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 61

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 120 reviews

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.

Robert M. Grenley, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 87 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
4.7 out of 5 stars 41 reviews

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.

Steven Vath, MD
Denver Plastic Surgeon
5.0 out of 5 stars 157 reviews

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

Bellesoma Breast Lift - No vertical Scar

For some women there is a new option for a breast lift WITHOUT a vertical scar and WITH the upper fullness usually requiring an implant!

Bellesoma Breast Lift is for women who are satisfied with their overall volume, (or perhaps feel they are somewhat too big) but are sagging too low.  You know who you are - you are always saying "I like my breasts if only they were up where they used to be"!!!

Bellesoma takes the breast tissue from the nipple down to the fold under the breast, and shapes it into a cone.  Straps of extra skin from the area are turned into "shoelaces" that are laced in and out of the pec muscle to hold the breast "where it used to be".  The skin from the collarbone to the top of the nipple is used to cover the cone and the nipple is brought out through a round opening.  That creates only the scar under the breast, and the scar encircling the nipple.  No vertical scar.

More importantly the breast is full at the top as if it were in a push up bra.  While it will not work for everyone, it is a wonderful option for those with sufficient volume and sufficient excess length on the breast. Invented by Dr. Horndesky in Houston, it is now being taught to other plastic surgeons across the country.  You will be hearing about it more often in the future as it produces a remarkable result.

Kaye Riolo, MD
Fresno Plastic Surgeon
4.7 out of 5 stars 9 reviews

Vertical scar is not a must

The only surgical option to avoid a vertical scar is a peri-areolar mastopexy. If you choose a peri-areolar scar only, which would avoid the vertical scar, there is a high risk of bottoming out, or residual inferior pole laxity with time. With this approach, the single correction is nipple/areolar position.  This does not address skin and soft tissue laxity in other regions. 

Other options for a lift that would avoid the vertical scar would include a 'scarless' radiofrequency assisted breast lift, which is indicated for in patients with mild to moderate soft tissue laxity. You might also consider a thread lift which offers temporary improvement only. A third option would be a non-invasive RF or ultrasound assisted lift which would generate new collagen formation, however the degree of correction would be modest.

Diane I. Duncan, MD, FACS
Fort Collins Plastic Surgeon
4.9 out of 5 stars 17 reviews

Breast enhancement

Restoring shape and volume is what breast enhancement procedures are all about.  When there is loose skin, this must be addressed.  There are many options available with different lift procedures and a multitude of breast implant options.  Here is a basic list of the four options available:

  1. Breast lift alone (mastopexy)
  2. Breast lift combined with a small breast implant (below the muscle)
  3. Breast lift followed by a large breast implant (2 separate procedures)
  4. Breast implant alone (on top of the muscle, silicone)

Every woman is built differently and every breast is different, even on the same person.  So, each procedure is customized for every individual.  The final decision on how to proceed can be made after a history and physical examination, detailed measurements, photographs, computer simulation, trying on sizers, reviewing before and after photographs of other women similar in shape and size and talking with your surgeon.  A surgical plan will be developed that depends on:

  • Patient desires
  • The breast "footprint"
  • The expertise of the surgeon
  • Cost
  • Down time
  • Scars
  • Risks and potential complications

Please consult with a Board Certified Plastic Surgeon who performs breast enhancement procedures frequently.  This is an outpatient procedure with a quick recovery and a very high patient satisfaction rating.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

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.

Elliot Duboys, MD, FACS
Long Island Plastic Surgeon

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.