Breast lift is probably the most tricky operation in plastic surgery. The reason is quite simple. We surgeons try to fight what nature and physics produce. Ptosis of the breast as far as nature is concerned is mainly happening because of two reasons. Weight fluctuations and more often pregnacy.
Physics on the other hand contribute by gravity. Lets see what happens when we gain and lose weight. Our skin expands and shrinks. At some point though this leads to striae and relaxation of the skin and eventually ptosis. Pregnacy-ies are the main reason of ptosis.
During pregnacy the breast gland enlarges and pushes out fat and skin as its getting ready for breastfeeding. When breastfeeding is completed it returns to its original size leaving the other tissues to fall back. This quite often doesn’t happen and it results to breast ptosis.
Typically patients present with either plain ptosis but with good volume or with both ptosis and loss of volume. The first group usually needs a plain breast lift procedure while the second needs a combination of lift and augmentation.
Patients in need of breast lift alone must accept that there will be a minor reduction of volume in order for the breast to go to its new position. The new breast will “look” smaller because it will be narrow compared to the original size. Our goal in surgery is to get the breast tissue high and then let the skin re-shape around it. Results tend to settle after 6 months and usually have a natural look. One thing to remember though is that eventually some degree of ptosis will re-occur as gravity is always a critical factor.
Patients that present both ptosis and loss of volume will require the use of an implant along with breast up-lift to achieve the desired result. This operation has more variables than a plain breast up-lift and many methods have been proposed as optimal. None of them though produces constant results. One way to go is to first lift the breast and 6 months after to augment. The truth is that i ahve never met a patient willing to follow this option.
The reason is that it is costly (2 surgeries instead of 1) and requires long recovery (2 surgeries).
My preference is to use a small implant with the breast lift. Sometimes patients ask for a big implant but I educate them that a big implant will just get them back to surgery sooner than later. The more weight we add on an already droopy breast the sooner it will present with ptosis again.
When it comes to incision choices for breast lift surgeries, patients must accept that there will scarring on the breast. Sometimes it is just around the areola but most of the times it will have a vertical extension also. Scars usually heal good or if not can be treated with steroids or minor revisions.
The most important issue about breast ptosis is education. Patients should know that secondary surgeries are common. Results are not long-lasting especially when the opt for having a large breast.
If you are one step before going into a plastic surgery book an appointment today with dr. FilGood!