This 50yo female was dissatisfied with the appearance and sagging of her breasts after breastfeeding 2 children and gradual weight gain. She reported a significant difference in the cup size and shape of her breasts. Her exam demonstrated inward displacement of the nipple areolas. She was also noted to have focal lipodystrophy with an unusual distribution of excess fat over the rib cage beneath her breasts. To address these issues, bilateral mastopexy and VASER ultrasound-assisted lipectomy (VASERlipo) was performed. A Wise pattern, inferior pedicle mastopexy technique was used. More tissue was removed from the left breast (350 grams) to improve symmetry. Liposuction of the upper abdomen and lateral chest helped to debulk and contour the areas of extra fat. Postoperatively, the patient was happy with the much improved breast symmetry and corrected nipple position.
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