I Have Breast Ptosis & Skin Problem Under my Breasts That Looks Like Hidradenitis Suppurativa, What Are my Options?

Question

Breast ptosis is making me feel so low & so down about myself. I can't wear low cut tops,swim suits, bras don't fit and causes lumps under my armpits as I have to have the straps as tight as possible to prevent sagging while wearing clothes & I have had this problem since I was 13 & had it for 7 years. I've a reoccuring rash which causes holes which pus,close up & reopen again which is suspected Hidradenitis suppurativa. What are my options & what has caused ptosis, as I don't want a reduction?

Kenneth Hughes, MD · Answer

If you have been diagnosed with HS and had medical treatment for the presumed HS without any results, it may be reasonable to excise this area in the inframammary fold. Allow this to heal and determine if your disease recurs. If it does not, then a full breast lift could be performed with or without an implant.

Gary M. Horndeski, MD · Answer

The best option for breast ptosis is a new technique called The Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to lift your breast tissue higher on your chest wall to increase your upper pole fullness, displace your breast medial to increase your cleavage and reshape your breast.  This will alleviate the rash underneath your breasts and is done without vertical or boat anchor incisions.  Hidradenitis suppurativa can be treated with antibiotics and surgery if there are deep infections.

	Best Wishes,

	Gary Horndeski, M.D.

Norman Bakshandeh Day, MD, FACS · Answer

This does not lok like hidra adenitis suppurativa nor is it in the right location. These cysts need to be excised and this problem will go away

Jourdan Gottlieb, MD · Answer

What you have is problematic, but does not fit the diagnosis of hidradenitis, which involves area of apocrine sweat glands which are in proximity to hair follicles in the axilla, groin, and inner thigh. 

	It may be that a breast lift will help here by eliminating the skin on skin contact. But before doing that it would be advisable to get the disease under control by excising all the abnormal tissue in the breast fold as a first stage, and later doing the more complicated lift is a clean surgical field. It looks like you have ample breast tissue to do a lift alone. If you are considering implants I would wait until the lift is healed, and that no recurrences are noted for at least six months due to the chances and consequences of implants infection.

	Thank your for your question and for the posted photos. All the best.

Steven Wallach, MD · Answer

I think that you should be treated for your hidradenitis first and then when things have healed and are stable it is possible that you may be able to have a breast lift/reduction.

Remus Repta, MD · Answer

Hello,

	Thank you for the question and photos.  You should be able to get a very nice result with a breast lift with and breast augmentation.  The skin lesions you show can be caused by a number of different factors and should be evaluated by your primary care physician and/or a dermatologist.  I suspect it may not be hidradenitis but in any event healing of the wounds is ideal prior to surgical intervention.

	All the best,

	Dr Remus Repta

Tom J. Pousti, MD · Answer

Thank you for the question and good quality pictures that demonstrate nicely your areas of concern.

	It is clear that your breasts have caused you significant physical and probably psychosocial “distress”. I would suggest that you work on controlling the skin reactions first; consultation with well experienced dermatologists may be very helpful to you.

	 Once the "dermatitis” has been treated  you may want to seek consultation with well experienced plastic surgeons to discuss options. Breast lifting may be at an operation that would be helpful to you at some point. As you know, the trade-off with breast lifting surgery is the presence of scars,  which may be a “deal breaker” for some patients.

	Many patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.

	I hope this helps.

Alberto Di Giuseppe, MBBS · Answer

you are a risky patient, i am afraid to say, as hidradenitis  is a chronic inflammatory skin problem ,reluctant to antibiotics, which may compromise even the result of the breast lift that you need . no breast reduction, just skin removal to allow the tissue to lift with the gland and redrape.

	problem is that the lower part of the breast skin is affected by the dermatitis, which must be resolved before you do uncertain surgery, too risky, at my advice, to perform surgery with a concomitant skin infection

Robert L. Kraft, MD, FACS · Answer

Hidradenitis is more commonly found in the axillary or hair bearing region. This appears to be a chronic dermatitis. You should see a dermatologist again. You may be refractory to many antibiotics. When skin touches skin, these irritations can develop and be very persistent. I would personally not perform a lift in an area with prurulence (pus) or ongoing infection so I think it is extremely important for you to address the derm issues first.

Darryl J. Blinski, MD · Answer

You have infra mammary infective dermatitis. You can have a lift no reduction that will remove the hanging breast skin that is rubbing causing the issue. Seek IN PERSON evaluations from boarded PSs in your city.

I Have Breast Ptosis & Skin Problem Under my Breasts That Looks Like Hidradenitis Suppurativa, What Are my Options?

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