Breast Augmentation and Reduction (BAR)
Breast Augmentation and Reduction is a novel concept in breast enhancement and only recently has it been described in the plastic surgery literature. For over a decade, however, I have been perfecting this alternative procedure, performing over 300 cases with great success and high patient satisfaction.
Breast augmentation today is one of the most frequently performed plastic surgery procedures, while breast reduction is commonly offered to women with overly large breasts that cause patient discomfort. In essence, the BAR procedure combines the best of these two procedures, removing saggy breast tissue at the bottom of the breast and adding volume to the upper breast with the implant. The nipple-areola complex is moved to the ideal place on the face of the new breast. Compared to a breast reduction, the BAR procedure offers great benefits in terms of breast shape and location on the chest. It truly is the best of both worlds.
A breast lift with implants does not require removal of breast tissue, but instead, reshapes the tissue and moves the nipple-areola complex to an improved location. This “lifting” procedure results in an improved shape but, again, the shape may not be particularly “youthful” and will not hold up over time; the breast will sag again within four months. A breast lift without an implant does not add superior breast fullness and if anyone tells you otherwise, I suggest you consult another surgeon.
Who Is The Best Candidate For A Breast Augmentation and Reduction?
These are my “top 10” reasons to consider a Breast Augmentation and Reduction:
- Had attractive and full breasts that have sagged over time
- Are considering a breast reduction and desire better, long-lasting results
- Do not want any sagging of the breast
- Have a long upper chest (distance from the clavicles to the top of the breasts)
- Have larger breasts that sit low. Your breasts are asymmetrical in size and shape
- Want your breasts to stand on their own (think strapless dress)
- Like the sound of “higher, tighter and perkier” breasts
- Want to put their bra on their breasts and not put their breasts into their bra
- Want more up top and less on the bottom
- Want larger breasts that are low to be larger breasts that are high
How Is The BAR Procedure Performed?
The “classic” procedure consists of the following steps:
- A reduction of some breast tissue. The amount and location depends on the individual case.
- Placement of a breast implant beneath the muscle. Size of implant is determined before the procedure.
- Shaping of the remaining breast tissue and relocation of the nipple-areola complex to the best position with a short scar technique.
In other words, a BAR procedure removes loose, saggy tissue while using the implant to impart firmness, enhanced breast shape and superior fullness. The breasts appear positioned much higher on the chest, and height is good. This will make the upper chest shorter and the abdomen longer — both shape-enhancing attributes. In experienced hands, the risk profile of the procedure should be the same as that of a breast reduction or augmentation. This is a revolutionary procedure that has proven to be safe and reliable in my hands.
The actual patient picture to the right helps illustrate the principles of the BAR procedure. This patient is wearing a bra with average size breast implants in the cup. Her actual breasts are sitting below the bra (her breasts are quite saggy). I know this looks really weird but it helps to visualize the plus/minus aspect of the procedure. The plus is the addition of upper volume from the breast implant and the minus is the actual removal of tissue at the lower part of the breast. The new breasts will sit in the upper level on this patient. I hope you can appreciate that this is a very powerful lifting and reshaping procedure that simply can’t be duplicated by any other breast enhancement available today.
If you’d like to see actual patient results, then study the before and after photos carefully. You will fully appreciate the power of the BAR and its ability to transform the most unflattering breasts. But don’t get too excited yet; this procedure is not for everyone. Careful patient selection for a BAR is another important factor that can only be evaluated by an experienced plastic surgeon. There are several alternatives to the BAR that have proven reliable for many years and can be considered as well.
Ultimately, the following five choices are available to all breast enhancement patients:
- Breast augmentation. This involves the simple insertion of a breast implant without tissue or skin changes.
- Breast reduction. This is the removal of breast tissue and skin to make the breast smaller and relocating the nipple-areola complex to the ideal location.
- Mastopexy or breast lift. This means the reshaping of the breast without an implant and no tissue removal. The skin of the breast is tightened for shape improvement and the nipple-areola complex is moved to the ideal location. View a video explaining the incisions made during a breast lift procedure.
- Mastopexy / augmentation. This is a reshaping of the breast by tightening of the skin and the use of a breast implant and repositioning of the nipple-areola complex to the ideal location.
- BAR. This is both a breast reduction and implant insertion with the movement of the nipple-areola complex to the ideal location.
Each of the five procedures produces a distinct outcome. It is important for you to know where you want to go, because each procedure will bring you to a different place. It’s also important that you consult with a Board Certified Plastic Surgeon who is well versed in ALL of the five alternatives. In doing so, you will ensure that all of your options are available so that you may fully achieve your personal goals from a breast enhancement.
— Robert Caridi, M.D.
Certified Plastic Surgeon
Founder of Westlake Plastic Surgery