THE 5TH ALTERNATIVE: THE BAR PROCEDURE OR BREAST AUGMENTATION AND REDUCTION
Breast Augmentation and Reduction is a procedure that I have been working on for the past seven years. It has not yet been fully defined in the plastic surgery literature, but it certainly has been performed in some form by plastic surgeons since breast implants were first used in the early sixties.
The BAR procedure developed from patients’ demands for higher, tighter, and perkier breasts and my own disappointment with the limitations inherent with breast reduction and mastopexy procedures – the most common procedures used to address those demands.
A breast reduction makes the breast smaller by removing tissue and reshaping the breast with an improved location of the nipple-areola complex.
A mastopexy, or breast lift, does not remove tissue from the breast, 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 is not particularly “youthful” and it’s unlikely that the shape will hold up over time (the breast will sag again within a year). In both cases, there is little to no improvement in superior breast fullness or the level at which the breasts are situated.
Saggy breasts occur naturally in all women over time. Sagging is accelerated by pregnancy and weight fluctuations. Even an augmentation of a saggy breast only creates a larger, saggy breast. So how does a surgeon manage this saggy, medium-sized breast that sits low on a woman’s chest, with an overall goal for a “higher, tighter, and perkier” breast?
This is where the BAR procedure comes in; remove the tissue that hangs, then build the new breast around a stable and firm foundation—the breast implant. The BAR procedure evolved with that goal of creating “higher, tighter and perkier” breasts, and because my patients want to see results better than what can be achieved through a breast reduction or a mastopexy. There are some other details of the BAR procedure, that when combined with this augmentation and reduction, enhance the long-term shape improvements and certainly result in a much higher breast on the chest wall.
The “classic” procedure consists of the following:
- a small to medium breast reduction,
- the use of medium-sized saline or silicone breast implants placed beneath the muscle,
- the preservation of the pectoral muscle attachment at the bottom of the breast for support,
- and the use of a “short scar technique” to limit the length of the scars.
In other words, a BAR procedure removes loose, saggy tissue while using the implant to impart firmness, enhanced breast shape, and superior breast fullness. The breasts appear positioned much higher on the chest (high is good). This makes the upper chest shorter and the abdomen longer—both shape enhancing attributes.
The complication and revision rates for the BAR procedure are higher than with a breast augmentation, a reduction or a mastopexy procedure performed alone. However, in my series of patients, the complications and revisions have been infrequent and minor. The procedure has proven to be safe and reliable in my hands. To my knowledge, I have the most experience with the BAR procedure as described in this article.
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; this procedure is not for everyone. Careful patient selection for a BAR is another important factor that can only be received from an experienced plastic surgeon. There are several alternatives to the BAR that have proven reliable for many years and should be considered as well.
Ultimately, the following five choices are available to all breast enhancement patients:
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 on the table and available to you so that you may fully achieve your personal goals from a breast enhancement.
Robert Caridi, M.D.
