Avoid boxy pancake boob? (Photo)

Question

I'm beyond ready for a reduction along with lipo under my arms/back. So many results I see are boxy and square and I definitely don't want that. What would you suggest for me? Ideally I'd be as small as possible with a snatched in waist but I'd like to be realistic too. My rib cage was a 34 until I hit middle age and my breast tissue took over and keeps growing (now a 42) ...I'm miserable. 5'7, fairly short waisted.

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. At the same time, liposuction can be done.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Casey Anderson, MD, FACS · Answer

I prefer superior medial technique to help with improved shape. The best thing is to see before/after pictures from your surgeon so you can see likely results.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. I would encourage you to be cautious about your expectations. A breast reduction is just that, a reduction of the breast to offload weight and tension. It will not likely produce perky and round breasts and it will certainly not produce a snatched waist. What you are speaking about is the squareness of early postop results with an inferior pedicle reduction. With large reductions such as yours, the inferior pedicle is likely going to be the procedure of choice. You should check out some longer term results to better understand the final outcomes.

Best of luck!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Best of luck!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Irena Karanetz, MD · Answer

Hi,
Thank you for the question. 
Based on your photos, you appear to be a great candidate for breast reductions surgery. During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller. It is easiest to think of breast reduction as including the breast lift. 
There are two main techniques and scar patterns for breast reduction: Inverted-T (Anchor) or Lollipop. The decision to proceed with one technique vs. the other depends on the amount of excess breast tissue present and your surgeon's preference/experience. 
I typically use Inverted-T (Anchor) superomedial pedicel technique for my breast reduction patients to create a round and uplifted breast shape, which helps avoid boxy breast appearance.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Hampton A. Howell, MD · Answer

Hi.  Based on your pictures you look like you would be an excellent candidate for breast reduction.  In most cases a boxy look can be avoided and the breast can be shaped nicely with a good rounded shape with the appropriate design and techniques.  I would recommend consulting with a board certified plastic surgeon with good experience with breast reductions.  Be open and frank about your concerns.  Also pay good attention to that surgeon's before and after pictures and make sure that they seem to match what you are looking for.  I have included some examples in case it is helpful.  
Good luck and take care, 
Dr. Howell

Daniel Barrett, MD · Answer

Dear chrismarie14,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

The best place to begin is by researching board certified plastic surgeons in your area.  A great resource is the ASPS website.  Here you can find links to surgeons in your area, review credentials, and see before/after photos. Look for surgeons whose results meet your expectations. From the submitted photos you appear to be a candidate for a breast reduction and tummy tuck.  Liposuction can be added for further contouring.  I've included a video I hope you find helpful.

Megan Dreveskracht, MD · Answer

Judging by your pictures, it looks like you would be an absolutely great candidate for a breast reduction. The shape, appearance and projection of a breast after a reduction are a combination of technique and a patient’s overall anatomy. The most common reasons breasts look boxy after a reduction, in my opinion, are a lack of tissue rearrangement, a lack of respect for the natural aesthetics of the breasts, and a lack of tailor-tacking (temporarily closing the skin and tissue to ensure you are happy with the results before you suture the skin). Think of a reduction in 2 dimensions--the outer skin and the inner tissue. In order to provide shape and projection to the breast, you must rearrange the breast tissue beneath the skin in a way that can withstand the gravitational effects over time. The tried and true pedicle for a breast reduction is an inferior pedicle. While this can be a great option, the pedicle must be shaped and tacked into proper positioning prior to skin closure to avoid a flat, floppy appearance that will sag over time. There are also alternative pedicles that aren’t as subject to gravity over time and, depending on the patient's anatomy, may be a better option to choose. 
An ideal breast has fullness medially (think cleavage) and has a great, rounded shape laterally. When removing tissue in a breast reduction, you want your surgeon to preserve tissue medially (to keep that fullness) and take extra time to shape the breasts laterally. I prefer to use liposuction to shape the outer aspect of the breast as I feel it gives me the best control over shape. I also prefer to use liposuction to remove the armpit fat that most women have. Regardless of how your surgeon does it, you want to look for a surgeon who is meticulous about these fine details. 
Lastly, assessing the shape of the breasts with the patient laying down but also while sitting up is key. We all know natural breasts have a dramatic difference in shape when gravity takes hold. I think the best results come when those markings are considered only ‘preliminary.’ I prefer to first remove excess breast tissue until I have reached the overall desired volume, and then sit the patient up to assess for optimal symmetry and contour before determining the final markings.

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