The Surgeon Minute

To Lift or Not to Lift, That is the Question

To Lift or Not to Lift, That is the Question

‘To lift or not to lift’ might not be the question of choice for any modern day Shakespeare, but it is one that Dr. Patricia McGuire of St. Louis hears a lot from her female breast patients. Many come in with sagging skin and breast tissue brought on my childbirth, aging and weight gain/loss. They want to rejuvenate the look of their breasts, but are often confused as to whether or not this can be done with an implant alone or if they will need a breast lift.

Figuring out whether or not you can get away with a breast lift alone, a breast implant alone or a combination of the two will require an in person exam. The right choice is really going to depend on your anatomy and your goals. Dr. McGuire walks would-be patients through the choices and explains why she always prefers to perform a breast lift with an implant as two separate procedures, even though this isn’t always a popular choice.

Do You Need a Lift?

Dr. McGuire has been a breast surgeon for over 26 years. During that time, she has seen a lot of patients confused as to whether or not they need a breast lift. Any number of factors can adversely affect the look of the breasts. The ones that most commonly lead to the loose, saggy appearance that is best corrected with a breast lift are:

  • pregnancy/breast feeding
  • aging
  • weight gain/loss

Her answer to patients who ask whether they need their breasts lifted or can it just be filled with an implant?’ is always “it depends”. It depends on:

  • your individual anatomy
  • what look you are trying to achieve
  • the scars that you are willing to accept

Dr. McGuire’s basic rule of thumb when determining whether or not a patient needs a breast lift is, “if the nipple is above the inframammary fold which is the crease underneath the breast then, usually, you can just have an implant. If the nipple is well below that fold then that patient is going to need a lift.”

If it somewhere in between then it’s going to come down to anatomy and the best method for achieving a patient’s desired outcome.

Breast Lift Alone

Surgeons will typically perform a breast lift alone on patients who have enough breast tissue of their own to provide the necessary volume. These patients simply have loose skin. They do not want their breasts to be any larger, but would like them to look more lifted, youthful and perky. “They do have to understand that their breasts will be a little bit smaller because part of what is filling their bra is skin,” explains McGuire. When that skin is removed, the breast volume will go down, but there will be more projection. This is the perky factor.

Breast Lift Scars

For any patient considering a breast lift, the number one deterrent is the scars. Breast lift scars can be a simple as around the nipple (a peri-areolar incision), a vertical extension (a lollipop incision), or a scar underneath in the crease of the breast (an anchor incision). The right incision for each patient is going to depend on their unique anatomy, the laxity of the skin and how much of a lift they will need to achieve the desired outcome.

The scar that usually concerns patients the most is the vertical scar that runs from the center of the nipple to the inframammary fold since it’s the most visible. However, that is the scar that tends to heal the best. The ones beneath the breast take the longest to heal since they bear the most tension and aren’t always as smooth as the vertical scar, but they are hidden in the crease.

Breast Lift with an Implant

Patients who suffer from loose breast skin and tissue and who would like more breast volume are going to need a breast lift with a breast implant. Unlike some of her colleagues, Dr. McGuire likes to do these procedures in two stages. First, she will create a nicely shaped breast with the breast lift. Then, she will expand that with more volume with a breast implant if necessary down the line.

There are a number of advantages to doing it this way. First, if there is any asymmetry, it can be corrected with the lift so that the patient can then have two implants of the same size instead of trying to use two different sized implants to fix the issue. Second, Dr. McGuire has more control over the skin and the subsequent position of the implants by splitting the procedures.

The interesting thing is sometimes patients who thought they wanted an implant find that they are perfectly satisfied with their breasts after the lift alone. While she understands patients concerns about not wanting to have two different operations, in her experience, “I get a better result”. And that is really what it’s all about.

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