Avoiding Vertical Breast Lift Scar?

I had a consultation today for a breast lift with implant. I really do not want that long verticle scar that accompanies most breast lifts. The surgeon measured me and said I was a 29? He said that I would need the lift with the anchor incision, or I could just have the implant without lift, but the implant would go on top of the muscle. I'm really dissapointed because I do not want that large vertical scar. What are my other options for a lift? I have another consultation scheduled with a different surgeon, but I want to know if they are just going to tell me the same thing.

Doctor Answers 58

Breast Lift Recommended, but limited scars

Your question is a common one. 
I often see breast lift patients with a similar concern. 

My answer regarding what scars are required in a breast lift (or Mastopexy) is simply based on the amount of tissue that sits below the level of the infra-mammary fold (IMF).  Keep in mind that an ideal, or youthful appearing breast is cone shaped with the nipple/areolar complex (NAC) sitting in a "perky" position above the inframammary fold.

In my experience that if this amount of sag (or ptosis) is significant then a lift by the areola (NAC) alone will not suffice.  This is inherently a mechanically weak approach.  It does not create the necessary coning of the breast, and if the technique's limitations are pushed, over time the breast tissue sag will recur, and often with a elliptical stretching of the once circumferential Areola.  Additionally if too much is required from a peri-areolar approach a good amount of natural breast projection is diminished.  This can lead to a flattened breast shape. 

In the cases where patients have come to me for a redo that have avoided a lift and had implants placed in the subglandular position, I find that they are often not satisfied for two reasons.  For one they often seem to have had significant size implants placed and feel larger, but not more youthful.  And more importantly, they still have the sag, if not increased over time by the added breast weight from the augmentation.

For these patients the consideration for a lift now is more challenging due to the added descent, and may require possibly the additional scars that one wanted to avoid initially.

This is a complex topic, best served by careful attention to the details and finding a plastic surgeon with significant experience in this area.

I hope this helped, and serves as a starting point of what the initial considerations may be.

Avoiding the vertical scar

Be very careful!  You are a set up for a bad result.  50% of my revisional patients are people who were just like you and did not want what they NEEDED and ended up making compromises and ended up with terrible results.  The irony is they ended up getting what they NEEDED originally except with more cost and suffering.  You need what you need.  Do not just fill your breast to make up for excess skin. It will look good for a short period of time while it is swollen and then bottom out.  Spend more time looking for a surgeon who gets good results and closes incisions well.  The vertical scar can in many instances become invisible.

Good luck

Rady Rahban, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 96 reviews

Scar is Part of Breast Lift

There are many different techniques and incisions for performing breast lift, but they don't all produce the same results and every patient may not be a well suited candidate for many of the techniques.

To add to the challenge, experts may disagree about what might be the best technique for a specific patient.

As you consult with different surgeons and research different techniques, look at before and after (at least 6 months post-op) pictures of women who start out with appearance (drooping and deflation) similar to yours.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.6 out of 5 stars 31 reviews

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Avoiding scars with breast lifts

Your photos show a relatively severe grade of ptosis or breast sag. In order for you to be happy with the shape of your breast long term, you really need to have some type of breast reshaping breast lift. Every surgeon is going to have a particular technique that works best for them and there really is no right or wrong way to provide a breast lift procedure. But every technique has slightly different scarring. I have found that if a scar heals poorly, it tends to be the horizontal scar along the IMF that is often used in the "anchor" style approach. Very rarely is the vertical scar much of an issue for patients once it has had time to heal. I think that you will find that the most important part of a breast lift is the final shape of the breast. I would advise you to find a board certified plastic surgeon that can show you results of well shaped breasts and be less concerned about the scar. I would use a vertical breast lift procedure for you that would involve a vertical scar and one around the areolae that would fade very well with time.

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
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Avoiding vertical scar of breast lift

Judging by the severe sagging that you have (the amount of breast overhang and the very low nipple position), you need a lift, and a stronger lift than just a circular periareolar lift...you need a vertical scar as well. If you just have a circular scar lift, you will have flattening of your breast in the nipple area, a worse quality scar around the areolak and an inadequate lift. I would pretty much guarantee that you would return unhappy with the shape and the scars and have a revision of the lift adding a vertical scar to improve your result. What really surprises me is that the option of having just an implant without a lift, placing the implant above the muscle, was offered. What a bad choice that would be! Implants fill out the breast, they do NOT lift the breast, whether under or over the muscle. Your tissues would stretch and sag more, and your breast would still hang off of the implant. Many patients want to avoid scars, especially the vertical scar of a lift, but trust me...in the long run, it is better to have the scars that are needed to give you a pleasing shape and contour than to avoid them and have a distorted unsatisfactory shape. No patient with a poor contour seems very happy that she avoided a vertical scar...she just wonders why her breast doesn't look like she imagined it would.

May consider staging the implant and lift procedures

Your questions hits at the core of breast surgery. The balance between breast shape and the resulting scar. The implant alone will give you a better volume and improved appearance in a bra/clothing. However, the implant alone will not significantly improve the droopines of you breast. Here is the trade off. If you cannot tolerate the scar, and can accept the droopiness, then get the implant alone, you can get a lift later if you desire. To get a nice result with one surgery, you may have to accept the scar.

Reza Nabavian, MD
Santa Monica Plastic Surgeon

How do I avoid the vertical breast lift scar?

I would recommend an anchor lift in your situation.  All too often I meet patients with sagging breasts who hope to avoid the vertical lift scar and still achieve a beautiful shape. Although this hope is understandable, it is usually not possible. Once a breast truly sags below the breast crease, removal of lower pole skin is unavoidable. But all hope should not be lost. When the proper techniques are used to tighten the lower pole breast tissue to keep tension off of the skin, scars usually stay thin and fade wonderfully over time.

A beautiful breast shape with a faded scar is still attractive and even sexy. But an unattractive breast shape without scars is still unattractive.

Best wishes.

Trade-Off

All surgery comes with scars and sometimes its a trade-off.  Scars for contour improvement.  There are several types of mastopexy all except one of which has a vertical scar (from the nipple to the fold).  The peri-areolar mastopexy  (PAM) involves a scar around the areolar and would not give a good result in your case (at least from your photo).  The "staying power" of a PAM is poor in that the scars widen and the breasts droop.  It appears from your question and comments that you saw an excellent plastic surgeon who gave you the appropriate advice.  Best of luck.

Reduced scar breat lift

Looking at your photo a procedure with a vertical scar will likely give you the best result.  If you are willing to compromise your result slightly then you may be able to avoid that scar.  Sometimes using an implant to increase your volume can make lifting you easier with fewer scars- it simply depends on your dimensions.

Scott E. Newman, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 40 reviews

Breast Lift Scars

This is a very common concern of most breast lift patients.  Unfortunately the best advice that I can give you is that most patients who elect procedures or incision types that are compromises to the ones that are recommended to them by their board-certified operating plastic surgeon, end up requiring revisional procedures to get the best cosmetic result.  The lift incisions are dependent upon how much breast ptosis that a patient has and the amount of breast tissue that sits below the level of the IMF, or infra-mmamary fold.  

While you can never predict the way that a scar will heal, these incisions typically heal quite well and can be helped along during the healing process with topical scar preparations.

Best of luck!

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.