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.
Avoiding Vertical Breast Lift Scar?
Doctor Answers 60
Breast Lift Recommended, but limited scars
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
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.
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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.
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.
Avoiding vertical scar of breast lift
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.
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.
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:
- Breast lift alone (mastopexy)
- Breast lift combined with a small breast implant (below the muscle)
- Breast lift followed by a large breast implant (2 separate procedures)
- 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
- Down time
- 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.
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.