women who have breast reductions do not want small breasts, they want smaller breasts. The vast majority of women that come to me want their breasts after surgery to look proportionate, sporty, perky, and sexy. This requires significantly more design, effort, and time than simply reducing a breast. The outcome will be heavily based on what your anatomy can do but also on the technique, approach, and artistry of your surgeon.”
What types of incision scars can you expect with this reduction approach?
“Any true breast reduction of significant size is going to have an anchor scar in my practice. I have seen other techniques used to avoid the scar under the breast, but I find significantly more precision and control using an anchor scar. Everyone is worried about scars. No one likes scars, including myself, but with this surgery the difference is drastic. Over time most scars flatten out, fade away and are barely detectable. These incisions are necessary to create that natural, teardrop shape most women desire.”
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