In Breast Reduction Surgery, Can Dense Breasts Not Be Reduced as Much?

In breast reduction surgery, X-ray examination is an essential test that provides important information.

Through this mammogram, not only can we distinguish whether the breast is dense or fatty, but we can also overall understand the distribution and location of the glandular tissue, infer why the breast has taken its current shape, and based on that, anticipate how the surgery should be designed to achieve good results.

Because the X-ray serves as such an important basis for judgment, we always take it before consultation and review it together with the patient while explaining the condition.

Young people are definitely dense-breasted

Older people are fatty-breasted anyway

Based on assumptions like this, many people do not get a mammogram at all. However, in large and sagging breasts to the extent that breast reduction surgery is being considered, cases often differ from these typical expectations, so it is best to have an X-ray taken in advance when deciding on reduction surgery.

After explaining during consultation whether the breast is fatty or dense, there is a question that comes up from time to time.

If the X-ray shows that the breast is dense,

"I've heard dense breasts can't be reduced very much."

Many people feel disappointed and say this.

When asked why they think this way, many say they believe that if there is a lot of glandular tissue, liposuction cannot be done, so the breast cannot be reduced much.

In some hospitals, this is indeed how it is explained, which seems to have allowed this mistaken prejudice to take root.

There is no reason why dense breasts cannot be reduced more than fatty breasts.

That is because, in breast reduction surgery, the factor that determines the final size is not whether the tissue is glandular or fatty,

but the length and thickness of the flap that must be preserved.

The more tissue that must be left behind, the larger the surgical result will inevitably be. Of course, glandular tissue is somewhat heavier than fat, so there may be a slight difference in weight between the two types, but it is not large enough to determine the overall outcome.

There is no reason why the flap of a glandular breast should be larger or thicker than that of a fatty breast.

Of course, liposuction is an effective method used in most cases of breast reduction surgery. However, it does not mean suctioning the breast itself; it is only an auxiliary method used to create a smooth transition with the reduced breast by working on the tissue around the breast, such as the outer side area or the axilla.

At first glance, you might think, "Cut out the part that needs to be removed and then use liposuction on the part that needs to remain to reduce it as much as possible."

However, this is a very dangerous method that is contraindicated in reduction surgery.

If you try to reduce the breast itself with liposuction,

1. Blood vessels within the flap can be damaged, increasing the possibility of nipple necrosis
2. Continuous microbleeding can occur

These problems can arise. In particular, liposuction is not a surgery where bleeding can be seen and hemostasis performed directly, and the likelihood of a seroma increases. To compensate for this, a drain must be placed.

Therefore, the basic principle of reduction surgery is

to directly excise the breast itself under thorough hemostasis to reduce its size, and to use liposuction only as an auxiliary means for a smooth transition in the areas around the breast.

"Still, isn’t the amount removed greater when liposuction is used?"

You may ask this, but a larger amount of liposuction does not mean the breast comes out smaller. This is not because the breast itself has become smaller, but simply because more fat has been suctioned from the surrounding area of the breast, so when looking at the breast itself, it has not become smaller.

Saying that "dense breasts are hard to reduce to a smaller size" is, in fact, a description that entirely reflects the position of the surgical team.

In other words, it simply means that it is "more physically demanding."

When excising firm glandular tissue, it naturally takes more effort and more time than cutting soft fatty tissue. So, to emphasize that point, people say dense breasts are harder to reduce to a small size.

The size of the breast that remains after breast reduction surgery is not determined by whether it is glandular or fatty, but is proportional to the size of the flap needed to maintain blood flow to the nipple.

If you keep this in mind again, I think you will understand that there is no rational reason why a flap with more glandular tissue must be left larger than a flap with more fat.

Whether dense or fatty, we can summarize that there is not a significant difference in the results of reduction surgery between the two types.

Therefore, if your breasts are dense, there is no need to form a negative expectation about your surgical result.

Thank you.