Scarless Breast Lift

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.

Hi there-

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.

Hi, Marian,

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.

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.

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

Hi,

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

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.

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.