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What is the Most Effective (And Preferably, Least Visible) Method of Breast Lift?

Due to considerable weight loss, I have been left with asymmetric breasts, one of which (the larger of the two) requires a mastopexy. I have consulted with several plastic surgeons and have received widely varying perspectives, ranging from the vertical lift (lollypop incision) to the crescent incision, on what approach is best. Being that the point of the operation (which will be accompanied by a breast augmentation) is to attain symmetry, what approach is the most effective?

Doctor Answers (15)

What is the most effective form of Breast Lift?

+2

In my experience, I have not seen a crescent lift that did anything other than create a scar and stretch the areola to a larger more oval shape.  Maybe it is possible to get a very mild nipple elevation out of it, but I am doubtful...there is no way to control the areolar size and shape so there is nothing to resist stretching of the areola.  The best lift is the lift that you need depending upon how much sagging you have...the lower the nipple and the more the overhang past the inframammary fold, the more extensive the lift you need and the more scars will result.  I have achieved excellent results from the periareolar lift, but only in patients who need a mild lift.  Overextending this lift, using it in patients who need more than it can effectively achieve, just leads to an underdone lift, worse periareolar scars, and a flattening shape to the leading surface of the breast (ie: at the areola).  Adding the vertical scar (a lollipop or vertical or cicumvertical lift) adds greatly to the effectiveness and strength of the lift and the ability to obtain a more pleasing shape to the breast, at least in those patients with enough sagging that need this.  And dealing with the skin excess in the inframammary fold, whether by a "J" extension or an "inverted T" excision or letting the skin settle and considering whether to do a later revision if needed, depending on the degree of sagging and the preference of the surgeon, is indicated in those patients whose sagging is more extreme.

And, as mentioned, there are potential risks in performing augmentation at the same time as a breast lift, whether they lead to a minor revision at a second surgery or a devastating complication (like nipple loss and bad scarring).  These risks increase the more extensive the nipple elevation required and the thinner the tissue (and of course in smokers!).  You may see examples of some of these significant problems in various patients' posts on these boards. You need to discuss these issues with any surgeon during your consultation, and of course you want to see photos of the surgeon's work, though you will probably not be shown any bad results!.  But if the "good results" you are shown are less impressive to you, that is important information to know as well.


Seattle Plastic Surgeon
5.0 out of 5 stars 70 reviews

Breast Lifting After Weight Loss?

+1

Thank you for the question. Congratulations on your successful weight loss.

Most patients who have  achieved significant weight loss  benefit from some form of mastopexy (breast lifting) as well as breast augmentation surgery. The type of  breast lifting surgery necessary and “most effective” will depend on the individual's physical examination and goals.

Therefore, it is very important to communicate your size goals with your surgeon.  in my practice I find the use of goal pictures to be very helpful.  I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.

Although patient's concerns regarding scars are very understandable I would suggest that their first concern should be obtaining the best results possible (scarring concerns should be secondary).  Most patients undergoing this procedure will accept scarring as long as their overall goals in regards to size, shape, contour and symmetry are met.  In other words, if  surgeon selection is based on  the offer of a “limited scar” procedure you may be disappointed with the results.  For example, the  “crescent  breast lift”  may leave  the patient with an unsatisfactory “lift” and potentially an elongated areola.

Therefore, it is very important to communicate your size goals with your surgeon.  in my practice I find the use of goal pictures to be very helpful.  I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.


By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.
 

 .

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 703 reviews

2 Surgeries = Higher Predictability

+1

 * Unfortunately you may need to accept possible poor scarring if your skin scars easily.

A W pattern full Mastopexy with reduction of your larger sized breast followed by a Breast Augmentation of your smaller breast at a later date may give you the most predictable results.

Ivan Thomas, MD (retired)
Los Angeles Plastic Surgeon
4.5 out of 5 stars 13 reviews

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Effective breast lifting

+1

As suggested by other posts, it is difficult to be specific without pictures, but it may be helpful to validate that there are many differing opinions and no one "perfect" answer.  Combining the lift with implants also makes this a more difficult operation.  The fact that you have had weight loss is also pertinent, as I tell my patients that have lost  weight ( usually a moderate to large amount), that this probably will require some of the more powerful lifting techniques and revision later on may be necessary.  Be sure and spend plenty of time with a board-certified plastic surgeron after you get your several opinions. Best of luck

Jerry Lugger, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 2 reviews

Best Breast Lift Method in a Massive Weight Loss with Breast Sagging and Assymmetry

+1

Your frustration is evident in your question but a few points must be made clear.

- very few women have truly symmetrical breasts. If you look carefully you will see that Asymmetry IS the rule of nature. If your breasts are asymmetrical to start with, it is very likely that they will be less asymmetrical after surgery but achieving perfect symmetry is not common and may be a source of disappointment.

- Massive weight gain with breast expansion followed by loss and breast deflation permanently damages the breast skin. Even when good breast lift / augmentation results are obtained in such patients the breasts frequently re-sag. As a result, the use of mini-"lifts" like crescents and Periareolar lifts is a mistake in such cases.

- A photograph of YOUR breasts would have been very useful. Without an examination or a  photograph all we can do is guess at WHICH breast lift method would offer you the best lift for the shortest scar. However, based on the "classic" massive weight loss breast, your best alternative would probably be an "inverted T" Lift or, in the least, a lollipop shaped scar with a gel (less visible creases) breast implants. Frankly, I would NOT pick s surgeon who recommended a very large implant and a minimal lift.

Good Luck.

Dr. Peter a Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 59 reviews

Breast lift and breast implants

+1

There are many different ways to perform a breastlift and even more minor variations of those ways. What is effective in one patient will not be so effective in another. As you have found out if you see 10 different plastic surgeons you will get 10 different answers as to what type of breast lift should be performed.

The aesthetic goal in breast surgery (augmentation, reduction and lift) is nipples that are 20cm from the notch on top of the breast bone, 11cm from the midline and 7cm from the fold under the breast with all of the breast tissue centered under the nipple. Sometimes we go to 21 vs. 20, 8 vs. 7 etc. to end up with less skin scarring/smaller skin incisions. When you think of it this way in the realm of breast lifting the surgery involves removal of excess skin in the vertical and/or horizontal planes to achieve the lift. The type of skin excision pattern to employ (lollipop, crescent etc) is therefore predicated on which plane the skin has to be removed and if on both planes the relative amounts on each plane. If skin removal is only required on one plane and the amount is minimal a crescent pattern will do. It the nipple only needs to be lifted upward a few centimeters the lollipop will suffice. As the amount of vertically lifting required increases you need to add a horizontal skin excision at the bottom otherwise you will end up with corrigated extra skin under the breast or a scar that runs down onto the abdomen. Some surgeons take out a larger amount of skin around the nipple-areola in attempt to get rid of the horizontal excision at the bottom. Though some surgeons get good results with this I personally do not like it because tension around the areola can cause it to stretch and the horizontal scar under the breast is less visible than a bad scar around the areola or vertically between the nipple and fold under the breast.

It is even more complicated if you place breast implants for augmentation at the same time. That is because the markings on the skin for surgery are made before the implants are placed and it can be very difficult to plan surgery accounting for skin stretch after the implants are in place. These combined procedure patients therefore have a high rate of redo or revision surgery even in the best of surgical hands.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

The most effective breast lift procedure

+1

Breast lift is about nipple position, shape of the breast envelope, and breast projection. The most effective breast lift will give good control of all three, though of all, nipple position is most important. The anchor lift will allow the nipple to lifted to any degree and permit adjustment of the skin in both the horizontal and vertical direction, and allow the glandular breast to be shaped and coned for better projection without an implant. A vertical lift is very effective for most, a lessor scar with good control of nipple position, improved projection, and shape. Not the most effective, yet a very good procedure if you can tolerate the scar. Next, the around the nipple lift, fair control of nipple position, slight scar, some effect on shape, loss of projection without an implant, can relapse. The crescent lift, not worth the effort or scar. Keep up your search, and be prepared for compromises.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 27 reviews

Breast lift and augmentation

+1

I agree with Dr.Sowder . The combination of the lift and augmentation is a difficult procedure with very high complication and redo rate. Please send picture to give you better answer. The pattern of lift should be decided by your board certified plastic surgeon based on your degree of ptosis, skin quality and amount of breast tissue. 

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 54 reviews

Breast lift and correction of asymmetry

+1

There are four different types of uplifts and each depends on what you need and what type of scarring you will accept. I always try and minimize the scars which usually do heal well but can also be unattrractive-raised/red and spread. My suggestion would be to do the smallest uplift with the least amount of scars. You can always do more but once the scars are there, you cannot remove them!

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 24 reviews

Breast lift and augmentation after weight loss

+1

Breast lift at the same time as augmentation is a very, very tricky procedure and the revision rate is high.  Pick your surgeon carefully and don't make the mistake of insisting on a certain type or length of scar.  Really saggy breasts need a lot of reshaping and that reshaping requires incisions and incisions  leave scars.  Body contouring after massive weight loss has taught many of us (sometimes the hard way) that shape and contour should trump scar length.  I think it's the same for breasts.

The crecent lift or a donut lift or a periareolar lift is very, very limited and if it is asked to do too much can result in a really, really nasty scar and/or a bizarre shape of the nipple and/or the breast. 

Be sure to see some of the doctor's work prior to making your decision. 

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Lisa L. Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 40 reviews

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.