Suction Lipectomy for Symptomatic Gigantomastia: A Two Year Experience

Introduction: Amputation of the breast and free nipple grafting has been the standard treatment of symptomatic gigantomastia. However, this procedure leaves the nipple-areolar complex anesthetic and discolored. Patients with large breasts are frequently obese and prone to wound healing morbidities as well. In order to avoid the potential complications associated with this standard method of reduction, we have been offering suction assisted lipectomy for gigantomastia patients.

Method: A retrospective single surgeon's breast reduction procedures were reviewed from January 2000 to February 2003. Demographics, reduction method, volume of reduction, and symptomatic relief as well as patient satisfaction were noted. The procedure was similar in all patients and consisted of standard wet infusion followed by suctioning using 4 to 6 mm cannulas. The volume of aspirate from each breast was allowed to settle and the layered fat volume was converted to grams utilizing a multiplication factor of 0.89 grams/cc. The reduction aspirate volume was then recorded in grams to assure insurance coverage. Gigantomastia was defined in our group as aspirates of 1000 grams or greater from a single breast.

Results: 61 patients were operated over the 2-year period identified. 59 were female. 28 patients underwent suction lipectomy breast reduction. Their average age was 37 years. The average reduction was 1232 grams from the right breast and 1435 grams from the left breast. Of the 29 patients undergoing suction reduction, 22 (75%) had reductions of greater than or equal to 1000 grams of tissue from at least one side. The average reduction was 1415 grams from the right breast and 1664 grams from the left breast. The average age was 36 years. Overall, musculoskeletal problems were reliably resolved with technique. No major complications occurred. Aesthetically the patients were satisfied with a few exceptions – these will be presented.

Conclusion: Suction assisted lipectomy is a viable alternative to standardized techniques of breast reduction with predictable results for patients with gigantomastia. Advantages may include minimal scarring, reduced morbidity in obese patients and reduced operating times. Possible disadvantages include contour irregularities and ptosis. This technique may be utilized in a staged fashion with mastopexy secondarily for cosmesis if desired.