Bilateral Wise Pattern Breast Lift - Question and Personal Recommendation (Currently 'D' cup). (photos)

Question

I have been looking at this breast lift pattern as it has been recommended for me. What are the risks and complications compared to seemingly simpler versions. Is this type done often? I like the idea of this pattern as it addresses above and around the nipple. I have decided to get a lift w/ implant to gain the upper pole fullness/firmness. I want to end with a full 'D' or slightly bigger. I have heard contradictory advice on how much one can loose due to lift. With this lift what is lost?

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for your question and photos.  I almost exclusively utilize this technique when performing breast lifts at my practice as I have found that it gives patients far superior results compared to other breast lift techniques.  Skin will be removed from your breasts during this procedure.All the best,Dr. ResultsMiami, FL

Kaveh Alizadeh, MD, MSc, FACS · Answer

The most important determinant for the outcome in your breast lift surgery is the knowledge of your surgeon with the various techniques, and the ability to individualize it to your desires. If you plan to be larger, naturally you will have to add an implant to your breast lift. The decision on whether to perform a two stage versus one stage lift and augmentation is purely based on the comfort level of your surgeon, and therefore I highly recommend you seek consultation with at least two board certified plastic surgeons who can provide their experience and expertise with various techniques. The Wise pattern has been a well respected approach to the breast lift. However, the long term outcome of this approach has not been proven to maintain the lower pole shape, mostly because the breast tissue is dependent on the skin, and if the skin of your breast has already been stretched from pregnancy or weight loss, it is unlikely to maintain the shape and symmetry over a period of greater than one year. This is especially true if you are planning to add an implant, which will increase the weight on the lower pole of your breast and expedite the bottoming out phenomena which is commonly seen with wise pattern techniques. Therefore I personally like a technique where i can provide an added internal support for the breast tissue and the added weight of the implant, and have developed a patented technique that I call the NaturaBra. This technique utilizes your own skin and uses it as a flap to provide internal long term support. We have shown over the past ten years that this approach allows you to maintain a nice shape as well as good control of the position of the implant so that you can continue to have superior pole fullness.

Sheila S. Nazarian, MD · Answer

The wise pattern delivers excellent results. I think you'll be happy. You won't really lose volume but your shape will change from your lift. Make sure to really investigate the breast lift results of your surgeon. Technique and skill are going to matter. My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Joe Gryskiewicz, MD, FACS · Answer

Hi Dr. C Pebbles,I love the coloration of your tat.  Lucky you're in Arizona, it was 7 below here yesterday.  The lift just removes some skin, so the breast isn't really smaller, BUT you do lose a cup size because the skin is pulled together.  I have an idea for you in case you want to try a different tact.  Please put
an index card in your breast fold. If your nipple is at the edge of the card or
below, then you would be a candidate for a lift, either a vertical or anchor or
areolar incision. If your nipple is above the edge, you could be a candidate
for an internal lift called the dual plane. The video below explains the dual plane
internal lift. I
believe the dual plane and implants alone will do it for you, and that you will
not need a lift. Be sure to seek a consultation with a BC PS to be sure. I would then have the complication discussion with your PS, since the informed consent can be long.  All
the best, “Dr. Joe”

David C. Yao, MD, FACS · Answer

Thank you for asking. The Wise pattern is very commonly done. It is done when there is more skin, tissue, and laxity that needs to be reduced. The other types (vertical-lollipop, crescenteric, etc.) are unable to reduce as much laxity but some patients do not need as much removed. The "simpler" patterns are right for the right candidates.With this lift the augmentation portion should be chosen wisely by an experienced PS. Discuss your goals and options with a board certified plastic surgeon who has significant breast lift and combination augmentation experience. Best wishes

Stephen W. Gordon, MD · Answer

The problem with the wise pattern for simultaneous breast lifting and augmentation with implants is that the surgeon can easily lose control of the operation and end up with misshapen breasts, wound healing issues and miss the mark relative to cup size. You have attractive breasts. In my hands, a vertical Mastopexy would be a much better choice. The wise pattern lacks flexibility. It forces the surgeon to use the same template for all comers and no two women have the same breast dimensions. Thank you.

Scott E. Newman, MD, FACS · Answer

Using a Wise pattern lift in your case will allow more tightening of your skin than a more limited vertical procedure- however you need to be confident that your surgeon will reassess your preoperative measurements once the implant is in.  This is why I beleive it's important in cases such as yours to place the implant first.  The second issue for you is that your plan will leave you with a singificant amount of natural tissue sitting on top of the implant and muscle.  As time goes on this natural tissue, supported only by skin, can descend faster than the implant.  For this reason I currently use a supportive internal mesh in procedures like yours.  Whether a Wise Pattern or a Vertical pattern is best in your case really depends on your new dimensions after the implant is placed.Good Luck!

Jason Brett Lichten, MD · Answer

For women who need a breast lift (or reduction) and want to maintain or achieve upper pole fullness, this is typically combined with a breast implant as well and I agree with you getting an implant for the fuller look you describe.  The skin pattern that is removed (periareolar, vertical or wise) depends on how much skin needs to be removed to properly reposition and shape the breasts.  From your pictures, you may still get a great result with less skin removal, but you need a consultation to properly measure your breasts.  Not sure you "lose" anything more with a wise pattern than the other lift patterns.

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Dear Ms. Drcpebbles1,Thank you for your questions and photos.BREAST LIFTMastopexy involves shaping the breast, repositioning the nipple areolar complex(NAC) and when needed reducing the size of the NAC, and by removing excess skin that causes the sag of the breast. The nipple is left connected to the breast tissue. Depending on how much excess skin and desired shape the three main types:1)Peri areolar = doughnut shaped scar around NAC2)Vertical = lollipop shaped scar 3)Inverted "t" = anchor shaped scarEach of the above techniques involves a progressive removal of excess skin and builds on each other to lift and contour the skin "bra" to the shape of the breast desired.SIZEBreast size will not significantly change because skin is only resected.SENSATIONThe nerve to the nipple areolar complex (NAC) is directly under the NAC and USUALLY not disturbed by removing the excess breast skin during a mastopexy. The surrounding breast skin may have some short term numbness but usually returns.UPPER UPPER POLE FULLNESSCurrent mastopexy techniques will not attain the "upper pole" fullness patients desire. A small augmentation can be added to create this upper pole contour and not to increase size substantially.SCARSScaring is always a concern. However there are various postoperative "anti scar" programs to optimize, reduce and treat scars.In my experience if the desired goals of shape and positioning of the NAC is obtained .... The patients rarely complain about the scars.I suggest you you collect several "model" or "goal" photos and then make a appt. with Plastic Surgeon, who has experienced and who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).My best wishes,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600p

Robert T. Buchanan, MD (retired) · Answer

The Wise pattern is the oldest successful pattern of doing a breast reduction or a lift. It addresses both the lateral and vertical skin excesses. I was taught this and still use it for very large reductions where anything else does not adequately address both components. The downside is not only another scar but the risk of decreased blood supply of the corners where they come together at the "T." This increases the chance of poor healing and increased scar. Because of this, for what you desire, I would never consider this method and have not used it for this in >20 years. By the way, one loses no volume with a simple lift which only removes skin unless you also remove breast tissue. I would suggest you get another opinion from a board certified plastic surgeon.

Bilateral Wise Pattern Breast Lift - Question and Personal Recommendation (Currently 'D' cup). (photos)

Answers (10)

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