I had a consultation today for a breast lift with implant. I really do not want that long verticle scar that accompanies most breast lifts. The surgeon measured me and said I was a 29? He said that I would need the lift with the anchor incision, or I could just have the implant without lift, but the implant would go on top of the muscle. I'm really dissapointed because I do not want that large vertical scar. What are my other options for a lift? I have another consultation scheduled with a different surgeon, but I want to know if they are just going to tell me the same thing.
Avoiding Vertical Breast Lift Scar?
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Breasts left without a vertical scar.
Thank you for your question.
As you may see there are multiple options for breast lift surgery. A crescent lift or a periareolar lift does not leave a vertical scar but if your surgeon did not recommend them he or she likely feels that you need a great deal of skin tightening.
There are vertical scar only lifts, which do not remove as much skin either, but this is the scar that is putting you off.
There it is a type of lift that leaves a scar only around the areola and underneath the fold of the breast. This lift pulls the skin of the upper breast downward like pulling down a window shade. Once the window shade is pulled down a whole is made in the center of it and the nipple is pulled through.
The reason that this lift is not as popular as the anchor pattern is because it only tightens skin up and down, and not side to side. The anchor pattern gives a more conical shape to the breast, whereas the lampshade approach can end up with what some would call a boxy shaped breast.
Even though this option exists, based upon your photographs I believe that you would likely do best with the anchor pattern. I suspect other plastic surgeons will tell you the same.
No vertical scar breast lift
Fortunately women like yourself not desiring a vertical scar with a breast lift, have an option. This technique was developed after many years of performing the same unsatisfying and non-aesthetic lifts. It eliminates the need for a vertical scar regardless of the degree of ptosis (sagginess or excess skin). It also provides for a "Barbie" like fullness that is achieved by 'coning' a woman's own breast tissue, therefore, eliminating the need for implants.
Examples are provided below. Hope this helps, Dr. H
Avoid Breast Lift Vertical Scar-Find an Expert
Thank you for your question.
Many surgeons today perform the Circumareolar, Donut or Benelli Breast Lift which places the only scar around the Nipple Areola and avoids the vertical scar.
However a good result requires and expert surgeon and not all breasts can be lifted using the no vertical scar technique.
Ask your surgeon about the risk of pleats aroung the Areola using this technique-this is the main limitation.
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All Breast Lifts Results are NOT the Same - Choose Carefully
Regarding: "Avoiding Vertical Breast Lift Scar? I had a consultation today for a breast lift with implant. I really do not want that long verticle scar that accompanies most breast lifts. The surgeon measured me and said I was a 29? He said that I would need the lift with the anchor incision, or I could just have the implant without lift, but the implant would go on top of the muscle. I'm really dissapointed because I do not want that large vertical scar. What are my other options for a lift? I have another consultation scheduled with a different surgeon, but I want to know if they are just going to tell me the same thing."
Many years ago in a study of College women, researchers found that the IDEAL distance from the sternal notch to each nipple was between 19-21 cm. Yours is 29 cm a considerable indicator of serious sagging. This means you have loosening of the Suspensory Ligaments of the Breasts allowing sagging with EITHER:
- too much Breast Skin
- too little Breast internal volume
- BOTH a combination of a deflated breast (too little volume) with excessive skin.
Since the ligaments cannot be renewed and shortened a Breast Lift (Mastopexy) depends on reaching the youthful ideal ration of Breast Skin to Breast Volume by either removing excess skin (Breast Lift), by increasing volume (breast augmentation with either implant or fat grafting) or by doing BOTH.
The AMOUNT of skin AND the LOCATION of the skin that has to be removed will determine the pattern of the scar and TYPE of Breast Lift. You can try it on yourself. Pinch various areas of the breast until you "produce" the shape and location of the breast you like. In your case, you will readily see that the skin that needs to be removed is mostly UNDER the nipple complex and further down the breast. THAT IS WHY if you want a sexy looking perky breast you WILL need a vertical scar in this location. You do NOT require an anchor lift. A Hall-Findlay Breast Lift would give you a better longer lasting result.
All efforts to avoid a vertical scar in this location will require placing an implant which is TOO large which in turn will result in breast thinning and rapid sagging making a certain subsequent revision much harder and less likely to result in an appealing breast.
Dr. Peter Aldea
Scar is Part of Breast Lift
There are many different techniques and incisions for performing breast lift, but they don't all produce the same results and every patient may not be a well suited candidate for many of the techniques.
To add to the challenge, experts may disagree about what might be the best technique for a specific patient.
As you consult with different surgeons and research different techniques, look at before and after (at least 6 months post-op) pictures of women who start out with appearance (drooping and deflation) similar to yours.
Your Picture Suggests That Your Breast Lift Could Be Performed Without A Vertical Incision
Patients frequently express anxiety about the vertical skin incision used when breast lift surgery is performed. Unlike incisions placed around the areola and in the breast fold, this incision is not easily hidden. Plastic surgeons prefer avoiding this incision whenever possible, but realize that in some cases it represents a necessity.
The correction of breast sag requires the removal of excess skin. The more severe the breast sag, the greater the amount of excess skin and consequently the greater the need for more extensive incisions. Every patient is unique and because of this treatment needs to be individualized. Each patient has specific anatomic findings and personal aesthetic goals.
Occasionally, the patient’s anatomic findings, don’t allow the patients aesthetic goals to be accomplished without significant compromises. These compromises might involve the shape of the breast and the quality of the scars. Smaller incisions may require more gathering of the skin and more tension on the closure which can often result in unattractive scars. Failure to remove excess skin can often result in distortion of the breast shape as well. For these reasons, great care needs to be taken when choosing the best treatment for any particular patient.
Although it’s impossible to be certain without performing a physical examination, your pictures suggest that an anchor incision would give you the best possible result when performing breast lift and breast augmentation in combination. It’s also fair to say that your breast lift could be performed without a vertical incision. This might require compromises, specifically involving the shape and contour of your breasts. By avoiding the vertical incision, you may ultimately be settling for breasts that are less shapely. Make sure you consult a board certified plastic surgeon who has appropriate qualifications and experience with breast lift surgery. Most importantly, understand your own priorities and any compromises that you are considering.
Avoiding scars with breast lifts
Your photos show a relatively severe grade of ptosis or breast sag. In order for you to be happy with the shape of your breast long term, you really need to have some type of breast reshaping breast lift. Every surgeon is going to have a particular technique that works best for them and there really is no right or wrong way to provide a breast lift procedure. But every technique has slightly different scarring. I have found that if a scar heals poorly, it tends to be the horizontal scar along the IMF that is often used in the "anchor" style approach. Very rarely is the vertical scar much of an issue for patients once it has had time to heal. I think that you will find that the most important part of a breast lift is the final shape of the breast. I would advise you to find a board certified plastic surgeon that can show you results of well shaped breasts and be less concerned about the scar. I would use a vertical breast lift procedure for you that would involve a vertical scar and one around the areolae that would fade very well with time.
May consider staging the implant and lift procedures
Your questions hits at the core of breast surgery. The balance between breast shape and the resulting scar. The implant alone will give you a better volume and improved appearance in a bra/clothing. However, the implant alone will not significantly improve the droopines of you breast. Here is the trade off. If you cannot tolerate the scar, and can accept the droopiness, then get the implant alone, you can get a lift later if you desire. To get a nice result with one surgery, you may have to accept the scar.
Breast Lift Recommended, but limited scars
I often see breast lift patients with a similar concern.
My answer regarding what scars are required in a breast lift (or Mastopexy) is simply based on the amount of tissue that sits below the level of the infra-mammary fold (IMF). Keep in mind that an ideal, or youthful appearing breast is cone shaped with the nipple/areolar complex (NAC) sitting in a "perky" position above the inframammary fold.
In my experience that if this amount of sag (or ptosis) is significant then a lift by the areola (NAC) alone will not suffice. This is inherently a mechanically weak approach. It does not create the necessary coning of the breast, and if the technique's limitations are pushed, over time the breast tissue sag will recur, and often with a elliptical stretching of the once circumferential Areola. Additionally if too much is required from a peri-areolar approach a good amount of natural breast projection is diminished. This can lead to a flattened breast shape.
In the cases where patients have come to me for a redo that have avoided a lift and had implants placed in the subglandular position, I find that they are often not satisfied for two reasons. For one they often seem to have had significant size implants placed and feel larger, but not more youthful. And more importantly, they still have the sag, if not increased over time by the added breast weight from the augmentation.
For these patients the consideration for a lift now is more challenging due to the added descent, and may require possibly the additional scars that one wanted to avoid initially.
This is a complex topic, best served by careful attention to the details and finding a plastic surgeon with significant experience in this area.
I hope this helped, and serves as a starting point of what the initial considerations may be.
Breast Lift Scars
Generally speaking, for a significant mastopexy or breast lift, you really need to have more than just a circumareolar mastopexy incision. Depending on the type of circumareolar mastopexy, that’s a simple donut mastopexy or anything that involves an incision around the nipple, you limit the amount of skin that can be removed.
And really, the degree of lift that you are going to get is in direct proportion to the amount of skin you remove. Likewise, the amount of skin you remove is in direct proportion to the length of scar.
So it is a continuum of circumareolar, to keyhole to an anchor incision.
I hope this helps.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.