The Surgeon Minute

How to Determine if You Need a Breast Lift

How to Determine if You Need a Breast Lift

Pregnancy, breast feeding and the inevitable weight gain and loss that happens to most women as they age are not always kind to the skin and tissues of the breast. Patients will often come in for a breast surgery consultation not liking how their breasts look, but not really knowing what needs to be done to improve their issues. Some believe that a small implant is the solution, but this surgery will only work in certain patients.

Dr. Tracy M. Pfeifer of New York City explains why someone would need a breast lift, what happens if you need one, but only get an implant, and why you should not fear the scars.

Mastopexy Patients Fall into Two Categories

Mastopexy, or breast lift, patients typically fall into one of two categories. The first are those patients who come into the office, usually after having children but it could be after losing weight, and say that they aren’t happy with the way that their breasts look. Their breasts are sagging. They would also like some more volume. “And they’d just like to have a little implant to replace that volume,” says Dr. Pfeifer. The problem is that many of these patients actually need a breast lift in addition to the implant in order to deliver their desired result.

The second category are those patients who know that they need a breast lift, but are not sure if they need an implant as well. The key question for these patients, says Dr. Pfeifer, is: “In a bra, how do you feel about your size?.” A bra takes away the shape issue, and converts your problem to a volume issue. So, if you are happy with your size in a bra then a breast lift alone should give you a great result. However, if you feel that your breasts are too small or just don’t have enough fullness at the top (upper pole fullness), then a mastopexy with a small breast implant is going to be the better procedure for your needs.

How Do You Know That You Need a Breast Lift?

When Dr. Pfeifer examines a potential breast lift patient, she is looking at:

  • is there extra skin on the breast and if so, how much?
  • how much of this extra breast tissue and/or skin rests below the inframammary fold or crease beneath the breast?
  • what is the patient’s nipple position?

If there is a large amount of excess skin or tissue hanging below the crease of the breast, then the nipple is no longer centered on your breast. The only way to restore your breast to a younger, more perky position is to lift it back up to where it used to reside.

Breast ptosis in breast lift.

What Happens if You Need a Breast Lift But Only Get an Implant?

Unfortunately, a number of patients shy away from a breast lift because of the incision lines. But there are two things that will happen if you only get a breast implant when what you really needed was a mastopexy or mastopexy with a breast augmentation. The first is that the position of your nipple can be too low on the breast. Since it doesn’t look proportional, it looks wrong. The second is what is called the waterfall effect. This is when your breast tissue falls of the edge of your implant. All breast implants have to sit at the crease beneath your breast, but if you have extra tissue, that skin will sag over the edge of your new implant and look like a waterfall.

Mastopexy patient - Dr. Pfeifer.

Why You Should Not Fear the Mastopexy Scar

The first question that a patient asks when she is told that she needs a breast lift is, “Well, what about the scars?.” There are a number of different ways to camouflage a breast scar. Patients who only have a mild amount of excess skin can get away with the periareolar approach. This is where the incision is placed around your nipple. Since both the incision line and the nipple are circular, the eye doesn’t perceive the scar as different, making it basically imperceptible.

Breast lift scar patterns.

However, if you have a moderate amount of excess skin then you are going to need a lollipop incision which adds a vertical component to the incision around the nipple. “Show a patient a picture of a vertical scar and it scares them because if you see an early post-op picture that incision is more noticeable,” says Dr. Pfeifer. The line down the breast does not conform to any other pre-existing anatomical landmark so it catches your eye. But over a 1-2 year period, your incision will fade to a thin white line that is really not noticeable.

Breast lift patient - Dr. Pfeifer.

Mastopexy Scar Therapy Options

Furthermore, there have been huge advancements in scar therapies. If a patient wants to do every thing possible to minimize the appearance of an incision, Dr. Pfeifer recommends that she start early post-operative laser treatments. These will blur the border between the normal skin and the scar skin, and reducing the abruptness of this transition helps your eye to no longer notice said transition.

And for patients who have a bit more pigment in their skin, which makes the white incision line more visible, there is the medical tattoo option. Basically, an expert tattoos the white vertical line so that it more closely matches your actual skin color. “Mastopexy is a great operation. It’s really simple. The incisions are going to heal. You just have to give it time,” explains Pfeifer.

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