Vertical lift or anchor lift to correct benelli? Opinions please! (Photo)

I got a benelli & implants 492r &457l. i have perm sutures, think rt broke. Really dont want nipple moved up as I fear being too high & not being able to wear low cut. willing to downsize implants- how many ccs would remove tension? Can u leave some of scarred tissue above my nipple w/ conversion or sew through it? Should I replace perm suture before revision? Lollipop or anchor- i want pretty breasts (not ugly scarred freak), like my breast size but want tension off, pretty boobs & more durable

Doctor Answers 16

Revision Lift

Hello (again!),

I want to reiterate again that vertical lifts rely on circumareolar reduction to get any vertical reduction of skin.  It too is not the best way of transmitting forces and directly removing skin redundancy.  Additionally, vertical lifts almost always increase the distance from nipple to inframammary fold, raising the nipples (unless a large circumareolar reduction is used).  In fact, anchor lifts are used to repair the high riding nipples after poorly performed vertical lifts.

I think that your desire to eliminate the need for a permanent blocking stitch and to have the finest scars with smaller areola precludes the vertical lift, and makes the anchor scar lift the best bet.  Please keep in mind that the inframammary portion of the anchor lift does not have to extend across the entire bottom of your breast.

Best of luck! 


Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Several Options

Hello 44wendall,
Thanks for your question. I see many patients with benelli lifts where the surgeon attempted to avoid a scar on the breast by having only the purse-string suture around the areola. Fortunately, yours have not spread nearly as bad as some (as evidenced by the last photo you included). Often surgeons place a permanent suture to help hold the tension around the areola in an attempt to prevent spreading.  However, as you noted that suture can come loose or even extrude leading to spreading of the areola, the degree to which depends in large part on the amount of skin that was removed to tighten the breasts and the size of the implants (if any). Fortunately, in your case it would appear as if they did not take much skin but only used the benelli suture to help correct the tuberous breast.  Downsizing the implants will definitely take some of the tension off of the areola, and I agree you do not want the areola moved much if any superiorly or it will appear too high. I typically start off with a vertical mastopexy then take some skin at the bottom along the IMF (anchor-type) depending on the nipple to fold distance and how things appear on the table once the new implants are in place.
I would definately see a board certified plastic surgeon to have a complete exam/consultation to discuss options, and expected outcomes.  Best of luck, Regards. Dr. Joseph Eby  

Joseph B. Eby, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 4 reviews

Breast Lift Options

Your pictures suggest a relatively good result considering the severity of your original tuberous breast deformity. Unfortunately, you continue to have several residual areas of concern. These include spread and distortion of the areolas, periareolar scarring and what appears to be a relatively tight skin envelope.

Although your pictures are helpful, it's virtually impossible to make a specific recommendation without a physical examination. In general terms, several therapeutic maneuvers might be helpful.

Switching to a smaller implant might decrease skin tightness and increase the number of options available to the surgeon. Increased skin laxity can then be utilized to help address spread and distortion of the areolas and periareolar scarring. This additional skin laxity might result in residual skin sag. Under these circumstances, conversion to either a lollipop or anchor type mastopexy may be indicated as well. These maneuvers have the potential to significantly improve the contour and shape of the breasts.

The combination of periareolar mastopexy and breast augmentation is often associated with excellent clinical results. Unfortunately, this procedure has limitations when patients have significant breast deformities. If you're unhappy with the results of your previous procedure, it's important to consult your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your concerns.

 

Conversion of Benelli Mastopexy to Vertical Mastopexy

44wendall,


Benelli lift revision alone is not going to provide ideal outcome. Conversion to a Vertical Lift, and still using the Benelli approach will allow the skin to both be tightened, and the vector tension forces to be changed, leading to less tendency to later recurrent stretch. This will not move the nipple up, but will gather the stretched tissue around the nipple a appropriate level, and the vertical incision will correct lower pole laxity.  A full lift is not likely needed, and would probably only add unnecessary incision scars, and it is the crease incision scars that are most prone to thickening and widening. Vertical incision scars usually heal nicely once the redness fades. All of the existing scar should be removed and the areola diameter should be reduced again.  I usually do this type of revision under local anesthesia, though sedation or general can also be used. I doubt that downsizing the implants would be necessary unless that is your desire. I hope that this helps.  Comparative information and examples of various lifts can be found at the link that follows.

Thomas M. DeWire Sr., MD (retired)
Richmond Plastic Surgeon
4.3 out of 5 stars 35 reviews

Breast revision

Your breasts currently look fine.  There is the possibility of the areola stretching out with time.  If that were to occur, you could have your lift converted to a vertical lift with the lollipop scars.  That procedure will prevent dilation if the areola.  If you do have the lift converted to a full lift,  you will almost certainly need to reduce the size of the implants used, because there will be less breast skin to cover them.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 25 reviews

Scars

Your scars are still maturing.  They should be taken care of and you should consider waiting at least a year after your surgery to have them revised.  I recommend my patients to wear very good support bras after these procedures to take the tension off the incisions.  Your overall result is very good and I would be hesitant to perform any revisions at this time.

Vertical lift or anchor lift to correct benelli? Opinions please!

  
   Downsizing the implant and a revision of the lift to vertical or anchor is probably the most reasonable alternative.  I always try to perform the procedure with the smallest possible scar without compromising shape.

Kenneth Hughes, MD

Los Angeles, CA

Type of Lift Needed to Revise Binelli?

Given the very challenging place from which you started, you overall have an exceptionally good result, and your before pictures indicate that a Binelli lift was good choice for your particular situation. Right now your scars are reasonably good and any revision is unlikely to achieve significant improvement. A lollipop or anchor lift will not provide additional benefit. 

Probably the largest contributing factor to the widening of your areola is that you have a relatively large implant for your frame and it is probably putting excessive tension on the areola and scar. You will need to downsize at least 50-100 cc to effectively reduce the tension and potentially allow for revision of the scar and some reduction in your areolar size.

Based on the information you have provided it sounds like you have saline implants, and if these are smooth surface implants you then you are at risk for future bottoming out and/or lateral malposition. This has much to do with the size of your current implant which significantly exceeds the base diameter of your original breast and when the implant exceeds that diameter, you tend to loose fascial support, the tissues get thinned out and are unable to support the implant. So if you decide to downsize, you might want to consider a new generation textured surface gel implant which will be softer, and because the implant is designed to adhere to your tissues, it will be less predisposed to future malposition problems. 

The picture you show of what you fear could happen is a good example of a misapplied Binelli lift with a large implant that was likely done to avoid the more extensive scars of a lollipop or anchor lift. The predictable result is a large sagging implant with a stretched out areola and a widened scar. You are not necessarily destined for this type of outcome, but some downsizing and switching to a different type of implant could provide a more durable result that would help prevent you from going in that direction. Downsizing in this situation is challenging and you should look for someone with much experience in revisionary surgery. 

Revise areola scars- No breast lift needed

I think that some of the surgeons who answered your question didn't realize that the final picture is NOT you. The appearance in the second picture (you now) represents an outstanding improvement from your constricted or tuberous pre-operative appearance. Your areolas are only mildly dilated or stretched. The scars around the areolas can be revised fairly easily before you consider a larger procedure with more scars, which you may not need (or at least not for a number of years). You are NOT bottomed out, and don't need any further lifting or tightening now, as a lollipop or anchor procedure would accomplish. I would strongly recommend first revising the scars, with or without a new interlocking GoreTex pursestring suture depending on your examination. If you'd like, the implant volume can be decreased by 50 cc or so to diminish tightness and tension while maintaining the general size you currently like. You have nothing to lose with this plan, since you can always undergo a more major lift in the future, IF it's needed. 

Andres Taleisnik, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 36 reviews

Vertical lift or anchor lift to correct benelli? Opinions please! (Photo)

Your scars and areolas have stretched and you may have a slight degree of "bottoming up".
I recommend a consultation in person for careful evaluation. In my opinion, you may not need to change the implants but you will need a vertical "lollipop" lift, pending your clinical evaluation.

Maan Kattash, MD, FRCS, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

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.