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

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.

     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