Why aren't all plastic surgeons using the Goes Mastopexy with internal brassiere for breast lift?

Question

I have been researching breast lifts as I am scheduled for one in March. A typical lollipop style with scaring. I just saw a doc online that does scarless (only around nipple) and his results look great. I cannot find a PS that does this near me though. My question is why aren't all PS using this technique? Is it just that its harder to learn? Or is it that there are risks or complications I am not aware of? Why do the one with major scaring if you don't have to?

Richard H. Fryer, MD · Answer

The technique used to perform a breast lift should be determined by the amount of repositioning required.  Yes there are some techniques that utilize fewer or less scars, but in so doing sacrifice something else -- usually the shape of the breast.I do not like placing scars on a woman's breast unless it is absolutely necessary to achieve the optimum shape.  Use caution as you select your plastic surgeon.  It is very difficult to repair a bad breast lift, or augmentation.  Use caution when looking at results as well; it is nice to see what the breasts look like 6-12 weeks after surgery, but what do they look like 2-3 years after surgery.  I have seen some of the worst results imaginable from a particular physician who only uses the scar around the areola regardless of how much they need to be lifted.  The patients are typically happy with the results for a year or two, but later as the areola begins to spread out they often become mortified at the appearance.  I have seen areolas as large as a salad plate on women after "forcing" the lift with only the scar around the areola.

Gary M. Horndeski, MD · Answer

Thank you for your question,                 
The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Attached is a patient who underwent The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. 
Best wishes and kind regards, 
Dr. Gary Horndeski

Eric Pugash, MD · Answer

The Goes mastopexy is based on removal of excess skin around the areola, and leaves a scar around that structure. This operation is easy to sell to patients, who can be persuaded that they will get a nice lift with a barely visible scar. In fact these so-called circumareolar lifts provide poor lift, flatten the breast, and, most importantly, very often leave stretched-out, deformed areolas. The operation has very high revision rates to deal with these areolar deformities. Also known as a donut mastopexy, a clever patient of mine once observed that it should be called the DO NOT mastopexy. In general, when an operation is not done by many surgeons, it is because the procedure is new and untested, or has been around long enough for most of us to know to avoid it. All the best.

Rian A. Maercks, MD · Answer

Periareolar techniques are nothing new.  They came and go with different names all the time.  They are variations of the Bennelli technique and they always expand stretch and develop unsightly scarring with time.  A lollipop type lift gives the surgeon the opportunity to allow structural support of the new nipple areolar complex that prevents the expansion and can yield very stable results.  techniques that attempt lifting with only a periareolar technique simple do not look good long term.  lots of surgeons have tried to reinforce this with different kinds of meshes with additional complexity and complications.  I recommend staying away from additional foreign bodies and periareolar techniques!  I hope this helps!All the best,Rian A. Maercks M.D.

Daniel Barrett, MD · Answer

Dear Jennifer6645,My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Justin B. Maxhimer, MD, FACS · Answer

Your surgeon should be choosing the mastopexy technique to match the degree of breast ptosis (droop) that you have.  Circumareolar can be used for only mild degrees of ptosis.  I also agree with my colleagues that it can leave a less desirable result flattening out the most projecting part of the breast as well as stretching out the areola over time. Vertical (lollipop) and Wise pattern (anchor scar) give much more control over the entire breast skin envelope and can help correct greater degrees of ptosis.  No one wants a scar, but sometime scars are necessary to get the results you are looking for.

Curtis Wong, MD · Answer

and saying the Goes method is better is fallacious as you must compare results years down the road and not immediately post-op.  If it was truly the best way to do something, all plastic surgeons would have to embrace it and learn it.  Periareolar lifts are simply awful because they flatten the projection, leave a palpable ring around the areola (from the cinching suture), eventually have widened scars and huge areola again, and do not produce the shape that most patients desire.  Lots of surgeons (myself included) flocked to the Benelli technique only to realize later that the pitfalls was not worth the less scarring.  So very few surgeons use that anymore except if very limited circumstances.  And the vertical scar really heals well as the it was the transverse scar that was the worst.  So choose what you think is best and if you really want the Goes method, ask to see photos 12 months post-op instead of 2 months post-op and then make your decision based on those as just maybe, he is truly more gifted than the rest of the plastic surgeons out there.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. There are a number of reasons why surgeons do not use the no-vertical-scar breast lift technique.  One reason is a lack of familiarity with the technique.  Another is that it is more technically and time consuming. Most important, a given patient may not be a good candidate for the technique (i.e., this type of surgery is not appropriate for all patients). It is essential that you have an in-person consultation to develop a treatment plan that specifically addresses your personal surgical goals, and your body’s anatomy. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon
  
Texas “Top Doc”

Francisco Sauceda, MD - Account Suspended · Answer

Thank you for your question.The way I do decide which techniques I am going to use with my patients depends on the results I can achieve with each one, and the results in years. For example, some of them I can achieve a very good results in the short time, but after a year they disappear (then it is not a good one), If I believe this technique add too much risk to my patient (then this one is out of the question also) etc .There is nothing like a hard or difficult technique, every year my colleges publish new techniques on the plastic surgery magazines , in the effort to achieve the best one. If I told you there are more than 500 of this just for breast lifts I am not exaggerating.Now why I don't do this specific technique , we'll because I don't feel conformable using a mesh very close to the skin. But this si my opinion, and this is the why I don't prefer this one in particular.Good luck and Hope this helps you.

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