**4.2 Breast liposuction**

Breast liposuction is performed with the Lipomatic machine in a closed system following the Power-Assisted Liposuction and Lipofilling (PALL) principles, as described in previous articles by the senior author [41, 44–47]. However, liposuction of the breast can also be performed by using a conventional liposuction with the hand piece attached to a suction system. The authors' extensive experience with the Lipomatic device enables more precise zones of liposuction and decreased operative times through less surgeon fatigue. A multiple-hole blunt cannula (3 or 4 mm) is used to perform liposuction to the lower breast quadrants and the retroareolar area in a superficial plane to detach the skin and facilitate undermining. It is performed in a deep plane in the inferior and external poles of the breast in order to reduce the volume.

To enhance matrix dissociation, supplemental subcutaneous tunnelization is performed at the retroareolar space and at the lateral and inferior poles of the breast. Tunnelization extends inferiorly to the inframammary fold in order to accelerate translation of the breast to its new position under minimal tension and to assist with redraping of the skin. The aspirate volume depends on both the shape and size of the breast as well as the extent of breast ptosis, intended amount of breast tissue to be resected, and type of breast parenchyma.
