Should I Be Concerned That If I Get Cresent Lift/Implants that the Scars Will Be Visible?

I'm so torn between a Full TT & reverse with mini TT. I really like the idea of keeping my natural belly button & having hidden scars under my breasts, as the doctor recommending the reverse TT says he won't cross the midline of my breasts. Most of my excess skin is above my BB & I have diastasis that can be fixed with the mini TT. I'll also get crescent lift/implants. My concern is that the scars under my breasts will eventually sag down & be visible, also possible bunching between breasts.

Doctor Answers 8

Breast lift/tummy tuck types

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Thank you for the question.

I think the operations you are discussing carry a high risk of complication, some of which you have already outlined.

In my opinion, the mini tummy talk and the reverse tummy tuck procedures are operations that  produce very limited results and are very rarely indicated. It involves a shorter incision but does not address the majority of the abdominal wall issues present for most patients who present consultation. For example, the area of skin excised is quite small. The abdominal wall musculature is addressed below the umbilicus leaving the upper number wall potentially lax. The appearance of the umbilicus is not necessarily addressed sufficiently.
For most patients who have had pregnancies and/or weight loss a full abdominoplasty is necessary to achieve the desired results. Of course, there are downsides (including a longer scar and probably a longer recovery time) but for most patients the benefits outweigh the downsides. It is not unusual to see patients who've had mini tummy tuck  surgery present for  revisionary surgery.
It is important to work with a well experienced board-certified plastic surgeon to obtain advice (based on good ethics and judgment) to  improve your chances of a successful outcome and minimize the need for further surgery.
I hope this helps.

Crescent lifts and reverse tummy tucks

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I would question the judgment of a plastic surgeon recommending a reverse abdominoplasty and a crescent breast lift. The so-called "crescent lift" is a misconception that has been tried and abandoned by most experienced plastic surgeons. It depends on the skin to "pull" the nipple-areola up and doesn't actually move the breast nor does it allow for the tension to redistribute around the areola. Resulting scars are usually worse than those around the entire areola. Crescent lifts only appear to provide a benefit in those that don't really need one or takes advantage of the lift illusion/effect from an augmentation implant. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Crescent Breast Lift and Reverse Tummy Tuck

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A crescent lift scar is definitely more noticeable than a scar around the lower portion of the areola.  I rarely use this scar because it tends to distort the areola by lifting in only one direction (upward) causing it to become elliptical in shape.  The circumareolar (all the way around the areola) lift heals very nicely and provides much more lift without distorting the shape of the areola.

I am more concerned with your decision to undergo a reverse tummy tuck.  This is a very rare procedure and invariably the scars under your breast will migrate downwards over time and become visible.  Additionally, with a reverse tummy tuck the scars will often cross the midline to obtain an adequate result.  Consider a traditional tummy tuck or simply accept some loose skin above the belly button.  Best Wishes!!!!

Breast Lift and Reverse Tummy Tuck Scars

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All breast lifts cause scars that are noticeable, some more than others. Breast lifts are all about trading off one problem (sagging) for the acceptance of another. (scars) While the crescent lift has the least amount of scar of all of the breast lifts, it places them in the one spot that is most visible to you. For the patient who needs just a little upward movement of the nipple with implants, it can produce a subtle but noticeable improvement. Generally that scar does well even though it is located on the top of the nipple. In regards to a reverse tummy tuck, it is hard to get much upper abdominal skin tightening if the scar does not cross the sternum. I would be careful about having a crossing scar under the breasts all in the effort to avoid a belly button scar from a more traditional lower tummy tuck approach. While in the few I have done I have not seen the scar migrate downward, that is always a possibility.

Migrating scars

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I think the combination of reverse abdominoplasty and mini-abdominoplasty is a nice procedure for a very small, select group of patients who have issues of skin laxity in the area above the umbilicus and diastasis issues below the umbilicus.  Good candidates for this procedure are always, always slender.  This procedure is particularly nice if implants or a lift are done at the same time.  Fixing the infra-mammary scar to the fold under the breasts is a challenge.  I use "three point fixation" stitches with permanent sutures and have not had migration issues (yet!).   Crossing the mid-line should not be done unless absolutely necessary to get a nice contour.

I don't do crescent mastopexy.  I think it leaves a weird looking nipple.

As for scars, all scars are visible when you look at them!  We plastic surgeons try to hide the scars in natural skin folds, creases or wrinkles or where the sun don't shine. 

Should I Be Concerned That If I Get Cresent Lift/Implants that the Scars Will Be Visible?

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Scars resulting from breast lifts will be visible.  They may do very well over time, but they are never invisible.  If a lift is necessary to get a satisfactory contour, the scars are a reasonable trade-off, and much better than an implanted breast where the skin hangs off of the implant or the nipple points at the floor.  However, I think crescent lifts are not very useful...they do not really lift the nipple, they do not control the size of the areola, and the patient is often left with a widened scar, a stretched oblong areola, and no real lift.  IF your nipple position is so mildly low that a crescent lift is being considered, perhaps you will get by with an implant alone, and see later whether a breast lift is really required. If, on the other hand, your nipple position and/or breast overhang is significant enough that a lift is needed, then you should get a lift that is at least effective.

Reverse tummy tucks are rarely performed. If the scar does not cross the midline, then it is rare to get an effective skin tightening.  Scars that cross the midline are of course more visible and don't always heal as well.  Since the tightening is by pulling AGAINST gravity (as opposed to a traditional tummy tuck where you are pulling in the direction of gravitiy), its effect and the longevity of the improvement are typically less than with a regular tummy tuck.

I would recommend that you see one or more board-certified plastic surgeons (certified by the American Board of Plastic Surgery) and get some other opinions.  Remember, if you go to a plastic surgeon for skin tightening procedures and instruct them on how you want to limit the scars, be prepared to limit the degree of improvement as well.

Watch out for peculiar surgeries

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Having a reverse TT is very rare and the scars usually do cross the midline and can be pulled down onto the abdominal wall creating an unfixable situation.  If you have a rectus diastasis it is also usually above the umbi and a miniTT won't get there.  A crescent mastopexy is also something I have largely given up on as it can distort the nipple areola shape and the scar half way around the areola can be more eye catching than one all the way around the areola. 

Please see some other doctors and be sure that you aren't dictating the surgery to them or having them try to tell you what you want to hear just to get your business.  Again, the combination of surgeries you are talking about is unusual. 

Reverse Tummy-Tuck.

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Your question asks about creascent breast lifts, but your discussion talks about reverse tummy-tuck.  As far as the 'reverse' tummy-tuck, you are right.  There is concern regarding the scar 'creeping' lower as time goes on.  Typically, with time, things that are high get lower.  An inframammary scar from breast augmentation tends to stay in place because the fold is an area where the skin is fixed to the tissues beneath.  Incisions with inferior pull such as what you discussed eventually migrate lower becoming very visible.  It would be a help if you posted photographs- I could then advise you further.  Scott Newman, MD FACS

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.