Breast Reshaping

This page is not about a particular operation. It is about the question several different breast operations have in common, and how I approach it.

Once it has been decided how much volume should remain in the breast, what determines the operation is how that volume is distributed and how it is supported. Volume and shape are separate variables. A change in volume of course affects appearance, but it does not necessarily determine the final three-dimensional form.

Established principle
Breast shape follows from the distribution of breast tissue and the support given to it, not from volume alone. This is accepted thinking in the breast surgery literature and is not unique to this practice.

The same question, four different situations

The value of the distinction becomes clear when it is set against operations that differ from one another. In each the answer is different.

Breast lift. Volume is broadly preserved, and the operation consists entirely of redistributing the tissue and supporting it. Breast lift page →

Breast reduction. Volume is removed. How much tissue is taken determines the size; what is done with the tissue that remains determines the shape. Breast reduction page →

Implant explantation. Volume that was never the tissue's own is removed, and the native tissue displaced over years is reassessed and, where appropriate, redistributed. Explantation page →

Implant exchange. Here the answer may be that no reshaping is required at all. Where the breast tissue and skin envelope are in good condition, exchanging the implant is the whole operation. This is the case that keeps the principle from becoming dogma. Implant exchange page →

The approach I use

My approach
What follows is the systematic approach I work by, rather than a general principle.

The sequence is the same in every operation where reshaping is required, and varies only with the tissue available. The tissue is mobilised inward and sutured to itself to form supporting pillars. The lateral pillar is anchored to the pectoralis fascia, so that the structure is supported from the chest wall rather than suspended from the skin. The tissue is imbricated to narrow the breast and add projection. The skin is closed last, over a structure that already holds its shape.

The practical consequence of that order is that the skin is neither the mechanism creating the shape nor the structure carrying the tension. It is also why, in implant surgery, the capsule is treated as available tissue rather than as something to be disposed of.

Techniques and publications

Published work
The specific manoeuvres and their applications have been published open access.

The application in breast reduction was described in a series of 338 operations, the application in explantation and breast reshaping was described separately, and the manoeuvre used to narrow the breast and add projection was described in a third paper, together with its applications in reduction, mastopexy, augmentation mastopexy and oncoplastic reconstruction. Full references appear on the procedure pages and on the research page. Research and publications →

What this page is not

The principle is not a single technique applied to every breast, and it does not hold that every breast operation requires reshaping. It states which question should be asked before the operation is chosen. The answer follows from examination, from the tissue that is present, and from what the patient wants.