Introduction Most patients schedule their pre-operative consultation for a breast reduction after struggling for years with the discomforts and pains associated with having overdeveloped breasts. Breast hypertrophy can affect patients of different ages, from teenage years and up to menopause. Studies show that one in five women suffer from changes in the volume of the breasts during menopause. Breast surgery is performed so these patients can get relief from these discomforts and live a better life, but also to get a more aesthetic appearance of the body after harmonizing the size of the breasts with the rest of the patient’s anatomy. As is the case with any other surgical procedure, breast reduction surgery can be performed as a stand-alone procedure but also with other procedures. In the case of breast reduction, a very common combination is with liposuction. In this article, we will discuss the need for breast reduction and liposuction, and your candidacy for the combined procedure. Breast reduction: When you know you need surgery Women with overly large breasts often suffer from back, neck and shoulder pain. The pain can be persistent and quite severe in some cases. Other signs of overly large breasts are deep indentations on the shoulders made by the bra straps, and the same type of indentations on the inframammary fold. Women with overly large breasts can develop dermatological conditions that are difficult or impossible to cure because of the constant perspiration and lack of air flow in the inframammary fold. For these women, wearing a bra doesn’t make much difference in terms of the support that the breasts get, but at the same time, it is almost impossible for them to leave the house without a bra on. Performing physical activities such as jogging and running can be painful and uncomfortable as the breasts will tend to jiggle with every movement of the body. This is why women with overly large breasts will tend to avoid most sports and physical exercises, even from an early age. If these signs and symptoms sound familiar, chances are you are confronted with breast hypertrophy and might need a breast reduction surgery. Some patients think incorrectly that the overdevelopment of the breasts is caused by an excess of fat tissue and that if you lose weight, the breasts will become smaller. This is not correct, and this is not what will happen if you lose weight. It is generally accepted that the results of weight loss on the breasts is sagginess and not necessarily a reduction in volume. Moreover, it is important to understand that when weight loss occurs, the fat might go away but the skin will continue to be overstretched. This is why it is important to see the plastic surgeon for a consultation before starving yourself in an attempt to make your breasts smaller. Chances are they will stay the same in terms of volume, but will become saggy on the chest wall. Breast hypertrophy can only be corrected by removing a part of the glandular tissue that is in excess. The plastic surgeon can do this when performing a breast reduction while also correcting other imperfections of the breasts. Liposuction on the breasts Despite what people might think, it is not very common to perform liposuction on the breasts. It is true that liposuction can be combined with breast reduction surgery, but its purpose is mostly to refine the results by eliminating fat deposits from other areas of the body. Fat can start accumulating in different areas as a result of not being able to exercise without being confronted with pain and discomfort. During the pre-operative consultation, the plastic surgeon will perform a physical examination on your body and the tissues of the breasts. During this examination, he will be able to understand whether there is fat or glandular tissue in excess on the breasts as these two types of tissues have a different consistency. A breast echography or a mammography is also recommended depending on the patient’s age. A mammography addresses patients over 40 years old, and the aim of the test is to tell us if there are abnormal formations in the breasts that would make the procedure contraindicated. Candidacy for breast reduction with liposuction Patients with overly developed breasts and unwanted fat deposits on the back and sides of the body are good candidates for the combined procedure of breast reduction and liposuction. It is not uncommon for liposuction to be also performed on the abdominal wall as many patients have the tendency to develop fat deposits in the area. Combining procedures is often beneficial for the patient and also more cost-effective. When procedures are performed in the same operation, the patient will only have to go through the recovery period once instead of multiple times. Aside from the physical characteristics that would deem you as a good candidate for breast reduction with lipo, there are other criteria to be met before being able to schedule the surgery. The patient should be free of contraindications to the procedure. Usually, we are talking about severe heart, lung and blood diseases that could trigger life-threatening complications. However, chronic conditions such as diabetes are no longer a contraindication to undergoing plastic surgery as it was in the past. It is preferable for patients not to smoke. There are numerous studies showing that smoking can have a terrible effect on the healing process, and patients who smoke have an increased risk of developing a severe complication. Among the complications that could be triggered by smoking are delayed wound healing, wound dehiscence, fat tissue necrosis, and infection. The procedure can be performed on patients who smoke with the condition to stay smoke-free for three weeks before and after the surgery. If a smoking cessation is not possible, the plastic surgeon might deem you as ineligible to undergo surgery. Also, when considering breast reduction candidacy, we need to have a look at the long-term implications of the procedure. There are certain consequences associated with undergoing breast reduction surgery that can be unacceptable for some patients, such as scars and the lack of ability to breastfeed after the procedure. Both of these aspects need to be discussed in detail with the patient during the pre-operative consultation. Patients who don’t want to deal with scars are not good candidates for plastic surgery. Any type of surgical procedure will leave behind scars, bigger or smaller depending on various aspects. However, scarring is impossible to avoid and also permanent. To be an eligible candidate for the procedure, you have to accept the idea that there will be scars on your breasts. Also breastfeeding might be impossible after breast reduction, so if this is important to you, it would be better to postpone the procedure until after you are done having children. Conclusion Your candidacy for undergoing breast reduction with liposuction will be assessed by the plastic surgeon during the pre-operative consultation. During this initial meeting, the plastic surgeon will perform measurements of your height, weight and thorax while also examining the structure of the breasts. The overdevelopment of the breasts is due to an overdevelopment of glandular tissue, but because the patient struggles to keep an active lifestyle and exercise regularly, there could also be fat deposits present in the body. By eliminating the fat deposits that are on the breasts or in the nearby area through liposuction, we can enhance the results and create a more aesthetic appearance for the patient. Often the plastic surgeon will remove fat from the axilla and the back. The candidacy for the combined procedure will be discussed in detail with the surgeon and is dependent on your health and emotional condition, as well as the condition of the tissues of the breasts.