Actual Breast Lift or Just Skin Removal?

Hi CanIgetSomehelp,

     I read with interest some of the answers given to the question you posed.  There in fact may not be a study out there that compares the two methods of breast lifting as to their longevity.  That may not be possible to do.  There is so much variability between patients and surgeons that large numbers would be required to have any statistical  significance.  The only other way to compare the two is to perform a skin lift on one side and an internal lift on the other.  There actually was a study like that comparing face lift procedures but their conclusions were questionable.  Therefore, I think we have to use other modes of reasoning to answer your question.  

     Firstly, It is well recognized that when plastic surgeons close an open wound, it is preferable to close the fascial layer under the skin for strength and support.  This is done in traumatic wounds but also in cosmetic procedures such as tummy tucks, thigh lifts, arm lifts, etc.  Without that fascial support there is a high chance of wound separation, poor scarring, and stretching.  This is irrefutable.  The breast, too, has a fascial framework.  The same principles should hold here as well.  Placing sutures in this fascial framework of the breast should lend additional support.  Secondly, one needs to realize, that when placing sutures within the breast tissue, the skin is sutured as well.  That is, an internal lift is a skin lift in addition to the internal support.  To make the argument that a skin lift is as good as an internal lift is to argue that internal sutures add nothing to the support.  That flies against logic and goes against all other principles of repair.  Finally, I have my own experiences to compare.  I was trained doing skin lifts only.  Early in my private practice the vertical mammaplasty became popular.  That is a breast lift technique that uses internal shaping and suturing.  I have been using that technique along with my own modification since the mid 90's.  In my opinion, the vertical mammaplasty is superior to the skin only lift in many ways.  It produces a better shape.  It produces exceptional scars.  It can avoid the horizontal incision.  And in my opinion it definitely stays higher for a longer period of time.

     That being said, I don't believe you need to fear that your lift is doomed to fail if you had a skin only lift.  Just because you had an anchor incision that does not imply that you had a skin only lift.  Also, some patients do quite well with regardless of which technique is used.

Good luck,

Ary Krau MD FACS

     While internal adjustment of tissue may have an impact, this has not been demonstrated.  Internal adjustment also has the potential to devascularize tissue, causing fat necrosis and nipple areolar necrosis.  The amount of skin and the way in which the skin is removed has a huge impact on the longevity of the result as well as general laxity of patient tissues.  In addition, deepithelialized tissues may be used to suspend the breast as well.  This issue can be extraordinarily complicated, and it is probably best to find the plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year.  If you had a surgeon like that perform your procedure, you are probably going to have as good a result as can be obtained.  Kenneth Hughes, MD Los Angeles, CA

In my opinion breast lifts should address two different parts of the breast - the breast gland itself, and the skin which covers it. That's why there can be many different variations on the procedure. The scars that show on the outside do not necessarily have to define what is done on the inside. If the breast itself can be reshaped on it's own, it will not have to rely on the skin to tighten it. Therefore there is less concern that the skin will loosen and release the breast lift.

It's the same thing. A breast lift removes skin and brings the breast back into a more youthful position.  If a patient also wants to be smaller, than some tissue can be removed at the same time.  

If you think of your breast as a skin brassier - the only way to make it tighter is to create incisions (anchor or vertical scar) and lift the breast up.

I do a lot of breast lifts in my practice and it is not a gimmick. My patients are happy to have thier breasts in a more natural position.

Best of luck,

Jennifer L. Harrington MD

Your plastic surgeon will be your best resource when it comes to answering your questions accurately;  online consultants can only speculate  as to exactly what was done. 

 Generally speaking, although breast lifting involves skin excision, they are not “bound to fail”.  It is true however that breast lifting is an operation that is potentially short-lived if there has been significant skin elasticity changes ( seen with significant weight fluctuation and/or changes after pregnancy).

 I hope this helps.

A breast lift can be performed with minimal skin excision for slightly sagging breasts or with more skin removal and even some suturing of the breast tissue when there is more sagging (ptosis). The type of incision depends on how much skin is removed but does not really give a clue as to what is done beneath the surface. Even with a full anchor type scar, there may be work done internally or not. No good studies have been done to assess if one method is better than the other. In my practice, I often do more work inside when the breast is larger since gravity will have more pull on that breast over time. A "skin only" operation would be done on someone who has smaller volume breasts. Your surgeon is the one who knows for sure and he would be able to answer your question. Either way, if you have already had the surgery and the reults are good then you should be happy and not worry about exactly techniques  your surgeon used as long as he is well qualified, board certified and has gained your trust.

Most surgeons use an anchor incision when they plan to remove signficant amounts of skin.  For breast lifting, simple skin excision can be undertaken, or breast tissue can either be sutured or moved with skin removal.  No concensus exists over longetivity of these different procedures.  There is unfortunately not one operation that is the best for everyone. 

Additionally, there is a plethora of opinions related to longetivity of soft tissue lifting, so talk to your surgeon, ask what type of procedure was performed and get his/her reasoning for having chosen your specific operation.

I would add that some breasts are skin removal only and that's all those patients need. 

You cannot tell from the incision alone if anything was done to reshape or reposition the breast itself. The breast can be reshaped through a periareolar incision, and can be left untouched through an anchor incision.

Your surgeon can describe the nature of the operation that was done. A surgeon looking at photos cannot.

All the best. 

The key component to most breast lifts is removal of the excess skin. I would disagree that "just skin removal is bound to fail". While some newer techniques advocate anchoring the breast parenchyma with sutures, there is really no good literature that shows that this really makes any difference in the final result. I would judge your results by your before and after pictures, not by the opinions of techniques in the blogs.

Depending on what is needed will determine waht type of lift is done. You can get this information from your surgeon or his operative note.