Why do some breasts have a square after a reduction?

Thanks for this interesting question.  As you know a breast reduction comes with a built in lift. after volume reduction the skin is tightened as well. Skin is much smarter than the average doctor and relaxes and changes its shape in the six months after breast reduction. Because we know that the skin will be relaxing we often make the lift just slightly too tight from the get go counting on the relaxation. This slightly too tight breast may look flat on the bottom and bulgy on the sides. We call this "boxy". in most patients after 3-6 months the bottom of the breast will drop and round. On some occasions patient may require some revision depending upon the final shape.Different reduction patterns can give different shapes as well . I prefer a "Wise" pattern which most refer to  as the "anchor" pattern. This gives both a vertical and horizontal tightening to the breast and I believe lends itself to a better shape in the end.I hope this helps.

The inverted T or anchor incision frequently results in square shaped breasts.  For that reason, an alternative was developed called 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.

Boxy appearing breasts is not uncommon after breast reduction. It usually improves with time and can often be  addressed with a pretty simple revision. There are many theories about what causes it or how to avoid it. It mainly has to do with how the breast tissue is shaped by the surgeon.

Hi.  Good question, and the answer is basically that "it depends ".  He can certainly have factors to do with anatomy and the particularities of the patient's tissue.  What I mean by that is that some tissue is structurally more sound and holds its shape a little bit better and other tissue may be less so and relax and ways that the patient and the surgeon may not desire.  There can also be differences in the nuances of how a surgeon designs the breast reduction.  As I mentioned in the video below, a breast reduction has a breast lift built into it.  But sometimes if not enough tissue is removed from the outer aspect or the inner aspect of the breast it may take on a more boxy appearance versus a more rounded appearance.  With all of that being said I try to design my and obviously to have a nice rounded appearance, but even so, occasionally some of mine will have a little bit more of a boxy appearance.  If desired that can typically be modified with some additional resection or contouring.  I have included a link to before and after pictures as well, in case that is helpful.Good luck and take care, Dr. Howell

Dear tighhter,
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

Breasts may appear square-shaped after a reduction due to the surgical technique used during breast reduction surgery. This can happen if the surgeon removes a significant amount of breast tissue from the bottom and sides, which can alter the breast’s natural round shape. Additionally, the healing process and scar formation can affect the final appearance. It’s essential to discuss your desired outcome and concerns with your surgeon before the procedure to ensure you have a clear understanding of the potential results.

Dear tighhter,A significant contributor to the postoperative breast shape after breast reduction surgery is the technique that is employed.  In general, the inverted T or anchor incision technique creates a more boxy shaped breast.  This criticism of the technique was one of the driving forces behind development of vertical (lollipop scar) techniques, which, in general, create the more smooth, rounder breast shape.