With a non-implant breast lift, the minimum that needs to be removed is about 30g (one ounce) of skin per breast, even with a full, Wise-pattern (anchor) lift. This leaves your present breast size intact, just in a higher, tighter (and one ounce smaller) skin brassiere. If one breast is larger, and the smaller breast is still of adequate size to fulfill the patient's final size goals, then the larger breast can have skin and tissue removed to match the opposite side (where only skin is removed).If both breasts are larger than desired, skin and tissue can be removed from both breasts to give not only the higher, tighter (perkier) skin brassiere, but also smaller breasts of the desired size. This would be called an elective, cosmetic breast reduction (which includes a lift because it involves the same skin pattern).If enough skin and tissue can be removed to qualify for insurance company guidelines, this would be considered a breast reduction (and again, a lift is part of the procedure since the same incisional pattern is used).I do recognize that there are other skin incisional patterns (lollipop, circumvertical, periareolar, donut) for performing breast lifts, but these have differing ability to actually "lift" breasts. The usual goal is to reduce incisions and the attendant permanent scars, as well as cost (time of surgery), but fewer incisions equal not only fewer scars or cost, but also ability to actually "lift." Always remember that less is indeed always less. Techniques that are marketed to reduce "ugly" scars always have the limitations required by the loss of the incisions that are eliminated. Less is less--no magic, no physics, and no engineering marvels can overcome the need to remove skin via incisions as this is what allows the surgeon to shape the remaining skin into the desired shape.Now, one last comment.How about those surgeons who tell you that they "must" remove tissue and "replace" it with implants in order to promote "shape retention," "upper pole fullness," " or "longer-lasting" results? IMHO, this is bogus BS, and it does not take a medical degree to understand that terminology! Breast implants are designed to replicate breast tissue, so why would you remove one to add back something designed to feel and act the same? Implants are soft, pliable, and even round ones have a teardrop shape when the patient is standing. So how does that improve a breast lift that retains breast tissue to "fill" the skin brassiere and that same upper pole?Correct--it doesn't!Now, I'm not calling those surgeons who say or do this unethical or ill-informed . . . but I am saying that their training or thought process is lacking (unless, of course, capsular contracture is part of the process). A few may indeed be "trained that way" and simply do what they have been trained to do without giving this much thought. And, it does bring in a larger check! But if a surgeon knows it is not necessary, yet promotes it anyway just because it sells a couple of implants and takes a bit longer in the operating room (generating more revenue), then this indeed is unethical. Let's hope board-certified plastic surgeons are more ethical than that!So, I hope that answers your question, because it was stimulated, I would assume, by someone "informing you" that your perfectly adequately-sized breasts (that need only to have an ounce of skin removed to perform a beautiful breast lift) will "lose a cup or two" of breast size and must therefore "require" implants. I would try to simulate a sneeze like Iceman in Top Gun and simply say "H****S***!"Properly performed, a breast lift on breasts whose size you like requires only an ounce (30g) of skin removed per breast. NO MORE is required (another 15 g per breast if they are super droopy and deflated with lots of "extra" skin), but if your surgeon CHOOSES to tell you more MUST be removed, you can choose to go to someone else who simply removes the skin necessary to reshape and lift your breasts. ALL of the patients in the photo gallery you can access by clicking on the web reference link below have had breast lift ONLY--not one implant in the bunch! Best wishes! Dr. Tholen
