Breast Lift

There are two important reasons to spend time reviewing before-and-after pictures when considering plastic surgery. The first is to determine what procedure, if any, actually serves to improve your undesired appearance. The second is to distinguish which surgeon performs the best work.

There are many procedures discussed on the web and touted by the cosmetic surgery community and media as aesthetic dream-makers. Often, however, they are not. Be skeptical and use before-and-after pictures to determine which procedures will actually address your concerns. If an operation works well, there will be thousands of pictures demonstrating its success. If it's hard to find good before-and-after pictures of a procedure used for the problem you're trying to address, then it probably doesn't exist. Remember to be honest with yourself about your appearance when evaluating web pictures. The mirror lies. We recommend that you take pictures of yourself and set them in front of your computer while you do your research. Make sure that the "befores" look like you and then determine what procedures work. Just because the media or some web site states that fat injection to the buttocks will lift the butt, that doesn't make it so.

Second, once you've identified the best operation for you, it's easy to determine which surgeons achieve the most natural and attractive results. All people are hard-wired to appreciate natural attractiveness. Fortunately, it's easy for you to identify who can meet your highest expectations simply by reviewing before-and-after photo galleries.

Many plastic surgeons perform cosmetics surgery procedures such as breast lifts. But few specialize in the cosmetic, rather than reconstructive side of plastic surgery and dedicate their entire practice to aesthetic procedures. Because Dr. Vath and Dr. Wolfe practice cosmetic plastic surgery exclusively, they perform hundreds of breast lifts per year and can assure each patient that she will get the most beautiful aesthetic transformation possible.

Seek a surgeon who upholds the proper credentials including certification by the American Board of Plastic Surgery (ABPS), membership in the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS). Learn more about selecting a surgeon here.

Your breast lift procedure will be performed in our AAAHC certified Apex Surgical Facility in Golden, Colorado. Apex is owned and operated by Dr. Wolfe and Dr. Vath, and is used exclusively for aesthetic surgery patients. Anesthesia is used to ensure that you feel no discomfort and that your breathing is maintained and controlled for the duration of your procedure. We use only board certified anesthesiologists, including Dr. Joseph Carpenter, the medical director of Apex Surgical Facility. Learn more about the Apex Surgical Facility here.

Perhaps the most important criterion for choosing a plastic surgeon is your intuitive sense of comfort with the physician as a person. Cosmetic surgery is an emotional and personal experience. After all of your research into credentials and before/after pictures, ultimately, you must feel good about trusting the plastic surgeon to care for you and your aesthetic results.

A breast lift serves the purpose of improving the shape of sagging breasts. Implants do not lift breasts nor do they help "hold up" breasts undergoing a lifting procedure. Implants will create larger breasts and fill deflated upper poles. Many women choose implants with their lift in order to gain these features, but it is certainly not required.

At the Center for Cosmetic Surgery, Dr. Steven Vath and Dr. Andrew Wolfe routinely perform breast augmentation and mastopexy at the same time. This can be accomplished safely, yielding the finest cosmetic result, and allowing for one recovery.

The areolae and nipples are NOT removed and sewn back on during a breast lift. Because a mastopexy leaves behind a scar around the areolae, people often assume that the areolae and nipples are removed and sewn back on. This is not the case. Skin above the areolae is removed and the areolae are elevated with the breasts to their new, centralized positions. Usually, sensation is preserved and the areolae can also be reduced to a more proportionate, attractive size during the operation.

Commonly, it is assumed that implants alone, without the mastpoexy procedure, will lift breasts and achieve a more youthful appearing shape. Many women hope for this implant-alone option to avoid the scars incurred with a lift. But implants do not restore attractive shape to sagging breasts: only a mastopexy can do that. Implants alone will successfully fill out deflated breasts that do not drop below the breast creases. Deflated A cup breasts after pregnancy often fit this scenario for an implant-only solution. Otherwise, when breasts truly sag, implants can be added to a mastopexy procedure to boost upper fullness and overall size.

The hallmark of a beautiful, youthful, perky breast is a round LOWER contour, not necessarily upper fullness. From A cups to DD cups, if the bottom portion of the breast is round, rather than pointy, boxy, or oval in shape, it appears attractive. Once breasts have dropped after pregnancy or weight loss, a mastopexy can restore the lower roundedness of youthful breasts. This is evidenced by before-and-after pictures of patients having undergone a lift alone where the breasts are transformed in contour without the use of breast implants. When desired, implants can also be placed to increase upper fullness but do not assist in improving breast shape or the lift.

The circumareolar breast lift (scar around the areolae) only minimally tightens the lower pole and is not a short scar alternative to a breast lift for most people. The circumareolar lift is primarily an areolar lift rather than a true breast lift. Although it does slightly tighten the skin envelope of the breast, this procedure does not elevate breasts that sag below the breast creases.
Learn More About Circumareolar Lift

Depending upon the discrepancy between skin volume and breast volume, women sense a variable degree in size reduction after a mastopexy. Only skin and a small amount of subcutaneous fat are excised during a lift; however, breasts feel and look somewhat smaller to women after the procedure. This is because they are more tightly packaged in a perkier shape that looks smaller because they're not as long and feels smaller because the weight no longer hangs. The more deflation and sagging that exist, the greater the sense of size reduction after lifting is accomplished. Some women choose to have breast implants placed at the same time as their lift to avoid this size reduction.

The amount of skin to be excised is precisely determined by a "tailor tacking" technique where the patient is sat up in surgery and the skin is tightened to the desired degree using surgical clips. If a patient is having breast implants placed during the same procedure, the implants are placed first followed by tailor tacking. Depending upon the anatomy of the breasts, this step may require either a wise pattern (double elliptical) excision, a vertical (single vertical elliptical) excision, or a circumareolar excision. The type of mastopexy technique is determined by the specifics of the breasts and volume of excess skin. Managing the skin removal in this fashion ensures that there is no guessing. The best breast shape is created via the tacking technique before any skin is actually cut. This not only guarantees the best breast contour, but also the least amount of scarring to achieve it.

Once the skin is excisied, the breasts with areolae and nipples attached, are rotated upward to a perky position. Because a mastopexy leaves behind a scar around the areolae, people often assume that the areolae and nipples are removed and sewn back on. This is not the case. Skin above the areolae is removed and the areolae are elevated with the breasts to their new, centralized positions. The skin is then rewrapped around the breast and areolae in its new position. A breast lift allows for a simultaneous reduction in the areolar to a more proportionate, attractive size and nipple sensation is usually preserved.

After the skin is removed and the breasts with areolae and nipples are shifted upward, the breast tissue (parenchymal pillars) are sewn together beneath the skin. This critical step creates internal support for the breasts ensuring a long-lasting perky shape. Tightening the internal breast tissue also keeps the tension away from the skin closure so there are less problems with wound healing and scars stay thin and flat.

Finally, the skin is closed with dissolvable sutures placed within the deep layers of the skin. There are no external sutures so that there is no need for suture removal. The length and positioning of the skin closure and resulting scars are dependent upon the amount of skin removal necessary to achieve the most beautiful breast shape.

The essential characteristic of an attractive breast shape is a round lower pole. Whether a breast is an A cup or a DD, this feature is consistently present in good-looking breasts. All people are hard-wired to appreciate this, although society and marketing attempt to convince us that upper fullness is the most important ingredient to a youthful, attractive breast contour. As a breast drops and requires lifting, modification of the lower breast pole is needed to transform a less attractive, pointy, boxy, or oval shape to a rounder shape. This is commonly referred to as "perky". If upper fullness was the key, implants alone would create a better looking breast. But this is not true. Implants placed in a sagging breast create upper fullness while leaving the non-round lower pole hanging and unattractive. When the lift is accomplished, it must be performed in such a way as too create a round lower pole that no longer hangs on the tummy. However, over-tightening must be avoided. This causes a flattening of the lower pole and distortion of the breast contour. Over-tightening is not the answer to achieving more upper fullness when undergoing a breast lift: an implant is. By utilizing the "tailor tacking" technique to remove precisely the right amount of skin, the ideal lower breast pole contour can be ensured.

During a breast lift, although the areolae are not removed from the breast, the skin around the areolae is excised allowing a resizing of the areolae. Areolae stretch out during weight gain and pregnancy so a reduction in their size during a mastopexy is usually a welcome improvement.

If inframammary scars are needed to achieve the best breast shape, they need to be placed precisely in the breast creases so they remain hidden. This is ensured by "tailor tacking" while the patient is sitting up to minimize the scar length and place the resulting scars in the creases.

A beautiful breast shape with a faded scar is still attractive and even sexy. But an unattractive breast shape without scars is still unattractive. Achieving a beautiful breast contour is the primary objective of breast surgery followed closely by limiting scarring to achieve the goals.
Learn More About Scars

If implants are placed, the breasts are lifted properly to avoid sagging off of the implants. Commonly, implants are placed behind sagging breasts with the hope that they will obviate or lessen the need for a lift and the resulting scars. One of the most common reasons for breast revision surgery that Dr. Vath and Dr. Wolfe see at the Center for Cosmetic Surgery in Denver and Golden, Colorado, is breast augmentation with inadequate lifting. It is critically important that the proper lifting procedure is performed with or without an implant. There are a few breast lift options to ensure a great shaped result, but an implant is not one of them.