The gold standard for breast reduction both reduces and lifts the breasts. A predictable amount of tissue is removed, a lift is done, but it does come with significant scars. For women with significant excess volume or much droopiness, there is not much of an alternative.
However, for women with less droopiness and who need a more limited amount of weight removed, the scars can be a difficult trade-off to accept. While the scar often fades, it never fully goes away, and in some cases the scar remains quite visible.
For the patient with a full and high breast, liposuction only (or “scar-free”) breast reduction is a fabulous procedure. It is a way to make the breasts smaller and lighter without any scars. One or two tiny incisions are made that are hidden in the crease under the breasts, and fat is removed from the breasts. Recovery is quick and very easy.
There are two shortcomings to this technique: First, it can only remove the fat in the breast; it cannot remove the firm glandular breast tissue. Every woman has some fat in her breasts, but surgeons cannot reliably predict before surgery how much of the breast size is due to fat or to glandular tissue. Surgeons cannot always predict ahead of time which problem a woman has. So it is possible that a breast reduction with liposuction will not remove as much as would be ideal. Nevertheless, usually enough can be removed to make a significant change in symptoms, how bras fit, and overall body proportions. Of those who did not get as much of a reduction as they would have ideally wanted, most everyone still says that they prefer having the more modest reduction without scars to a more complete reduction with scars.
The second shortcoming of liposuction breast reduction is that it does not lift breasts. With less weight in them the breasts typically recoil upwards. The extent to which this will happen is not predictable, and that recoil is in no way comparable to the lift that is achieved with a breast lift procedure. Liposuction-only breast reduction is best reserved for women who do not need or who do not want a breast lift.