All of the I have seen on this site show that the women have huge, long scars afterward. I want a breast lift but I don't want huge scars! Is there any way to get the lift with some other incision that won't run all the way from my areola to my breast fold? Are there alternatives like some sort of mini breast lift?
Can I Get a Breast Lift Without Huge Scars?
Doctor Answers 61
We hate scars as much as you do!
If we could avoid breast lift scars, we would. When we can reduce their length, we do. But they are there for a reason.
The brief answer to your question is that yes, breast lifts can be done with a scar only around the areola. But depending upon your breast shape and size, that may not give an ideal shape.
The history of breast lift surgery (and breast reduction, too) is really a journey into finding a better pattern of scars for removing the excessive skin, so that there is an optimal shape, a longlasting result, shorter scars, and thinner scars.
As you would imagine, some breasts require more scar to get an ideal shape. And some women put a different value on the trade-offs of scar length and location for breast shape. And surgeons have their own opinions about which looks the best and gives the best result.
The most common procedure is something that involves an "inverted T" or an "anchor" scar,one that goes around the areola, goes straight down, and then underneath. It's a lot of scar. Advocates - and I am one - feel that it gives the best shape, tightens the breast most completely and thoroughly, and because tension is distributed evenly along the length of the scars, that though long, the quality of the scar is likely to be good. Critics think that the benefits of the shape do not justify the length of the scar, and that this technique is prone to something called "bottoming out", which is when the lower part of the breast stretches.
Gaining in popularity is something called the vertical lift, which involves a scar around the areola and then straight down the breast, eliminating the underneath scar. Proponents think that the shape is good, that the breast maintains a lot of projection over time without bottoming out, and that the underneath scar is avoided. I believe that many of these breasts look overly projecting to my taste, and that bottoming out can be minimized with the inverted T style pattern. I also feel that the underneath scar is rarely seen, and that the scars that are seen - around the areola and going straight down, seem relatively more visible with this technique since it requires some bunching up of the skin during closure. Understand that some of the best surgeons in the world argue with one another about this issue at meetings all the time!
Finally, lifts can be done with a scar just around the areola. A frenchman named Louis Benelli popularized this procedure, as did a Brazilian named Goes. But they do extensive work on the inside to shape the breast, something that few american surgeons actually do. In their hands, terrific results can be achieved, but I have seen inconsistent results with this procedure with american surgeons. Allegedly, it is the operation that has the highest incidence of malpractice suits. This is not due to anything inherently wrong with the procedure, but that the procedure is being used in breasts that are probably too droopy, heavy, and loose for this technique. I have achieved excellent results with this, but only on breast that are relatively small and light, and that don't have a lot of droopiness.
While on the subject of minimizing lift scars, many people use breast implants to fill up an empty or slightly droopy breast. Though this is just a semantic way of thinking about it, droopy breasts need to be lifted, and deflated/collapsed breasts may be fixable with an implant. Of course, a woman has to want to have implants and be larger to approach droopiness with an implant. And one of the most common problems I see in women with implants is women who really needed a lift, but instead chose to put in a big implant, making them larger than they wanted to be and stretching and thinning their tissue out more.
What you need to do is to see several well-recommended surgeons, and listen to their advice. Don't just go with the one who promises you great results with less scars; make sure that everything they say makes sense. If one person suggests that they can get a great shape with substantially less scar than everyone else, be a little suspicious. It may be true, but it may not. Try going to surgery.org to find a good plastic surgeon. Good luck.
Breast Lift Using a Vertical Incision
For several years I have been using a 'vertical scar' technique for most breast reductions, which eliminates the long, horizontal incision in the inframammary fold below the breasts. I have also adapted this technique for breast lift surgery, and have been extremely pleased with the results. As with breast reduction patients, this new technique not only eliminates the horizontal incision, but also creates more impressive breast projection and maintains it better over time. The breast lift procedure I perform not only removes breast skin but also moves some lower pole breast tissue to a higher position, increasing the projection of the nipple/areola area.
Breast lift surgery works well for patients with enough existing breast tissue to build a projecting 'breast mound'. However, in most patients it is difficult to create sustainable fullness in the upper poles of the breasts by means of a mastopexy alone. This is particularly true in patients who have experienced significant deflation following pregnancy and lactation. For patients who indicate that they wish to achieve a fair amount of fullness in the cleavage area as a result of their breast lift surgery, I recommend that they undergo augmentation mastopexy. This surgery combines a breast lift with the placement of a breast implant usually of modest size, which produces the most youthful breast profile possible.
Michael Law MD
Raleigh, North Carolina
Minimal Breast Lift Scars
If you have breasts that sag only a small degree, you do have two options to correct the problem while leaving only small scars. The first option is the Crescent Mastopexy, which removes skin from the upper area of the areola, leaving a minimal scar around the outer edge of the upper areola. The second option is the Concentric, or Doughnut, Mastopexy. This procedure will correct breasts with slightly more ptosis. Your surgeon will remove skin from both above, as well as below, the areola. Although, typically more skin is removed from above the areola to position the nipple higher on the breast. Both of these types of lifts can be combined with an implant, or performed on their own.
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Minimal Scar Breast Lift
In the past, breast lift was performed in the same manner as breast reduction, except for removing the extra breast tissue. The scar looked like an anchor, around the areola, down the breast, and across the loser breast. Newer understanding has allowed surgeons to appreciate the specific factors that lead to breast droopi loss of skin tone, laxity of Cooper' s ligaments (internal support tissue), and breast volume loss.
The keys to a successful breast lft include:
1. Understanding that the breast itself must be reshaped
2. Understanding how to create support within the breast- rather than relying on the already stretched skin to support the breast ( similar to using a stretched out pait of Spanx to hold your tummy in....)
3. Reshaping the skin envelope so that it drapes over the new breast with mininal scars. (like a beautiful dress over a NEW pair of Spanks.
This is done by
1. Suspending the majority of the breast tissue from the top of the breast, which also supports the blood supply to the reshaped areola, and uses gravity to its advantage.
2. Placing the inferior tissue, if present, beneath a muscle sling that holds it into postion and allows the layers to settle into a new cone- shaped mound
3. Tailoring the skin so that the final scar looks like a lollipop, with scars around the areola, and down the center of the breast, where they are barely noticeable.
Appropriate post-op care- careful wound care, support bra, avoidance of high impact activities in the early postoperative period, are also important to ensure your best result.
Types of incisions for lift candidates
Breast lifts and scars
It is not possible to perform a good, long-lasting breast lift (mastopexy) without leaving some form of scar. The more minimal breast lifts that involve just a circular incision around the areola often times give only a minimal result and can sometimes distort or flatten the breast shape. For a more involved breast lift, you may require an incision from the areola down to the breast crease, this is referred to as a lollipop incision (vertical mastopexy).
The scar is more involved however it gives a much better shape and overall breast contour. The breast skin is thin and usually heals quite well. For an even more advanced type of lift, you may need an "anchor-type" scar which does involve the lollipop scar plus a horizontal incision in the breast crease. The horizontal portion of that scar typically does not heal as well as the rest of the scar because the skin there is thicker in quality.
If you want a better overal breast shape, you must be willing to accept a scar.
Please consult with a board certified plastic surgeon to determine which type of breast lift is best for your particular anatomy.
Until There is Shrink-Wrap Skin and a Magic Wand vs. a Scalpel, There Will Be Scars
Without question, the single aspect most feared by most women when it comes to Breast Lift or Breast Reduction is the necessary scars.
Both Breast Lift and Breast Reduction involve creation of a pattern of skin removal in order to decrease the skin envelope, whether or not the breast itself is reduced in volume. This is quite similar to dress-making or tailoring, wherein a beautiful dress that your mother once wore needs to be taken in a bit so that you or your daughter can wear it. There is an excess of "material" or skin in this case that needs to be reduced so that the proportions are appropriate.
In a similar fashion to tailoring, we plastic surgeons attempt to hide the scars within "natural" skin folds or otherwise disguise their presence. In the case of the breast lift or reduction scars, there is almost always a scar around the areola, and a scar of variable length extending down to and along the fold beneath the breast.
A well-healed scar around the areola is almost indistinguishable, as it is hidden to our eye by the "normal" expected color difference between the darker areola pigment and the lighter breast skin around it, even on close inspection. The benefit to this scar is that it would be impossible to reduce the diameter of the areola without it.
The next most-feared scar for a lift or reduction is the vertical scar extending from the bottom of the areola circle down towards the fold beneath the breast. Ironically, although this is the most "exposed" of the scars, being located on the front of the breast, I find that it usually heals the best, provided that the skin is not closed "too tight" at the time of the operation. In these cases, the scar may widen and become more noticeable.
Often, the scars must extend into the fold below the breast ("infra-mammary" fold or crease) in order to properly shape the breast skin envelope. This scar should not be a "deal-breaker", however, as long as the following points are kept in mind: 1) the scar should not extend in the fold beyond the width of the breast itself (i.e., not too far towards the cleavage area or past outside border of the breast), except in cases of very large or very droopy breasts; 2) the fold below the breast is like a natural "seam" where the scar can be hidden; 3) the breast is likely to still be somewhat pendulous even after lift or reduction, and will probably over-hang the scar in the fold to some extent, thereby obscuring it's visibility.
Although wide, hypertrophic (thick), or atrophic (weak and thin) scars do occur on occasion, these can often be improved by topical treatment or surgical revision where necessary.
Finally, my experience has been that every patient who was asked post-operatively whether they prefer the appearance of their lifted or reduced breasts with the scars, or if they regret the scars and would prefer to have the heavy and/or droopy breasts back without the scars, choses the new breasts over the old. In fact, most patients tell me they wish they had done the operation sooner, and would have done so if not for their (unfounded) fear of the scars.
So, conquer your fear of scars. They are a necessary evil of the current state of surgical art. Until there is shrink-wrap skin and a magic wand instead of a scalpel, there will be scars. It is the job of the plastic surgeon to hide them as the best tailors do when making a beautiful new dress from an old sack.
Scars depend on the surgeon and the patient
As answered by many of my colleagues, the amount of sagging and the size of your breasts determine the number of scars necessary to properly lift your breasts. Trying to do a major lift with minimal scars is like trying to hem a dress with only one or two stitches--it won't work! Many types of breast lift exist, each trying to give a nice shape and as few scars as possible. You cannot shape a breast properly with only a few scars, regardless of whatever is done inside the breast, which is one way some surgeons try to promote their "special" techniques. The vertical scar from the areola to the crease is the most visible when newly healing, but often is the best and least visible scar, IF carefully and precisely closed with fine monofilament sutures, and IF your healing genetics (which neither you nor I can alter) heal scars nicely. Fortunately, most patients heal well. Not every surgeon (even plastic surgeons) takes the care to suture the incisions carefully and precisely. Speed and staples, for example, do NOT yield better results, only shorter operations.
Mini Lift = Mini Results
There are always tradeoffs with surgery.
It is too easy to delude yourself into a procedure or treatment that is "less invasive," less expensive, with less scar, and faster recovery that will give the same result.
Rarely (if ever) true.
Wanting it to be so isn't enough to make it so.
Make sure your surgeon understands your expectations and the planned surgery is the best one to likely meet those expectations. If not, are the tradeoffs worth it to you?
Breast Lift Without Large Scars
The type of breast lift performed primarily depends on the amount of breast sagging that needs to be addressed. The absolute minimal scar is called a 'crescent' lift and involves a small scar (half circle) over the top of the areola. This provides only a very small lift and is not used very often. Most breast lifts involve incisions that go around the areola (a full circle) and possibly a vertical scar ('lollipop' incision that extends directly down the front of the breast from the areola to the breast fold). If there is a lot of sag, an additional scar in the crease can be added as well. The extent of the scars usually correlates with the amount of lift needed. Adding an implant may help decrease the amount of scars necessary. The good news is that these breast lift scars usually heal very nicely!
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.