I'd like a breast lift. A recent convo with a plastic surgeon greatly discouraged me; he said an anchor scar was my only option. I've seen women with greater degrees of ptosis with lollipop lifts. I was also interested in the internal sling lift. My biggest concern is feeling like "myself but better," w/ minimal scars; I want natural looking results individual to my case. I don't want implants or tiny nipples. Sagging is mostly on the top of the breast down, not under by the fold. Please advise.
Breast Lift Options? Don't Want an Anchor Scar or Implants. (photo)
Doctor Answers 22
Breast Lift Options
Thanks for your question -
A lollipop lift - or a vertical mastopexy - can be very powerful in terms of correcting breast ptosis. A Wise pattern lift (anchor scar) has the ability to typically provide better correction but you may be able to get the look your seeking with a vertical alone.
What can be a valuable step is to bring photos of what you'd like your post-op results to look like. Review them with your surgeon to best determine the appropriate surgery.
Also keep in mind that the transverse part of the scar is usually well hidden within the breast fold.
I hope this helps!
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There's a couple ways you could approach your breast lift
As noted, we all have our biases for incisions for these types of surgery. We uses multiple types (t-scar, true vertical, J-shaped vertical, periareolar only, and horizontal only) of incision based on your breast shape, volume, and skin quality
I think the best answer for your cases is that you "might" be able to shorten on minimize a horizontal component, but it could be hard. You have a very dilated areola diameter that is going to produce a lot of vertical tension with a straight up-down closure (ie. a lollipop incision). That may be manageable, but you may have to do some kind of extended "J" shape horizontally to deal with the skin pucker and you're going to have to be very careful with the nipple inset as it would be easy to place it too high with a vertical reduction/mastopexy pattern.
While you can be done with an extended vertical pattern (j-shape), I think your areolar size might make it a little less predictable then a T-scar. While I don't do many of them anymore, you're actually also a real good candidate for a horizontal (no vertical scar) mastopexy if you want the shape to look most like an implant kind of result.
Vertical (Lejour) breast lift with lollipop scar gives the best long term results.
Get another consultation. Almost nobody needs anchor scars for a breast lift, and you certainly don't need implants. The extra scars are not even the worst thing about the anchor lift. It lifts the breast by pulling on the skin, and since skin stretches, you don't get a lasting result.
The lollipop lift reshapes the breast internally with no skin tension. And your nipples don't have to be small.
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Amount of Breast Lift Scars Equates With Degree Of Sagging
With your current breast shape and amount of sagging, either a completely vertical breast lift scar pattern or one with the addition of some horizontal scar along the inframammary fold is necessary. The one concept that you will have to abandon is getting a significant breast lift with 'minimal scars'. That simply is not possible. Minimal lift breast procedures are for those breasts that have a minimal sagging problem...not the situation that you have. Such breast lift scars can fade and blend in quite well but there will be not getting around the amount of scar length needed.
Breast lift options? (photo)
Although it is difficult or impossible to determine from a single frontal view, you appear to have tuberous features. If so, a good peri-areolar lift with implants to fill the skin envelope and parenchymal (breast gland) remodeling will improve the shape of your breasts (less "sagging") and leave a scar concealed in the border of your areolae without a vertical lower breast component or a scar in the crease beneath your breast. You admit there is not excess skin under the fold, only on top. If so, skin removal should be on top to lift the breast, not on the bottom, leaving the area below the areolae unscarred. See case 11 in the augmentation-lift portion of feelbeautiful.com gallery for an example.
Breast lift without an anchor scar
Most often in our practice for both lift and reduction we like to avoid the anchor scar, and find that the vertical lift will give satisfactory lift and stability. You will not need an implant unless you want the extra volume. Best of luck
You can't cheat mother nature
Unfortunately there is no way to give you a proper breast lift without the full scar pattern, just your anatomy doesn't allow for that. If this would make you unhappy, then the best thing to do is to do nothing. What I can tell you is that if you get a great shape (central pedicle free hand shaped is best IMO) you will eventually not mind the scars. It is a trade off of shape for scar. Check the photos on my web site and ask if you would be happy looking like these folks. If not, please do nothing.
Options to improve the shape of the breast
You would be a good candidate for a vertical mastopexy with a breast implant for volume. There are several different types of breast lifts including a peri-areolar crescent lift, a doughnut or Benelli lift, a Vertical Mastopexy and a Key hole or anchor type mastopexy. All have specific parameters. Based on your appearance and the degree of breast tissue below the inframammary crease you would get the best result with a vertical mastopexy with a breast augmentation. If you were only interested in a breast lift then a vertical mastopexy with a dermal pedicle autoaugmentation may be a reasonable alternative.
Breast Lift Options
Even the guy who 'wrote the book' on vertical type mastopexy, Dennis Hammond, MD and his famous SPAIR technique, would end up giving you a J or L shaped vertical scar, essentially half an anchor. The problem is the degree of vertical excess of skin that you have requires an excision that either forms an inframammary scar in the case of an anchor incision, or is taken up in a giant circle of skin around the areola in the case of a vertical incision. I have seen too many people walk into my office with devastating deformaties from surgeons who've tried to do a vertical mastopexy on the wrong candidate.
I agree with Dr. Rand. 99.9% of my patients find the appearance of their breasts much more pleasing with the incisions after surgery, compared to how their breasts looked before surgery. If you cannot come to terms with scaring, you are much better off doing nothing at all. You should be skeptical of the 'internal sling' lift. If it sounds too good to be true....
Best of luck!
Options for breast lift.
From your photo, but without the benefit of a direct examination, I believe your best result would come from an anchor incision to best reposition the nipple/areolar to the proper place on the breast mound and to shape the breast into a conical shape. There is no substitute for an excellent final result and a well closed incision should be be well hidden over time. Good luck.
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.