Traditional Breast Reduction Vs Laser Bra Surgery

Question

I am doing research for my Breast Reduction. When researching the Laser Bra, I discovered that the procedure is about 1 & 1/2-2 hours, however when researching traditional Breast Reduction and Lift, some doctors say that the procedure will be around 4-5 hours for sculpting my own natural tissue.

	Do any of you have any reservations about the Laser Bra technique? Why is the time difference so big? I have not found any pictures of traditional reduction and lifts on the Internet that wowed me; however, the Laser Bra before and after pictures are amazing. BUT - I will not compromise my health if the technique is not safe. Please advice. Thank you so much for your time.

Robert Heck, MD, FACS · Answer

I trained with Dr. W. Grant Stevens of Marina del Ray who created the Laser Bra technique. As breast surgery is becoming more and more popular, it is not surprising that accompanying procedures have been developed to improve results or make them last longer. The Laser Bra is a technique that proves this.

Martin Jugenburg, MD · Answer

Laser Bra is just a great sounding name but that's about it.

If your concern is about the timing of 'traditional' surgery, then you should not think that laser bra is anything special.  While some surgeons describe breast reductions as taking 4 hours or so, it is also very possible to do this surgery in under an hour.  Dr. Lista and I perform these procedure in under an hour, and the cosmetic results certainly are nothing to be ashamed of.  The technique which was developed by Dr. Lista is exceptionally efficient and cosmetic.  We do not use a laser and do not ever feel the need for a laser.

Thus your choice of a surgeon should be not based on whether or not he or she does use a laser, but whether or not you like the results of his surgical technique.  Do not get tricked by clever marketing.

Sincerely,

Martin Jugenburg, MD

Scott C. Sattler, MD, FACS · Answer

There is nothing unique about a 'Laser Bra' lift compared to to traditional breast reduction and breast lift surgery. The laser is used to remove the surface of a portion of the breast skin. This technique is also done with a knife, which is much more cost-effective than a laser. See out a plastic surgeon that does a lot of breast reduction procedures.

Shahram Salemy, MD, FACS · Answer

When considering your options for breast reduction surgery, be very cautious as to what is being advertised as the latested and greatest in minimally invasive or noninvasive procedures. 
Breast reduction surgery is not just about making the breasts smaller, but also about reshaping and sculpting them to provide a more youthful shape and look.  This is difficult if not impossible to acheive without surgery in my opinion.
In terms of time, I think most of us would agree that we can perform a breast reduction in most patients in about 2-21/2 hours or less.  This can provided you with a wonderful, natural and durable result.
There are multiple photos on many of our websites showing before and after photos of breast reduction surgery.  My advice is to sit down with one or more Board Certified Plastic Surgeons in your area for a consultation and review of your options.  I think this is the best way to make an informed decision as to what you feel is best for your body.
Best of luck,
Dr. Salemy

Heather Vande Ven, DO · Answer

Traditional breast reduction involves surgical removal of excess breast tissue and reshaping the breasts, addressing issues like discomfort and heaviness. On the other hand, laser bra surgery utilizes laser technology to enhance breast lift and support, often with less scarring. Both procedures have pros and cons, and the choice depends on individual goals and preferences. Consulting with a skilled plastic surgeon is crucial to determine the most suitable option for your specific needs.

Joseph L. Grzeskiewicz, MD, FACS · Answer

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.

Tom J. Pousti, MD · Answer

Thank you for the question.

	When it comes to the success of breast reduction surgery I would suggest you do not put too much weight on breast reduction time. In other words, a shorter breast reduction time does not necessarily equate to a better or worse result. 

	Ultimately, I think you should concentrate on selection of a surgeon who you feel will most likely be able to achieve your goals as opposed to selecting a technique first and the surgeon secondarily. Fortunately, plastic  surgical results are very visible;  patients need only do their due diligence to make the important decision of surgeon selection.  Ask to see lots of before and after pictures ( and better yet) see patients who have had similar procedures in person.

	Best wishes.

Grant Stevens, MD · Answer

Interesting how many call this a gimick when they dont even know what it is.............. I have done this on hundreds of happy women for over 14 years ( including 2 family members, numerous employees, numerous nurses who have watched it, and multiple physicians including a past fellow who does the surgery herself!) Many of my Board Cerrtified Fellows are doing it around the country and I would be happy to assist any of you to find a qualified Board Certified Plastic Surgeon if you email our office.

	The C02 laser is used to remove the outer skin creating an internal dermal bra ( alive and well vascularized) which is secured to the breast bone ( sternum) . This "Laser Bra" lifts and supports the breast. Interesting that many of the same surgeons who are critical of The Laser Bra would not hesitate to buy cadaver dermis( alloderm) or pig dermis (stratice) and sew it in as a non viable graft (not a healthy vascularized flap like The Laser Bra). Surgeons use Alloderm and Stratice in breast reconstruction as well as now to help with mastopexies. Look at Life Forms own literature. The Laser Bra is free, vascularized, alive, and uses tissue that most surgeons otherwise discard while doing traditional breat lifts or mastopexies.

	I have written 2 peer reviewed papers in the Aesthetic Surgery Journal on Breast Reduction using The Laser Bra and Laser Assisted Breast Reduction for those critics who missed them. I have also given numerous talks around the world since 1996 regarding laser breast surgery. This includes ASPS, CSPS, ISAPS, Copenhagen, Swizerland, American- Brazillian Aesthetic Surgery Meeting, and numerous visiting professorships in the US.  This dermal pedicle is alive, thick and has widely patent artereolar vessels within it.  As our numerous fellows around the country and the world will tell you, we dont do free grafts, have done large numbers of women with 40-55 cm nipple to notch measurments, the reductions are almost bloodless and they take between 1 1/2 and 2 hrs tops.  Have frequently done 3 and gone to lunch.  Ask any of the fellows or residents.  The photos dont lie.  The breasts are perky and look beautiful.  They are not pancakes or flat with poor projection.  

	May I suggest that you try this living dermal internal bra sometime? You might actually appreciate the lift it gives our patients. Also gives more medial fullness or cleavage. I used to secure it laterally and medially but now only medially as it lifts in an upward and medial direction this way. Numerous surgeons have watched me do it and many are doing it in their practice now. Those who dont understand it, havent read about it , havent heard about it , and havent done it are all too quick to criticize it.

	I am sure that each of you get fine results with what ever method you use for mastopexies and reductions.  You may want to try addding a living internal dermal bra and comparing the projection and medial fullness.  You may want to de epi the flap to the nipple with a co2 laser one time also.   It is bloodless, efficient , easy and gives a very harty dermal leash to the nipple and areola.  

	I am happy to speak with any of you regarding this technique in Toronto at ASPS or Boston at ASAPS. Or you may call or email me anytime. All the best to all of you and all of our patients!

	Grant

Carmen Kavali, MD · Answer

When you see something with a catchy name that only one or two surgeons is doing, you can pretty much bet that it's a marketing gimmick.  In many cases, these fancy things are procedures that most of us already do--we just haven't bothered to give it a cute name and start telling the public that it's a great thing.

	The laser bra is a name for the use of a laser to remove the skin from the breast during breast reduction.  It is thought that the heat from the laser may cause some collagen deposition, which MAY lead to some skin tightening---but nobody has ever proven this, and nobody, to my knowledge, has ever shown long-term results using this technique that are superior to the results of other techniques.

	Find a few surgeons who interest you.  Meet with them; look at their before/after photos.  Many of us have a lot more photos in our office books than we have online, by the way.  Then schedule with the surgeon who makes you feel comfortable and who answers all your questions.  Best wishes!

Pat Pazmino, MD, FACS · Answer

There are many options today for breast reduction surgery. Be wary of marketing gimmicks and unproven technologies. When discussing this surgery with your plastic surgeon, make sure that he or she is very experienced in all the different techniques that are proven to be effective. To ensure that your breast has a youthful and full appearance internal suturing of the deeper breast tissue is important. This restructuring may be performed with sutures or even with the laser. However, the toll that is used is not as important as the technique employed. In our practice, patient benefit from the internal framework that we create with the breast parenchyma. The overlying skin is then gently draped over the breast but no tension is placed on the skin. The combination of these techniques allow for a long-lasting results and for minimal tension on the skin which will also prevent the widening of the scars.

Traditional Breast Reduction Vs Laser Bra Surgery

Answers (19)

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