I like the idea of the laser bra, in conjunction with some other maneuvers to try to achieve a good, lasting fullness of the breasts, but I don't like the notion that you can't achieve this without using a laser. In fact, I would argue that the need to pull a laser into the OR to perform an operation that traditionally doesn't involve a laser is wasted motion, time, and expense. If you go back to basics and look at what lasers do, it's pretty simple: they use light energy to vaporize the superficial-most cells of the skin, meaning the epidermis and upper dermis. That's it. If the settings of the laser allow for it, there can be some heat build up in the tissues too, called "dissipation," and this can cause some contraction, shrinkage and tightening of the dermal elastic and collagen fibers. However, one must be careful, because this is the same heat that can injure the deep dermal blood supply to the skin and compromise its health and viability. These principles are in operation in skin treated with a laser regardless of where it is: face, breast, chest, hands, or any other location. The main reasons for taking the epidermis off of the breast tissue are: 1. because we have to leave some breast tissue attached to the nipple for blood supply, and this can't have epidermis on it because once it's buried under the breast tissue as an "internal bra," the epidermal cells would continue to grow and cause all kinds of problems, and 2. it gives us something strong to place sutures into to suspend the breast tissue, thus the "internal bra." There are MANY acceptable ways to remove this skin, laser being just one of them. One can also use a scalpel, surgical scissors, or as I do, the electocautery or Bovie. I do this because with certain attachments, like a Utah tip, the electrical energy of the Bovie is focused and it cuts very cleanly, leaving a bloodless plane, just like a laser. Depending upon the size of the breast, this maneuver takes me about 5 minutes or less to accomplish, and I would bet that the layer of dermis I have left is every bit as viable and strong as any I would get using a laser. The thing is that I do it with an instrument that is on every operating table for every breast reduction case, and I don't subject myself or anyone else to additional risks like exposure to laser smoke and aerosolized infectious agents or laser injury to the eyes. Once I do this, I believe that the rest of the operation is about the same as many others do it. The skin is used to suspend the breast to the deep structures, and the rest is pretty standard. I just haven't found a fancy way to call this procedure the "Bovie bra," it just doesn't have the same ring. It's not that the "bra" part of the laser bra is not a worthwhile idea; many of us do it and actually figured it out on our own. Rather, it's just a matter of how you "develop the bra." Do you use a laser, a Bovie, a scalpel, and so on. I maintain that if you look at lots and lots of pictures of results of operations that were performed identically with the exception of the use of the laser versus other methods of removing the epidermis, in other words a properly controlled study designed with scientific method in which the breast tissue was suspended the same, the design of the incisions was the same, etc., I think you would find that there is little significant difference between the results. The "laser bra" is a decent operation, it's just that deep down inside, it's not really that unique, and it adds elements of risk and expense that I don't think need to be added to an otherwise very straightforward breast procedure. One other point to make about the shaping of the breast is that this argument makes us place way too much emphasis on the importance of skin in the long term shape/support of the breast. We should all realize by now that over time, all skin that is bearing tension or load, including the "laser bra" skin will relax and lose its tone. When this happens the breast will droop. One very important, and in my opinion often overlooked, aspect of planning the long term shape of the breast is the design of and distribution of the resected breast tissue. That is, if you simply remove breast tissue without regard to where it comes from on the individual breast and how the remaining breast tissue is distributed over the breast mound, you will possibly miss an opportunity to shape the breast in a way that will leave optimal long term fullness. If you preferentially remove upper pole breast tissue or simply thin your flaps uniformly without considering the final position of the tissues, you will probably be left with a bottom-heavy, saggy appearing breast which is flat on top and without projection, as opposed to leaving fullness in the central upper pole which will not bottom out and will result in longer term upper pole fullness. And this has nothing to do with the skin, or "laser bras," or Bovies, or anything else.
The second point is very simple to make: I think that those surgeons who claim to do breast reductions in an hour or slightly longer most likely have more than one surgeon operating; perhaps there are two or more surgeons, operating on two breasts simultaneously, or there are fellows and residents sewing one breast (probably the part of the case that takes the longest) while the primary surgeon reduces the other. I just don't think it's humanly possible for a surgeon to perform the entire operation himself/herself (as is frequently done in a solo private practice setting) in that short of a time. I have done probably over a thousand breast reduction and lift procedures at this stage of my career (using a technique very much like the laser bra), and they still take me every bit of 3 to 4 hours to do a good job and get it right.