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

Question

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

Gerald Minniti, MD, FACS · Answer

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!

Richard J. Bruneteau, MD · Answer

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.

Ronald J. Edelson, MD · Answer

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.

Yuly Gorodisky, DO, FACOS · Answer

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.

Kenneth Hughes, MD · Answer

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, MDLos Angeles, CA

Andres Taleisnik, MD · Answer

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.

Josh Olson, MD · Answer

While it's reasonable to be concerned you don't want your scars to worsen like the attached photo I would not recommend a new lift just to prevent it as there is no guarantee it will. You have a great result considering your tuberous breasts and while a minor scar revision may improve the single area with a widened scar I would not recommend undergoing a new lift. Discuss your concerns with your plastic surgeon but reoperation doesn't always guarantee better results when you already have a good outcome.

Joseph B. Eby, MD, FACS · Answer

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

Stephen M. Davis, MD, FACS · Answer

Based on the significant size of your implants and the visual tightness of the breasts skin. There will always be an issue of spreading scars ( permanent sutures can help this) and eventually bottoming out. The chest wall and the abdominal wall are one vertical plane; gravity and weight ( heavy implants) works. That and the chest wall ( ribs) shape will allow over time the implants to migrate down and out. Measurements such as base width and implant projection are also important to ensure the implants fit the thorax appropriately. The type of lift should be based on the degree of excessive skin in the vertical and or horizontal plane, this is especially true with bottoming out when the skin from the bottom of the areola to the breast crease is excessive and the nipple are now too high. The decision will also be made based on the size of the implants and will there be any excess skin. I would seek a Board Certified Plastic Surgeon with lots of experience in augmentations, implants revisions and utilisation of additional materials to help control implant position. Good LuckStephen M. Davis, MD, FACSGreen Hills Plastic Surgery

Lavinia K. Chong, MD · Answer

Your results are quite good.  Are the implants smooth? saline? under muscle? Your preop pics appear to show tubular breast with good breast skin quality, which is one of the few circumstances, in my opinion, when a Benelli lift can be effective.  The last pic, undesireable result shows the more usual case whose results make everyone cringe.  The patient's breast skin appears excessively stretchy and the implant has "bottomed out", resulting in upward displacement of the nipples = wardrobe malfunction.  Discuss your concerns with your PS.  Revision of the right NAC should be fairly easy, can be done under local and can improve the widened scar above the nipple.  Completely understand your motivations: pretty, mobile (soft), symmetric, long-lasting results.  The latter requirement is the most difficult to maintain as women go through life's milestones: pregnancy, lactation, weight gain/loss, menopause.  Assuming you have smooth saline, submuscular implants, which are not encapsulated, I would try to revise the right NAC before electing to downsize and choose a longer scar lift technique.  If you are motivated to downsize, consider choosing a silicone implant, whose "base diameter" = foot print approximates the set you currently have.  Good luck.

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