Breast Reduction without implants "tethering" question

Question

I'm thinking of going down from a DD to maybe an A cup. I was wondering if it is standard practice to tether the breast to the rib's facia? Do all surgeons do this? If so, then how many spots get tethered? It makes sense to do this so the breasts don't sag again. I'm just not sure if this is how a reduction is done or not as I'm still looking into the procedure.

Gary M. Horndeski, MD · Answer

It is impossible to suture the breast to the rib fascia since the fascia is underneath the muscle and your breast is on top of that.  Some surgeons will suture the breast to the underlying muscle or fascia but not ribs directly.  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.

Best Wishes,

Gary Horndeski, M.D.

Robert Cohen, MD · Answer

Hi there- so if you are downsizing from a DD to an A cup, there will be a lot less tissue for gravity to work on so re-drooping won’t be much of an issue. If a superomedial pedicle technique is used (where the upper/middle breast tissue is maintained with the nipple connected and the excess lower and outer breast tissue is removed) the breast will be naturally fuller where it needs to be. I have performed over 1000 reductions and do not routinely fix the breast tissue to the underlying connective tissue as I don’t think this makes much of a difference long term when the surgery is performed properly and a superomedial (as opposed to an inferior / lower breast tissue) pedicle is used.

Irena Karanetz, MD · Answer

Hi, Thank you for the question. 
There are many various techniques and approaches to performing breast reduction/breast lift. In certain cases, there is a way to "secure" breast tissue to the chest wall to help maintain breast shape but decision to perform that specific technique/procedure is typically made on the individual patient basis. 
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

Phillip Chang, MD · Answer

Hi Intellectual1247

Breast reduction is both a functional as well as a cosmetic surgery procedure that can often be covered by your health insurance.  Breast reduction has the highest patient satisfaction rate of any procedure in plastic surgery.  The goals of breast reduction are obviously to reduce the size of the breast to a size and shape that is aesthetically pleasing and proportionate to the rest of your body. To learn more about this procedure, please visit our website.

Ronald J. Edelson, MD · Answer

I am familiar with what you are referring to. Personally I don’t do it because I don’t think it makes a difference long term. I’m sure some surgeons do what you are saying but I can’t say sir officially what your surgeon has in mind.

Breast Reduction without implants "tethering" question

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Breast Reduction without implants "tethering" question

Answers (8)

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