Axillary skin removal with breast lift/augmentation - best way to proceed? (Photos)

Question

Hello, I am seeking advice for a breast lift. I am particularly focused on having the axillary skin removed from under my armpit, down my side bra area. I am 53 years, 5.8” and 130 lb. Had lipo 10 years ago and have loose skin with aging. I want to have a breast lift with implants and have had a few consultations with dissapointing and conflicting recommendations. One surgeon recommended extended breast lift with incisions going up bra sides, but then come back in 3 months for implants. Another said breast lift with implants all at once, then come back in 3 months for a skin excision of the sides, to see how much skin is used up by the augmentation. Last surgeon recommended breast lift and for me not to wear such tight garments that create a skin fold there, basically dismissing my concern Is it best practice to have the augmentation first and the skin excision after? How is skin excision scar done, lateral or vertical? I am imagining vertical from my armpit to sides of breast, and I’m not concerned with scars. Or have everything tightened first, then implants after? Will that be too tight for implants to look natural?

George Marosan, MD · Answer

Thank you for your question and photos. It is not unusual to get different recommendations from different plastic surgeons based on their experience. It all comes down to how comfortable you feel with the surgeon. Sometimes, these complex issues cannot be corrected in a single surgery. Unfortunately, based on these photos, no realistic recommendation can be made with the breasts covered. All the recommendations you received could be viable options, but if you are not pleased, you should seek further in-person evaluations. Be careful with lateral torsoplasty so as not to lateralize the breasts with aggressive lateral chest wall skin excision. Good luck in your search.

Gerald Minniti, MD, FACS · Answer

There is nothing stopping you from having an augmentation mastopexy and chest skin excision in one surgery. The laxity or relative skin excess is in the vertical vector, and so an extension of the inframammary incision, which travels mostly in the horizontal vector is nearly ideal to remove that skin. This no different than a breast reduction on a woman with very wide breasts that extend into the armpit. Keep looking for more experienced surgeons.

Gary M. Horndeski, MD · Answer

Your excess skin appears to be vertical excess, which is creating horizontal creases. It is possible that an elliptical incision in the axilla can take care of this and be separate from the breast surgery. Unfortunately, you have not provided photographs of your breasts without a bra. The breast lift technique I recommend is the Bellesoma. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in long term stability. Vertical scars are avoided and nipple sensation (in 95%) is maintained. Later, fat transfers or small implants can be placed if additional volume is desired. I would need more photographs to give you a more accurate answer regarding your case.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

John LoMonaco, MD, FACS · Answer

The procedure is called a "lateral torsoplasty" or it can be part of an "upper body lift."  It can include a breast lift (with or without implants) an arm lift, or a "bra roll lift."

The procedure usuallymeans a scar that goes from under the breast to to armpit, so if you are OK with that, it can be a good procedure.  Sometimes a shorter scar can be used.  Also, placing the implant properly can also help pull out some of the loose skin !  Cheers from Texas !

Here are photos of the procedure for you

Axillary skin removal with breast lift/augmentation - best way to proceed? (Photos)

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