Scarless Breast Lift
Doctor Answers 90
Breast lifts are wonderful today
In my opinion, using an implant to lift a breast is a losing situation for the patient. Typically the size of the implant necessary to remove the sag is too large for the patients ultimate aesthetic desires. If you are sagging and want llarge breasts then fine. But if you want to be lifted and desire to remain around the same size then just get a lift! The Donut Mastopexy is a deceiving term - There are many different types of procedures that utilize a scar only around the areaola - The Benelli mastopexy, The Goes mastopexy, Skin Only Mastopexy. In my opinion, the only one that give a beautiful, durable shape is the Goes Mastopexy.
Breast lift - Minimizing scars is important
I agree with you- minimizing the appearance of scars on the breast is critically important. The whole point of a breast lift procedure is to make the breast more attractive and youthful, and this is defeated if scars are unfavorable or conspicuous.
I believe strongly in taking an aggressive approach to scars in this situation, with progressive suturing techniques and postoperative scar treatments as a complimentary service to my breast lift patients, so that they will never feel like the improved shape was not worth the scars they have.
Having said all of that, I also strongly believe that the technique for breast lifting should be determined by the patient's goals for breast shape, and the shape they are starting with. Each different technique (I do 4 different types) will tend to produce a characteristic change in the shape of a breast, and so the technique needs to be matched appropriately to the patient, using her examination and her goals as guides- otherwise you may end up with a small scar, but a funny or unfavorable breast shape.
I would find a board certified plastic surgeon you like and who has a lot of experience performing breast lifts of all forms, and talk to them openly about your goals and your concerns for the scars. Listen to their recommendations and see how you feel about them. But don't let yourself choose an operation solely on the scars if it otherwise would not be the best procedure for you.
Most breast lift patients need a "lolly pop" scar.
1) If you have only a little sagging, maybe you just need breast implants, which are put through very short incisions in the armpit, or in the fold under the breast, or under the nipple.
2) Also, if you have minimal sagging, an internal lift can be done through one of the scars described above.
3) Some patients (depending on the anatomy), can get a good lift with a "doughnut" scar just around the nipple.
4) If you have a lot of sagging, then you need a vertical breast lift with a lolly pop scar. This can be done with or without implants. But is the MOST scarring that you might need. For breast lifts, I never use the traditional longer scars that look like an upside down T.
5) The thing to understand is that, if properly informed, most women are happy with the trade off. Afterwards, you have some scars (which fade but do not disappear) BUT you have nice, perky breasts. It usually is a trade off, though.
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Breast Lift Scars - "Minimal Scar Lifts" May not leave minimal scars
For several years I have been using a 'vertical scar' technique for most breast reductions, which eliminates the long, horizontal incision in the inframammary fold below the breasts. I have also adapted this technique for breast lift surgery, and have been extremely pleased with the results. As with breast reduction patients, this new technique not only eliminates the horizontal incision, but also creates more impressive breast projection and maintains it better over time. The breast lift procedure I perform not only removes breast skin but also moves some lower pole breast tissue to a higher position, increasing the projection of the nipple/areola area.
Breast lift surgery works well for patients with enough existing breast tissue to build a projecting 'breast mound'.
All surgery results in scars. On my website, I show before and after patients at all stages of healing from just weeks after surgery, to several months after. The vertical scar will typically fade to a thin, white line that most patients find acceptable and definitely worth the trade off of perkier, more youthtful breasts, but only you know if the trade off works for you. Please view my videos about breast lifts and scarring.
Breast lifts and scars
There are many different types of breast lifts available. These range from around the areola lifts, to short scar / LeJour / lollipop lifts, to limited incision "T" incisions to conventional "T" incisions. In general, the more the incisions, the greater the lift that is possible in the breasts. When a great deal of saggy skin is present, larger lifts are necessary.
There is some evidence internal elevation and fixation of breast tissue may also help with the conduct of the lift over the long term.
Some patients have a periareolar or "Benelli" lift, with an incision just around the areola, in hopes of avoid the incisions of a conventional Wise pattern lift. When a large breast lift is attempted through such an incision, characteristic problems can occur, with gathering of the incision, decreased areolar circulation (some patients can actually have nipple death), and large resultant nipple-areolar complexes. It is in my opinion a mistake to attempt too great a lift through too small an incision. We have redone many Benelli lifts to Wise patterns and have much more satisfied patients, with much less apparent scarring (even though the actual incisions are longer).
The patient should discuss with their surgeon whether the size is appropriate or needs to be increased or decreased. They can then have a discussion of simultaneous breast implants / reduction, depending on the patient's needs.
For this reason, it is best to select the lift which will give the desired shape safely to the breast, then decide if the tradeoff (incisions) is worth it. In the great majority of patients, it is.
Don't compromise your result by trying to minimize scars.
Marian, Many patient are afraid of the scars / incisions used to perform breast lift surgery. However, in general, these incisions heal very nicely. It is a shame when patients compromise their result by demanding shorter or fewer incisions. There are minimal incision breast lifts, but these are best for people who only need a minimal lift. For people who need more extensive lifting, then you need longer or different incisions to achieve a nice aesthetic result. Sometimes, if you have an implant placed at the same time as the lift, then you may not need as long of incisions, but this also depends on your anatomy. I hope this is helpful. David Shafer, MD New York City
Scarless breast lift
Fortunately, you do have another option other than the ones mentioned above. It is called the "Ultimate Lift". It is a technique that allows for the maximum amount of lift and upper pole fullness without the need for implants. The final results are very natural. Scars are hidden around the areola and in the natural crease of the breast mound. There is no vertical scar. I hope this helps you. Best wishes Dr H
Lots of information for that great question...
Marian- this is a great, and very common question. The principle thing that I would recommend to you is to avoid compromising the form of your breast for fear of the scarring. Any qualified plastic surgeon will be able to minimize the scarring with suture techniques, and although there are no guarantees, you should hopefully end up with fine white lines for your scars that progressively fade with time. You are better off having a great breast form and a little more scarring than a breast shape that is inadequate or unattractive with one scar less.
If you are indeed borderline, it is likely that you will require less, rather than more incisions to re-create a youthful breast form. Several options with or without breast implants are available to you, with varying degrees of correction and size changes. The key is choosing the right operation for you, and that involves a careful discussion with a caring and qualified plastic surgeon. Perhaps the right answer for you is not to have surgery at all, and that is an option that you should also be happy to consider.
I’m going to include here some text from one of my breast information websites, which I hope will help you with your choices:
Many women, particularly those who have had children, will notice that their breast tissue will droop and “deflate” following breast-feeding. This phenomenon is not limited to mothers, however, as changes in weight as well as hormone fluctuations can cause these same issues. Some women, in fact, are born with breasts that may not be as “perky” as they would like. Many patients who complain of this breast deflation, or “breast ptosis” in medical terms, benefit from an elevation of the breast tissue, known as a breast lift or mastopexy. There are several ways to go about providing true or apparent lifting of the breast tissue.
Wise Pattern Breast Lift:
Classically, breast lifts were done through a pattern similar to classical breast reductions, resulting in a scar around the nipple, down the center, and underneath of the breast, which you can think of as an anchor type of configuration. While this operation works well for many patients, it provides a lot of scarring, and can, in certain patients, give rise to a breast that lacks proper projection. Efforts were subsequently made to try and improve the deficiencies of this operation, and a plastic surgeon named Dr. Lejour developed a breast surgery that eliminated the scar under the breast and improved postoperative breast form. This is called the vertical mastopexy.
Vertical Breast Lift:
The vertical mastopexy has become one of the mainstays of the breast lift here in my practice. This operation works well for most women who do not have massive breasts, and allows some degree in reduction of the size of the breast if this is what you are looking for. Alternatively, the vertical breast lift can be combined with a breast implant in order to increase the breast size. In either situation, the scars from this vertical breast lift look like a lollipop- around the nipple and down the center of the breast. The concept behind the vertical mastopexy is the rearrangement of the breast tissue itself to a higher position, rather than creating a skin sling to suspend the breast tissue. This breast tissue rearrangement is felt to give a more pleasing shape and a longer lasting result.
Benelli Breast Lift:
For those patients that require only minimal lifting and who may be adverse to the longitudinal scar of the vertical breast lift, an alternative may be what is called a purse-string, or Benelli mastopexy. This operation is performed by resection of an eccentric area of skin around the nipple, which can be thought of as an oval shaped doughnut where more skin is resected above the nipple than below it. Following a small amount of dissection in the breast tissue to strengthen the breast lift, this incision is closed with a purse-string suture that “cinches” the breast envelope centrally and upward to provide a lift. The scar resulting from this breast lift operation is only around the nipple along the transition between the pigmented areola and the skin of the breast. This operation does have the limitation of lifting the breast tissue only one to two centimeters, however, and so only patients with minimal ptosis may be candidates for this procedure.
The Use of Breast Implants With Your Breast Lift:
With any breast lift procedure, the result may be enhanced with the ancillary use of a breast implant to increase volume and fullness. A breast implant may be used with the classic breast lift, the vertical breast lift, or the Benelli breast lift procedure. Placement of large breast implants during these procedures is discouraged because of the following safety issue. When dissection of the breast tissue is performed in order to achieve a higher and more youthful appearance, careful attention must be given to the blood flow to the breast tissue that is being rearranged. Large implants placed under this dissection can put undue tension on the lifted breast tissue, causing compromise of the nipple. This complication has been the subject of much discussion recently at national educational Plastic Surgery meetings.
You may be advised to undergo a staged breast lift procedure when using a breast implant in order to achieve the best result with minimal risk. This plastic surgery sequence usually entails placement of the breast implant as an isolated operation several months before performance of the formal breast lift procedure. This sequence allows the nipple to be placed at just the right position on your new breast form following the initial augmentation, and may result in the most safe, aesthetically pleasing result. Again, breast implants that are not excessively large may be used at the time of your initial breast lift operation as a single procedure. Discussion regarding your individual anatomy and expectations will allow a plastic surgery plan to be tailored to your specific situation.
There are many different lifts available depending on your needs
The degree of lifting and the amount of scars required to restore to you a youthful and toned breast depends on how much droopiness you have. The key relationships are where the nipple lives relative to the crease under the breast and whether it points forward or downward. The farther down, the farther it needs to come up to look good and the more incisions it takes to get there. The other key issue is the degree of horizontal skin laxity or excess skin present. Periareolar lifts require an implant and are good for patients whose needs for lifting are less with their nipples above the crease and pointing forward to start with. If overextended, this lift will result in a flat, baggy looking breast with a large areola with poor scars around it. Vertical lifts, "L" lifts, short"T" lifts and full"T" lifts are the next level and can be done with or without implants. They have more scar but provide a better looking conical projecting breast in the hands of an excellent sculpting surgeon. Nobody wants scars but everybody wants the best shape and the scars are a trade-off for that. They fade with time and generally most all patients will trade their best shape for the scars to get there.
Periareolar or Vertical breast lifts have the most non invasive scars
In cases where the ptosis (droopiness) of the breasts is not excessive the innovative uses of periareolar or vertical lifts have revolutionized the appearance and the extent of the scars on the breasts. Both of these are used with or with out implants depending on the shape of the existing breasts. The periareolar lift also known as a donut mastopexy places the scars around the areola. It is best used in cases were there is minimal ptosis of the breasts. It is also best used with implants. The vertical lift or the lollipop lift is a major lift that is used to enhance the shape of the breast with out the excessive horizontal scars of the breast fold. It provides excellent projection of the breast and can be used with or with out implants.
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.