Sjogren's and Breast Lift vs. Lift w/ Augmentation. Is Sjogren's a contraindication for augmentation?

Question

48 yo mom of 3 and lost 80lbs with umbilical hernia. I will have a TT as part of the hernia repair and now considering full MM, but very fearful of scar from from BL &/or BA surgery. The thought of having my nipple removed scares me to death. Are there alternatives to having the nipple involved? If I have to get implants, is it true that the more painful behind the muscle placement gives the better/ more natural result? I have Sjogren's Syndrome, is it a contraindication for augmentation?

Vincent N. Zubowicz, MD · Answer

Breast implants do not influence any systemic immunologic activity. There's no reason not to proceed with this is part of a mommy makeover.

Edwin C. Pound, III, MD · Answer

I have had patients over the years with Sjogren's Syndrome and they have not had any problems with their cosmetic surgery.  Also, to address the other issues that you brought up - breast lift procedures to not require the removal of the nipple.  It stays attached.  Also, placing an implant behind the muscle is not necessarily more painful.  I have had many patients who have not needed so much as a Tylenol following their surgery with submuscular implants.  Still, your doctor should give you plenty of pain medications just in case.  Finally, any time the full thickness of the skin is cut, there will be scars.  Everyone heals differently, however.  Some people scar more than others.  There are various creams and ointments that may also help improve the appearance of scars.

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your significant weight loss.  I think that, after you discuss your concerns with your rheumatologist, that you will find that Sjogren's disease is not a contraindication for breast augmentation surgery. It will be however important that both your anesthesiologist and plastic surgeon be aware of the condition,  and the specific organ involvement (for example, ocular), and any medications you take. Generally speaking, I prefer the sub muscular (dual plane) position for the vast majority patients undergoing breast  augmentation/lifting surgery. Given that you are considering this operation, I think you may benefit from some general information regarding this combination surgery: 
Breast augmentation/lifting surgery is more complicated than either one of the procedures done separately. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate  size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.  Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
 Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts.  Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness).  It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation.  The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery,  Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia,  lateral displacement etc).
 Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity  of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately.
For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or  whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).

Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks  are greater with a 1 stage  procedure and the patient does have a higher  likelihood of needing revisionary surgery.
Having discussed some of the downsides  and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.  Also, given her young age, I would suggest that you TIME  the procedures carefully in relation to your life circumstances ( such as relationships, pregnancies…).
 Obviously, much to consider… The attached link may also be helpful.
 Best wishes.

Jeffrey Zwiren, MD · Answer

Your overall health and anatomy will dictate the correct procedures for you to meet your expectations.  Contact your immunologist and get medical clearance for an elective procedure is prudent.  The nipples are not removed with a breast lift just re-positioned.  You have many questions which require specific answers and need a consultation and examination to start your journey.

Australia Fragoso-Baez, MD · Answer

Your condition wont avoid your surgery if you have it under control, please before doing the procedure consult your doctor (dermatologist) to check that your condition is fine and you must let your PS know that you have  Sjogren's  Syndrome. Good luck!

Sjogren's and Breast Lift vs. Lift w/ Augmentation. Is Sjogren's a contraindication for augmentation?

Answers (5)

Answer: Medical clearance for elective surgery

Answer: Medical clearance for elective surgery

Answer: Consult with your doctor

Answer: Consult with your doctor

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Sjogren's and Breast Lift vs. Lift w/ Augmentation. Is Sjogren's a contraindication for augmentation?

Answers (5)

Answer: Medical clearance for elective surgery

Answer: Medical clearance for elective surgery

Answer: Consult with your doctor

Answer: Consult with your doctor

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Recommended reading

Everything you need to know about Mommy Makeover

Our mission is to create a world where every investment in modern beauty is Worth It.