high rate of recurrence. contraindications breast reduction by liposuction only cannot be performed upon a woman whose mammogram indicates that the oversized breast is principally composed of hypertrophied milk glands. furthermore, liposuction mammoplasty also is contraindicated for any woman whose mammograms indicate the presence of unevaluated neoplasms; likewise, the presence of a great degree of breast ptosis, and an inelastic skin envelope. pre-operative matters consultation: the plastic surgeon evaluates the elasticity of the skin envelope of each breast, and determines the degree of breast ptosis present. the woman is informed of the alternative, surgical reduction techniques available for diminishing her oversized breasts; of the consequent surgical scars; of the possible loss of breast sensation; of the possible impairment of lactation capability; and of the possible impairment of breast-feeding functions. the woman is further informed of the possible medical complications, and is shown surgical photographic records of the average outcomes of breast-reduction surgery. the surgeon answers the woman's questions to assist her in establishing realistic expectations (self-image) about the breast-reduction outcome possible with a lipectomy procedure; and that, should lipectomy not satisfactorily reduce the volume of her breasts, a secondary, surgical breast-reduction procedure can be performed later. the measures of the bust: a liposuction mammoplasty procedure does not feature a surgical-incision plan delineated upon the woman's breasts, chest, and torso. yet the measures of the bust are established in order to determine the required degree(s) of correction; thus, with the patient sitting erect, for each breast, the surgeon records the jugular-notch-to-nipple distances, the nipple-to-inframammary-fold distances, and any asymmetries. afterwards, the anaesthetized patient is laid supine upon the operating table, with her arms laterally extended (abducted) in order to fully expose the breasts. anaesthestic preparation: to limit bleeding during the liposuction, the proper degree of vasoconstriction of the breast's circulatory system is established with an anaesthetic solution (lidocaine + epinephrine in saline solution) that is infiltrated to the deep and the superficial plains of each breast. using a blunt-tip, multi-perforation cannula, the anaesthetic infiltration begins at the deep plane of the breast, and continues as the cannula is withdrawn towards the superficial plane of the breast. the entire area of the breast is infiltrated with the anaesthetic solution until the tissues become tumescent (firm). moreover, as required by the patient's physique, an intravenous (iv) pressure bag can be applied to hasten the infiltration; after the anaesthetic has numbed the breast, the plastic surgeon begins the lipectomy breast-reduction. operative technique the surgeon effects a stab incision just above the lateral aspect of the inframammary fold (imf), piercing the skin 2-cm above the inframammary fold, in the midline. the pre-tunnelling is performed with the blunt-tip, multi-perforation cannula used to infiltrate the anaesthetic solution to the breast tissues. a blunt-tip, 4-mm cannula, connected either to a medical-grade vacuum pump or to a syringe, is used to aspirate the adipose fat. the cannula is maneuvered laterally (in fanning movements), beginning in the deep plane of the breast and concluding in the superficial plane of the breast; the adipose fat sucked from the breast is a yellow, fatty, bloodless fluid; the liposuction concludes upon drawing the required volume of fat, or when the fat becomes bloody. after the liposuction, the superficial layer of adipose fat is undermined with a blunt-tip, 3-mm cannula (which is not connected to a vacuum pump). the breast ptosis is corrected by stimulating the controlled retraction of the incision scar, by undermining the superficial fat of the medial and the lateral upper areas of the breast; the maneuver tightens (retracts) the skin envelope of the breast. procedurally, the liposuction-only breast reduction procedure concludes with the application of an elastic, foam-tape dressing that molds the reduced breast into its new shape, and lifts it higher upon the chest. technical note: for the reduction of very enlarged breasts, the plastic surgeon makes a supplementary incision just above the medial aspect of the inframammary fold. procedurally, the placement of this incision later allows converting the lipectomy breast-reduction procedure into an inferior-pedicle breast reduction surgery, if liposuction proved inadequate to satisfactorily reducing the volume of the very enlarged breasts. convalescence the patient is discharged from hospital either the same day or the day after the breast reduction operation. because the liposuction-only procedure featured only a few, small, surgical incisions, the woman quickly recovers her health, usually resuming daily life activities at 14 to 28 days post-operative – when the breast-molding dressings are changed; she also resumes her personal hygiene regimen to include washing under a water shower. in the initial convalescence period, the surgical-incision wounds are inspected at 1-week post-operative, during which time the woman has continuously worn a strapless brassière to contain and immobilize her corrected breasts; afterwards, she continuously wears a strapped brassière for 30 days after the breast-reduction operation. complications early complications include infection and hematoma (blood outside the vascular system); late complications include an unsatisfactory breast-volume reduction that might require either surgical or liposuction revision. as with other liposuction procedures, the final result of a liposuction-only breast reduction becomes evident at 6-months post-operative; although the edema usually subsides at 2–3 weeks post-operative. to date, no incidence of tissue necrosis has been reported; likewise, there have been few reports of lessened nipple sensation. generally, the long-term rate of patient-satisfaction is high, provided that the indications for the liposuction-only technique are abided with proper patient selection.