The vast majority of breast reduction techniques used by plastic surgeons involve removing a considerable amount of breast tissue and skin while elevating the nipple/areola complex to a higher position on the breast. The main difference between these techniques is what direction the pedicle of breast tissue is based to keep the nipple and areola alive and sensate.
No Skin Removal
In recent years, liposuction of the breasts without removing any skin or raising the nipple and areola has been popularized as an alternative technique for reducing the size of the breasts to eliminate problems such as back, neck and shoulder pain which can be caused by excessive size and weight of very large breasts.
Liposuction has the advantage of much smaller scars and generally less pain with a much shorter recovery period. On the flip side, less tissue is generally removed so the breasts are not reduced in size or weight as much as is with a standard reduction, and a lift is not performed so there may actually be more, rather than less sagging after the procedure; particularly if the skin has many stretch marks revealing a significant loss of elasticity.
Dense Breast Tissue
In some cases, especially in younger patients where the breasts tend to be very dense, there may not be a lot of fat, so a reduction by liposuction could be minimally effective if at all. Unfortunately, there is no good way before surgery to tell how successful liposuction alone would be.
Liposuction as a form of breast reduction has also not gained much popularity among insurance companies. At this time, I am not sure that any third party carriers have started to approve liposuction as a medically necessary form of breast reduction surgery.
During a standard breast reduction, the tissue that is removed during surgery is sent to the pathology lab for analysis to make sure that none of it was cancerous or pre-cancerous. This is much more difficult to do when the tissue is removed in tiny fragments as is done with liposuction as a form of reduction. Even if a cancerous lesion was found, it would be impossible to determine where it came from in the breast, which would eliminate the possibility of any sort of conservative cancer therapy.
One option is to first perform liposuction of the breasts as a form of reduction first to see how much of a reduction can be obtained while not committing to the permanent scars of a standard reduction. If not enough tissue was removed for a satisfactory reduction to eliminate the symptoms of excess weight or, if too much sagging resulted from the procedure, one could then later undergo a formal breast reduction or a breast lift to correct the sagging. This may be particularly attractive to the patient who does not have insurance coverage or to one who is considering having multiple procedures such as liposuction, a tummy tuck or another cosmetic surgery.