Needing a Second Breast Lift

Hello CT43,

There are two factors at work that lead to your recurrent sagging.  The first was your skin and soft tissue quality has been comprimised by being heavier previously.  Loss of tissue elasticity due to weight gain is a permanent change and prevents the skin from staying tight after skin tightening procedures.  This loss of tightness is usually not significant, but can present recurrent skin sag in certain situations.

The second issue is you got a breast lift with breasts that may not be 'enormous', but were still in the D cup range.  The problem with breast lifts in larger breasts is that the pressure and weight of the tissue accelerates the recurrent stretching of the skin.  The best looking breasts are gotten from a concurrent breast reduction and breast lift, which removes the heavy, unsupported breast tissue, allowing the new and smaller skin envelope to keep its shape.  Combining this with sub pectoral implants will give an idealized contour.

Performing a single surgery that encompasses breast lift and reduction, in addition to breast augmentation is a complex surgery that requires significant experience and an artistic eye.  Be sure to see a breast specialist who is certified by the American Board of Plastic Surgery and is a member of the the American Society for Aesthetic Plastic Surgery. 

Best of luck!

Congratulations on your significant weight loss and ongoing healthy lifestyle. Yes, once your body has reached a “stable state” further tightening of the skin envelope of the breasts (mastopexy)  will likely be helpful. Most patients who have had significant weight loss also benefit from breast implants to increase fullness of the breasts  as well.

Best wishes.

Recurrent laxity is not too surprising given your history.  If your nipples are still at the right level then I would consider a small implant to better shape your breasts and provide superior fullness.  That will fill out the top part of the breast very nicely.  You may require a small amount of skin tightening as well, depending on the size implant you choose.  If you still have a considerable amount of breast tissue then you could consider the "internal bra" lift but I have found that it doesn't work well in the long run for maintaining that fullness in the upper pole- gravity usually wins! Good luck

If your breast skin has lost elasticity, it is very difficult to fill the superior breast unless you use an implant.  If you are happy with your size and understand the difficulties with superior breast fullness, a repeat lift would tighten your skin and improve the contour.

When the breast is thin and deflated through weight loss, a breast lift will raise and shape the breast, improve the nipple position, though still leave the breast rather soft and flaccid. In addition, to considering a second breast lift, more volume can dramatically improve the breast shape and appearance. The idea of an 'internal' lift is likely to leave the upper scoop and provide less than what even a smaller breast implant might provide.
Best of luck,
peterejohnsonmd

There are many different kinds of breast lifts, some are designed to cut out excess skin, others reshape the internal breast tissue. The latter procedures last longer and look better. The only problem is that sometimes after performing one type, other types are off-limits because of blood supply issues.

I routinely peform secondary lifts, but only when safe and indicated.

As for the Goes technique - internal brassiere, the above holds true for this technique as well.

Recurrent laxity is not that unusual after a mastopexy following weight loss. This is especially true if you continue to lean out. Options you have include a redo pexy(which is usually easier with a quicker recovery), implants or a combination of the procedures. More persistent fullness generally is obtained with implants.

Patients who undergo massive weight loss have sagging and stretching and overhang of their skin, and the skin has been damaged.  A breast lift is designed to lift the breast and nipple and reduce the overhang while still keeping the scars under a swimsuit line.  Breast lifts do not tighten the upper pole of the breast, and in MWL patients the skin of the entire chest has been stretched in all directions. So, although a lift will tighten the skin in the lower breast, the damaged skin will have some tendency to restretch...not as much as before, but probably more than you would like to see.  And the upper breast will not be tightened...only filling out the relatively empty and oftentimes flattened upper pole with an implant may help. You will probably benefit from a second breast lift to tighten the skin and around an underlying implant for better filling of the deflated tissues. 

Weight loss patients present many challenges for a breast lift (mastopexy) because the breast skin and  tissue have been severely stretched  and have little remaining tone.  There is a significant risk that a revision would be needed.  If your lift was performed merely as a skin tightening procedure, recurrent sagging is almost guaranteed.  Some sort of internal remodeling, what you call an "internal lift," is required for your best shot at correcting the sagging.  Sometimes the redundant skin can be used to support and even augment the breast tissue.  For pronounced  upper fullness, you can consider implants.  You need a discussion with your plastic surgeon about your goals as well as realistic expectations, and you should work with a plastic surgeon who is experienced with weight loss patients.

The problem you have is basically one of poor tissue elasticity and lost fat volume.  This makes for a very difficult starting point to get a great breast result.  You probably will need another lift plus implants to get more tone in the tissues.  "Internal lifts" are mostly marketing and don't work well with poor elasticity, and they certainly won't do as much for you as an implant would.