Is a breast lift always included in a breast reduction? [Kyle Baltrusch, MD, Portland]

Dr. Baltrusch (00:00):
My name is Kyle Baltrusch. I'm a plastic surgeon in Portland, Oregon.

Eva Sheie (00:04):
Is it normal that you also get a lift at the same time as a reduction? Is that just part of the deal?

Dr. Baltrusch (00:09):
Yes. Inherently a breast reduction is also inherently a lift, and that's not true vice versa. So a mastopexy breast lift is not always a reduction, but a reduction is always a breast lift. So the volume that you're keeping, or whatever size the patient wants to be in bra cup size, you're lifting that to make a tighter skin envelope or breast mound where you're bringing out that nipple areolar complex at the most projected part of that breast mound. So yes, you are also doing a breast lift at the time of the reduction.

Eva Sheie (00:37):
So you're eliminating volume, but where do you actually take the volume from and how do you get it out of there?

Dr. Baltrusch (00:42):
Yeah, so there's different techniques, and so that's certainly a conversation that we have with our patients. But most patients are good candidates for what's called a wise pattern. And so it's just named after Dr. Wise, but it's, our typical incision pattern for creating a smaller skin envelope. And then there are different techniques within that as well, based on the blood supply of the nipple, because it's a misconception that the nipple areolar complex comes off the breast and then gets put back on. It stays attached to the underlying glandular tissue or that blood supply. And so depending on measurements or goals, you have to keep at least one of those blood supplies. And so you keep that as a pedicle of tissue, and then you're able to resect the majority of the rest.

Eva Sheie (01:24):
Do you also make the areolar smaller?

Dr. Baltrusch (01:26):
You can. Most women who have macromastia, or large breasts, have a larger areola, and so it does depend on the patient's goal size. So if a patient wants to be, say, a C cup, then we make that about four centimeters. So yes, we would decrease the size of the areolar to make it more proportional to that cup mound.

Eva Sheie (01:45):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.