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What is a Breast Reductive Augmentation?

The term “Reductive Augmentation” was created by San Diego Plastic Surgeon and founder of Ranch & Coast Plastic Surgery, Dr. Paul E. Chasan. It applies to a situation in which a breast reduction is performed in conjunction with breast augmentation. During this surgery, the surgeon removes the extra tissue so the volume can be replaced by implants. This procedure results in a smaller breast with more attractive, longer-lasting upper pole fullness.

Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness. Over the last 14 years, Dr. Paul Chasan developed a one-stage technique of breast reduction combined with breast augmentation termed “Reductive Augmentation” to solve this problem.

Who is a Good Candidate for Breast Reductive Augmentation?

This Breast Reductive Augmentation procedure is unique to Dr. Paul Chasan’s practice and creates a breast that is much more round appearing with upper pole fullness. Also, many patients want a smaller breast, but like a rounder shape. This Breast Reductive Augmentation technique is also extremely useful for correcting breast asymmetry, as well as revising significant pseudoptosis (drooping of the bottom of the breast) in the patient who has previously undergone breast augmentation with or without mastopexy.

Choose the Right Implant

Deciding on an implant for reductive augmentation can feel a little daunting, more so perhaps because the client wants smaller breasts. Our surgeons can help women who need breast implants that are proportionate to their frame and body size. The Ranch & Coast surgical center stocks hundreds of different sizes and shapes to help you make the best decision.

Best Shape

There are different types of implants, but we recommend the type called INSPIRA®. The shell is filled with a highly cohesive silicone gel that retains its shape and form. INSPIRA® implants have a natural slope on the top with a fullness along the body, plus they feel more like actual tissue.

Some patients may prefer a more pronounced effect, with the higher round look of silicone implant. These implants look and feel like natural breast tissue, have more definition, and round shape.

Best Size

The size of an implant is determined by the volume of the implant, measured in cubic centimeters – not the easiest thing to visualize. In addition to volume, implants come in different widths measured along the diameter (largest point). This is where having an experienced surgeon to help can make all the difference.

Most of the women who seek breast reductions know their breast size is out of balance with the rest of their body. The implant you choose should correct that. If you have a smaller frame – narrow shoulders, thin torso, slimmer hips—you will need a smaller implant. If you have a larger frame, you can carry a bigger implant without it looking unnatural while remaining in proportion to your shoulders, waist, and height.

Schedule a Consultation.

Reductive Breast Augmentation Procedure

The discussions above will take place during your initial consultation with the surgeon and your medical team. In addition, you can expect to provide much of the same information needed for any successful surgery – health history, allergies, medications, tobacco, or alcohol use. If you’ve had prior breast surgeries or breast health problems, please let the doctor know.

Prior to Surgery

This surgery will require general anesthesia, so our patients must have someone who will see them home after the procedure. We staff each procedure with a dedicated surgical R.N. and a board-certified anesthesiologist. Please follow the pre-operative instructions carefully. Do not eat or drink after midnight.

If your surgery is later in the day, please clarify any changes in that timeline. Make sure the doctor is aware of any medications you’re taking and follow his guidance regarding the procedure. Comfortable, loose-fitting clothing is best for your trip home. Our surgical center does offer the option for an overnight stay if that’s your preference—just let us know.

The Surgery

Once the patient has been fully sedated, the doctor opens the breast around the areola, typically with either a keyhole incision or a lollipop incision (encircling the nipple, along with an opening to the bottom of the breast). This allows the doctor full access to remove fatty tissue from the breast. The weight of an extremely oversized breast can cause sagging, loose skin, and an oversized areola that can be repaired during the lifting process. The nipple itself is not typically detached, but it may require some repositioning, and the areola may need to be smaller to align with the new measurements. For women with severe breast hypertrophy (gigantomastia), the nipple and areola might need to be removed and grafted to the reconstructed breast (this is very rare).

Once the breast is properly prepared and reshaped, the doctor will create a pocket for the implant. They may first insert a sizer to confirm the size and profile. Our doctors have special medical equipment that allows them to view the augmentation in both a prone (lying on the table) and sitting position. Once placement is confirmed, the sizer is removed, and the implant inserted. At that point, the doctor will close the incisions and if needed, insert drains to avoid fluid build-up. (These drains are removed during a follow-up appointment.) Then the patient is taken to recovery. Normally, the stay in the recovery room is one to two hours while the anesthesia wears off.

Post-Operative Recovery

A follow-up appointment will be scheduled in conjunction with your procedure. We strongly recommend that you have a friend or family member stay with you the night of your surgery. You should expect to experience some discomfort in the first week following the procedure. We suggest that our clients take a week off from work. It is very important that you avoid vigorous activities that may place strain on your incisions.

The doctor will provide any necessary medications for pain and may encourage the use of an elastic bandage or special bra to help facilitate the healing process. There will be some minimal scarring that would typically be covered by a bra or bathing suit top. You can expect them to fade over time and of course, the advantage of a skilled plastic surgeon is most helpful.

Take time to rest and let yourself heal. Follow the instructions provided by our medical team and contact our office if you have questions or concerns.

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