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Breast Lift

  • 2-2.5 Hour Surgery
  • Back to Work: 3-5 Days

In Denver, Colorado, breast lift surgery is chosen by women from Colorado Springs, Fort Collins, and the Denver area to elevate and reshape sagging breasts and to give a perkier, more youthful appearance. Sometimes, breast implants are placed during the same surgery to create more fullness than would result from a lift alone.

The need for a breast lift is usually the result of an inflation and deflation of breast volume due to pregnancy or significant weight loss. Sometimes, merely gravity and time can cause the need for a mastopexy. And in some cases, women develop with lower, relaxed breasts and can benefit from a lifting procedure.

A breast lift entails removal of the extra skin that is allowing the breasts to drop to a less attractive position. The breast tissue (parenchyma) with the arealae and nipples attached, are moved upward, and the lower pole tissues are tightened to hold the breasts up. Underlying breast parenchyma is sewn together in the lower pole to reinforce the lift prior to closure of the skin. Occasionally, women are candidates for the areolar lift that does not require the vertical scar down the front of the breasts. Ultimately, the best shape must be achieved using the minimal scarring to do so. Most women feel the scar is a small price to pay for a perkier breast position.

Breast Lift Options

Wise pattern (anchor) mastopexy

Wise pattern (anchor) mastopexyThe amount of skin removal and resulting scar is precisely determined based upon the needs of each breast. The wise pattern skin excision that results in an “anchor” scar is necessary in many breast lift cases due to the large amount of extra skin that needs removal in order to create the best breast shape. There is no magic here. The wise pattern is 2 intersecting ellipses with an area above for areoalar elevation and in-setting. These two elliptical excisions reduce the vertical and horizontal dimensions of the breast skin to achieve a tight, round lower pole–the hallmark of an attractive, perky breast. The breast tissue (parenchyma) is tightened beneath the skin to support the breast and keep tension off of the skin. The final scars are surprisingly inconspicuous. The scar around the areola is hidden between the darker and lighter skin tones. The horizontal scar is hidden in the breast crease and the vertical scar fades and flattens most nicely to become barely perceptible over time.

Vertical (lollipop) mastopexy

Vertical (lollipop) mastopexyThe vertical mastopexy is the same operation as the Wise pattern except the horizontal ellipse of skin and resulting scar in the breast crease is omitted. This is feasible for smaller breast sizes, especially when breast implants are added to restore some volume. Again, there is no magic to these procedures. The breasts are supported from within by suturing the breast tissue together in the lower pole beneath the skin. The skin is “tailor tacked” with surgical clips while the patient is in the upright position during surgery. This method delineates the precise amount of skin removal necessary to achieve the best breast shape. This step determines if the horizontal elliptical excision can be avoided resulting in the “lollipop” scar. At the Center for Cosmetic Surgery, Dr. Vath, Dr. Wolfe, and Dr. Steinwald often perform a modified vertical mastopexy where most of the excision is performed with the vertical ellipse and only a small, additional horizontal elliptical excision is added, rather than the full length “anchor.” This small, additional horizontal scar is usually of no concern to patients because of its inconspicuous nature in the breast crease; however, it can be a critical element in completing the perfect, uncompromised breast shape.

Circumareolar or Bennelli (doughnut) mastopexy

Bennelli (doughnut) mastopexyThe 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. Primarily, a circumareolar mastopexy is for patients that have low areolar positioning on the breast, but not true sagging below the crease. Generally, good candidates for this procedure have tight lower pole breast skin with a short distance between their areolae and breast creases. This procedure is often used to even out asymmetrical areolar position or to achieve areolar reduction. This operation absolutely does NOT replace a vertical or wise pattern mastopexy, and when used in the wrong situations, leaves patients with a deformed, unattractive breast shape. Misuse of this operation is one of the most common mistakes made in cosmetic breast surgery and a frequent reason for breast revision surgery. This common problem is somewhat attributable to patient demand for avoidance of the vertical scar.

Even though the circumareolar procedure avoids vertical scars, the disadvantages can be significant:

  • No appreciable lifting of a sagging breast
  • Slightly flattens the forward projection of the breast
  • Scar puckering and irregularity

The following pictures are examples of patients at the Center for Cosmetic Surgery who were good candidates for the circumareolar or “doughnut” breast procedure.

Patients before and after a breast lift

Breast Lift Scarring

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 a breast lift, followed closely by limiting scarring to achieve the goals.

All too often, however, Dr. Vath, Dr. Wolfe, and Dr. Steinwald meet patients with sagging breasts who hope to avoid the vertical lift scar and still achieve a beautiful shape. Even though this is understandable, it usually is not possible. Once a breast truly sags below the breast crease, removal of lower pole skin is unavoidable. But all hope should not be lost. When the proper techniques are used to tighten the lower pole breast tissue to keep tension off of the skin, scars usually stay thin and fade wonderfully over time.

mastopexy before and afterThis is a 40-year-old, 5’9″ woman who previously underwent a breast augmentation at another center with 390cc saline breast implants in Denver. She did not undergo a breast lifting procedure at that time. She presented complaining of an unattractive breast shape. Dr. Vath performed an implant exchange placing 350 cc silicone gel implants and then a breast lift. Postoperative pictures were taken 2 months, 1 year, and 3 years after surgery. Notice the appreciable fading of the scars by 3 years from surgery. A beautiful breast shape with a faded scar is much more attractive than the alternative without the scar.

How to Choose a Surgeon

For optimal safety and results, it’s important to choose your surgeon carefully. Important considerations include:

  • Review many impressive before-and-after photos.
  • Find a surgeon who specializes in cosmetic plastic surgery.
  • Seek a surgeon who upholds the proper credentials.
  • Make sure the surgeon uses only an accredited, state-of-the-art surgical facility.
  • Decide, if upon meeting the surgeon, you make a connection.

Fact & Fiction About Your Breast Lift

A breast lift does not require the placement of breast implants. 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.

Breast implants can be safely placed at the same time as a breast lift. At the Center for Cosmetic Surgery, our plastic surgeons routinely perform breast augmentation and lift 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. Because a breast lift 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.

Breast implants do NOT lift breasts or assist in lifting breasts. Commonly, it is assumed that implants alone, without a lift, will raise 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 an attractive shape to sagging breasts: only a breast lift 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 lift procedure to boost upper fullness and overall size.

A beautiful breast has a round LOWER pole. 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 breast lift can restore the lower roundedness of youthful breasts. You can see this in before-and-after pictures of women 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 only minimally tightens the lower pole and is not a short scar alternative to a breast lift for most people. The circumareolar lift (donut 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.

Patients often feel their breasts are slightly smaller after a breast 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.

Identifying Good Breast Lift Results

The lower pole is tightened just enough without over tightening. 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.

Areolae are reduced, if desired, to a more attractive, proportionate size. 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.

Any inframammary scar, if needed, is well hidden in the breast crease. 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.

Scars are thin and fade with time. 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.

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 eliminate or reduce the need for a lift and the resulting scars. One of the most common reasons for breast revision surgery that Dr. Vath, Dr. Wolfe, and Dr. Steinwald see 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.

Lift vs. Implant or Both? How Can You Tell?

How can you determine at home if you need a breast lift? Often, the answers to two questions can help. First, have you had children and/or significant weight loss? Second, what cup size are you now? If the first answer is yes and the second is larger than a small B cup, usually a lift is necessary, but this is not a reliable way to know for sure.

If your breasts hang below your creases, you need a lift. But often women aren’t sure. Deflation with collapsed or empty upper breasts does not require a lift and can be managed with implant placement alone. The most reliable means to determine if you need a lift is to look at your breasts in the mirror with your body angled at 45 degrees so you get an oblique view of yourself. Then look at the breast that is farther away and see if it hangs over the crease. Alternatively, you can take a picture of your breasts on a 45 degree angle (oblique view) and evaluate the picture for the same overhang. You can also take this picture, sit in front of the computer and peruse the web to identify the procedure of choice for women with a similar breast position.

If the lower poles of your breasts are no longer round, but rather oval, pointy, or boxy shaped, then a lift is essential. A lift serves the purpose of improving lower pole contour- the hallmark of attractive, youthful breasts. An implant does not improve shape but serves two other purposes: to fill out the upper breasts and to increase overall size. If your breasts sag, the lift is critical while the implant is optional depending upon your goals. If there is no sagging but merely deflation, an implant alone will do the trick.

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