Could Reducing your Breasts Improve Your Health?

Dr Tannous Frangieh is a Brazilian-certified plastic surgeon whose areas of specialization include the most popular aesthetic techniques of today. After obtaining his Medical Doctorate from the American University of Beirut, he completed two years of general surgery, training at the American University of Beirut Medical Center. Realizing his passion lay in plastic surgery, he headed to train at the prestigious Hospital da Plastica in Brazil. Today he specializes in the latest techniques of Facelift, Eyelid Rejuvenation, Breast Lift, Body Contouring, High Definition Liposuction and Brazilian Butt Lift.

Here he talks in detail to TRU & Beyond founder Miriam Abadi about the popular breast reduction surgery trend.

The topic of breast reduction surgery has recently gained a lot of momentum. Could you tell us what exactly breast reduction surgery is ?

Breast reduction is a surgical procedure that reduces the size of the breast by removing fat, breast tissue, skin, or a previously inserted implant. It is not just about reducing the size of the breast, but also about lifting and reshaping the breast in order to give it a more defined cleavage line. This gives the breast a fuller upper volume and prevents it from falling or sliding to the lateral part when lying down. The main purpose of this procedure is to reduce the size of the breast, to lift it and to reshape it.

How do you assess if someone is a true candidate for this surgery?

Breast reduction surgery is meant for people who have large breasts and are complaining of neck pain, back pain, shoulder pain. Or for those who have shoulder grooves from bra straps and develop chronic irritation or rash under their breasts. It is great for patients who have low self-esteem due to large breasts and those who have difficulty maintaining their posture or have trouble fitting their breasts into a bra. Breast reduction in this case, helps the patient restore their self-confidence and relieve their symptoms.

In the past women used to think the bigger the breasts the more appealing they are. Nowadays these same women want to remove the big implants and feel more natural and at ease. Do you have a lot of patients demanding this?

That's right. The trend ten years ago was to put large implants to increase the size of the breast. But now the trend is to have natural breasts, more elegant breasts. And that is why we're reducing the size of the implant. We're using smaller implants, we're putting implants below the muscles and we're using fat grafting to camouflage the edge of the breast. Recently we are removing a lot of implants and changing them for smaller ones.

For someone wanting a breast reduction do you need to lift and put an implant or are there other techniques?

Breast reduction can be done without the use of an implant. Patients who already have large breasts have enough to be able to manipulate them, to reshape them in a way that we can give a well-defined line. We have several techniques available to be able to reshape the breast and to give it a nice look without the use of an implant. I would prefer to use the implant for patients who don't have enough tissue to be able to reshape it.

Nowadays, many surgeons are talking about an internal bra? What is it exactly?

An internal bra implies using specific techniques, special sutures or a mesh to secure the lower pole of the breast. The main purpose of this technique is to support the breast tissue in place so it doesn't fall down with time. Also to increase the distance between the breath, the chest and the belly button, and to make sure that the breast stays in place and doesn't fall to the side when lying down. Also, with the use of an internal bra the patient can decide not to wear an external bra because with this technique, the breast will already be supported.

Women seem to be after a more refined, not too in your face kind of silhouette these days. What trends are you seeing?  

Yeah, that's true. In general, they want a more natural result. They want smaller implants and that's why in 95% of my cases I put the implant below the muscle to have a more natural result with a drop shape. I also use fat grafting to camouflage the edge of the for a more natural look. As I said, I always try to do the breast lift or the breast reduction without using an implant because it gives a more natural result. But in certain cases I have to use an implant.

I've spoken to a lot of women who did a breast reduction and it really changed their lives, as you said, the back pain, the whole composition of their bodies, everything improved. But after a while they said the breasts came down again. How do you prepare patients for this? 

During the consultation I recommend choosing the right size of breast for the final outcome. If we don’t reduce the size of the breast enough, gravity will pull the breast downward with time. Other factors also impact the outcome like the quality of the skin e.g. if the patient already has stretch marks on her skin or the quality of the breast tissue, a patient may have fatty breast tissue or glandular tissue. If she has stretch marks on the skin and she has fatty tissue, the patient will be prone to have more sagginess with time. This needs to be explained to her. In order to prevent this, I learned a technique in Brazil that uses the lower pole of the breast. In general, surgeons remove this lower pole of the breast, I dissect it. It's technically difficult to explain, but I dissect the lower pole of of the breast and then we fix it on to the muscle. By doing this the result is similar to an implant and at the same time gives a better-defined cleavage line and a fuller upper pole for a better long-term result. I think 90% of surgeons don't use this technique.

Some women who had a fat transfer done through their breasts, said it didn't really last. Is this something that all patients should be aware of or does it depend on the patient?

If we do the fat grafting while the implant is above the muscle, definitely the fat will not last. That's why we should do the fat grafting part with the implant below the muscle. And we should not dissect a lot of the tissue. There are certain technicalities in how we inject the fat, how we harvest the fat, and how we treat it. We should inject a little bit of fat not to overdo it, for the fat to have enough blood supply to survive. There are a lot of technicalities.

Going back to breast reduction, what are the main risks associated with it?

Any procedure in general has the risk of complications. Breast reduction is generally considered a very safe procedure. It involves the skin, fat and glandular tissue, which is above the muscle. However, even with breast reduction, we have several complications that can arise after the surgery, which include infection, bleeding, loss of nipple sensation, loss of the ability to breastfeed after the procedure, and in extreme cases, loss of tissue or ariola tissue, or even skin.

Would recommend women to do this if they're planning on having kids or after they have kids?  Is there an age that you recommend? 

Ideally, I would recommend for the patient to do the procedure after she's done with pregnancies. This way the results are more likely to be long-term. But in certain cases, for example, in a 20-year-old female who has very large breasts that are affecting her normal daily activities, causing back pain, neck pain, shoulder pain, and she's not married and she's not willing to have children soon, I would recommend doing the procedure and then we can redo it or do a lift or reduction at a later stage after ten or 15 years.

When you do a breast reduction, does it reduce the risk of cancer? 

Studies have shown that breast cancer doesn't increase with breast reduction and manipulation, but in fact, breast cancer decreases with breast reduction. Why? Because during the procedure, we remove breast tissue, and this breast tissue may be prone to developing breast cancer in the future. And that's why it indirectly reduces the risk of developing breast cancer.

Is there any preferred way of doing the breast reduction surgery? 

I always prefer to use the internal bra technique, to use the lower pole of the breast and to fix it on the muscle to be able to give a long-term result and to choose the breast size for each patient. For example, if a patient has big breasts but she wants to reduce them by only 30%, but she has very bad skin quality and fatty breast tissue, I can't reduce the breast size by only 30%, it would have to be by 60/70% in order give a long term result.

Women have been removing, their breast implants because they think that it can lead to some hazardous health issues. What are your views on this? 

We have a lot of patients that are removing their implants, which is called, breast explantation. This is a procedure during which we remove the breast implant because they complain of a syndrome that's called breast implant illness. Implant illness is an autoimmune syndrome that includes several symptoms, including joint pain, muscle pain, fatigue, dry eye, dry mouth, usually attributed to a foreign body that is inside our body. In this case, it's mainly the implant. Around 10% of the population suffer from this problem. When they remove the implant, they feel more relaxed and the symptoms disappear.

When you do a breast lift it is usually done through a T scar around the nipple. Is there also a way of doing a breast lift by only scarring the nipple. Is this a new thing? 

We can do breast reduction surgery with only a small incision around the nipple or the areola by only doing an incision around the nipple and with the vertical scar downwards on the breast or with three incisions, an incision around the nipple, another one downwards on the breast and the third incision, which is a horizontal incision within the fold of the breast. For the very big breasts we should do the inverted T scar, which includes the three scars. Now, if you want to reduce the breast size by only 10/20% without lifting it a lot, then we can use only the ariolar scar. But in order to achieve a well defined line and the upper port fullness you have to the full procedure. I understand that a lot of patients are afraid of the scar after we discuss it a lot during the procedure and how we should take care of this scar after the surgery by applying creams, silicone gel, and silicon patches, avoiding sun exposure and using a lot of laser skin resurfacing to improve the quality of the scar.