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What is a Reductive Augmentation of the Breast?

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 Reductive Augmentation of the Breast?

This Reductive Augmentation of the Breast 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 Reductive Augmentation of the Breast 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.

Breast shape classification diagram

Woman in black lace bra lookin to the side

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 Augmentation of the Breast 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.

In the OR with Dr. Paul Chasan - Reductive Augmentation

In the OR - Reductive Augmentation

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.

Reductive Augmentation of the Breast Before & After

Origins of the Reductive Augmentation of the Breast

Few plastic surgery procedures result in as high a level of patient satisfaction as the breast lift. It is a popular and well-loved procedure, but one not without its shortcomings, limitations, and potential to develop problems years after the initial procedure. Additionally, a significant and growing subset of the women getting a breast reduction, as well as women with macromastia in need of breast reduction, are seeking a more perky and rounded breast, with greater upper fullness and a more pronounced projection off the chest wall. This observation in combination with data gleaned from thousands of successful cosmetic breast surgeries led Dr. Paul E. Chasan to pioneer and develop a novel approach to breast reduction: The Reductive Augmentation of the Breast pioneered almost two decades ago in 2003, perfected by 2007, and satisfactorily performed since to this day.


Dr. Chasan began his development in an effort to better serve women with macromastia. It proved to be a versatile and effective technique that was also well suited to patients with one or more of a range of breast health or cosmetic concerns, including:

  • Macromastia
  • Redundant lower pole tissue
  • Significant pseudoptosis (wherein a large percentage of the breast falls or hangs below the inframammary fold), even if after an earlier breast augmentation
  • Pronounced asymmetry in the breasts

The procedure isn’t simple. It’s not without its surgical nuances. It requires 2 to 3 times as long in surgery as the typical breast augmentation. But for decades now, results have proven exceptionally worthwhile and patients exceptionally satisfied.

Reductive breast augmentation is an involved undertaking that amounts to a 3D remodeling of the breast. The technique pioneered by Dr. Chasan takes a number of standard surgical techniques that are typically done as two or three separate surgeries (first breast reduction, then breast augmentation), and it seamlessly combines them into one procedure.

Surgical Technique of Dr. Paul E. Chasan, Reductive Augmentation of the Breast

The surgery is initiated with the placement of an implant sizer in the subpectoral location via an infra-areolar vertical incision.  Next, the breast lift is simulated using a freehand “tailor tack” technique utilizing staples.  Once the overall appearance and shape of the breast is created, the excess or redundant breast tissue is then removed.  Oftentimes, this necessitates a different size or shape sizer.  The last surgical move before the closure is called the secondary mastopexy in which the final skin modifications are made.  The implant is used to shape the breast and create a much more round-appearing breast while removing breast tissue to further modify the shape and create a more beautiful appearing breast.  Additionally, having removed the breast tissue on the inferior pole of breast prevents the typical bottoming out as is commonly seen in standard breast reduction surgeries.

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.

Dr. Paul Chasan

Dr. Paul Chasan

Read the full publication as featured in the Aesthetic Plastic Surgery journal.

Aesthetic Plastic Surgery journal

Reductive Augmentation of the Breast

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