In Depth Breast Lift Information Mountain View

The breast lift information provided below can give patients a more detailed understanding of their surgical breast lift options.

Breast Augmentation and Breast Lift

Women who want breast augmentation may have too much sagging of their breasts to get an attractive and flattering breast shape with augmentation alone. They may be surprised to learn this when they come for their breast augmentation consultation and are disappointed to find that longer, more extensive incisions will be required to both lift and augment the breast for a complete breast lift.

Periareolar Scar Breast Lift

When nipple/areola elevation of up to five centimeters is needed, a peri-areolar incision can give good results when done in combination with an augmentation and the scar can be limited to only around the areola. If the skin envelope is stretched out more than this, accompanied by a large distance from the lower border of the areola to the infra-mammary fold, than a classical inverted-T lift is needed to shorten this distance and elevate the nipple.

Vertical Scar Breast Lift

This technique allows a lift with a peri-areolar scar and a vertical scar below the areola. It can but does not always avoid a scar in the inframammary fold, which can be the most problematic in breast lift or breast reduction because they may become hypertrophic, or raised and ridge-like. In the standard technique, if care is not taken, the scars can be visible at the medial or lateral edges of the inframammary fold. This is why the vertical scar technique was developed, in the attempt to minimize if not entirely eliminate any scar under the breast. This will maximize the breast enhancement results.

This breast lift technique takes advantage of the possibility of skin contraction in a vertical direction, avoiding excision of the lower breast skin and the resulting scar in the inframammary fold of the standard technique. Success with this technique requires careful surgical planning and execution and proper patient selection. Very large lifts or reductions in patients with stretched out, inelastic skin will often require a supplemental second stage skin removal with a scar in the inframammary fold. The advantage, however, is that the resultant scar may be much shorter than it would have been if the standard technique was initially carried out. The second stage is carried out at four to six months and is a minor office procedure.

Another advantage of the vertical breast lift technique is the opportunity to shape the breast thus increasing breast enhancement. Internal suturing of the medial and lateral parts of the breast to each other in the midline under the elevated nipple/areola can provide long-lasting improvement in breast shape. The standard technique is more likely to be accompanied over time by sagging or “bottoming out” of the lower part of the breast, since the standard technique depends on skin reduction to maintain breast shape and skin will stretch and does not ensure good long term support for breast shape.

After reduction of any excess breast tissue, excess skin is gathered along the vertical incision and bunched together in such a way as to decrease the distance between inframammary fold and areola. The upper breast tissue is lifted and secured to the chest wall by a suture that dissolves in three weeks. With all weight taken off the lower breast skin during the initial healing phase, the excess skin can shrink. By the time the upper breast starts to descend to fill the loose lower skin envelope, most of the excess is gone.

The breast has a peculiar “Snoopy”-like appearance until the upper breast tissue descends, and patients must not expect to have a normal breast shape for several months. During the first two months after the breast lift procedure, a support bra is worn day and night. The breast shape gradually improves and reaches its final configuration between four and six months. At that time if there is any excess or wrinkled skin at the base of the vertical scar, a limited excision in the inframammary fold is done. Long-term follow-up has demonstrated maintenance of breast shape without the bottoming out seen in the standard breast lift technique.

Standard or Inverted-T Breast Lift

The goal of this breast lift technique is to reduce the breast tissue and excess skin in both the vertical and horizontal directions. Since skin is excised in the vertical direction, a scar along the inframammary fold occurs. Although attempts to decrease the length of this scar by so-called “short-scar” techniques have been described, they are difficult to carry out consistently and do not avoid the main problem of having a scar in the inframammary fold.

This pattern of incision is a good choice when subsequent breast augmentation is desired in those women who have an excessively loose skin envelope, a lower breast that sags below the inframammary fold, and poor skin elasticity. Since the goal of augmentation is to fully fill the loose skin envelope, reducing excess skin with a breast lift is critical to obtaining a nice breast shape. If there is significant disproportion between skin envelope and implant volume, the breast will slide off the implant and less than optimal results will be obtained.

A pattern of skin that looks like a keyhole with the lower part widened is drawn on the skin prior to the breast lift procedure, and the lower breast skin is marked for excision as an ellipse drawn horizontally at the lower part of the keyhole pattern. The lower border of this ellipse is the inframammary fold. The upper part of the keyhole is marked at the desired future location of the nipple/areola and the intervening skin between the borders of this pattern and the existing areola is removed superficially, leaving the areola connected to underlying breast tissue that maintains its blood supply.

Skin is then removed and the areola repositioned. The vertical limbs of the keyhole are brought together under the areola and the breast is shaped by suturing all the margins together. The resulting scar is around the areola, vertically below the areola down to the inframammary fold and along the inframammary fold.

Problems with the standard technique when used for breast lift without augmentation and for breast reduction include late bottoming out of the breast as the lower skin stretches and a tendency for the breast to look more boxy than conical. The larger the breast and the less elastic the skin, the more likely these problems are to develop.

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Risks of Breast Lift

Every surgical procedure involves some risk, and the breast lift procedure is no exception. For more information, visit our Mountain View center serving San Jose and the South Bay to speak with Dr. Lowen.

Areola or Nipple Necrosis

Partial or total loss of the tissue of the areola and the nipple can occur. Impairment of blood flow can result in tissue death. Risks are higher in smokers. Reconstructive techniques and scar revision would be needed to improve the appearance at a later stage.

This risk is greatest if a breast implant is placed at the time of breast lift in conjunction with the standard technique, and least when a small, peri-areolar lift without an implant is done. A large implant done in conjunction with a significant lift has the greatest risk.

Asymmetry of Size, Shape or Nipple Level

Asymmetry can be the result of pre-existing irregularity that is not entirely corrected during the breast lift procedure. While careful measurement and surgical planning is done, perfect symmetry is rarely achieved. Small asymmetries should be acceptable, but major asymmetries would require a revisional procedure.

Interference with Breast-feeding

The ability to breast feed after breast lift and breast enhancement surgery is unpredictable and should not be expected. Some women may be able to breast feed if sufficient continuity is present between the nipple ducts and retained breast tissue. A peri-areolar lift is the procedure least likely to interfere with subsequent breast feeding if it only involves moving the areola up a short distance. If a peri-areolar lift is done in conjunction with internal rearrangement of breast tissue the risk of interference with breast-feeding would be greater.

Seroma or Fluid Accumulation

After a breast lift, drains may be placed to remove tissue fluid that can accumulate under the breast. These drains will not always prevent accumulations of fluid known as seromas. If seromas occur, they are drained with a needle through the skin until they resolve, usually within a week or two.

Bleeding or Hematoma

Bleeding or hematomas are general surgical risks that could necessitate reoperation in the immediate post-operative period. Patients are advised to not take any medication that can interfere with normal blood clotting for two weeks before and after surgery. The main medication to avoid is aspirin. Anti-inflammatory medications such as Advil® and Motrin® should also be avoided, as well as supplemental Vitamin E and herbal medications.

Excess or Unfavorable Scarring

The main trade-off for breast lift is the acceptance of scars on the breast. Although an attempt can be made to minimize them, there will always be at least a peri-areolar scar, and usually a vertical scar in addition. Healing in any given individual is not predictable, and raised, red and unattractive scarring can occur.

Should excess scarring occur, recommendations for treatment include application of silicone gel ointment or silicon sheeting over the scar for several months, or vascular laser treatment, and occasionally steroid injections into the scars. The use of post-operative bio-corneum scar gel is a refinement that Dr. Lowen routinely recommends to his breast lift patients to lower the incidence of unfavorable scarring. The vertical scar is not as likely to undergo excess scar formation as the inframammary scar. The peri-areolar scar may become raised, or widened or show a color contrast with surrounding skin if it becomes very white. Sometimes scar revision is done to try to improve unfavorable scars.

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