Explore Plastic Surgery

Of the many body deformities that result from excess skin after massive weight loss in the bariatric surgery patient, the most difficult in my experience is that of the breast. Loss of breast volume, a low nipple position, and sagging skin from a ‘deflated balloon’ creates a breast problem that offers a lot of challenges. Lifting and reshaping a bariatric breast is a four-dimensional problem consisting of tightening and lifting the skin sleeve, elevating the nipple into a more central position on the breast mound, adding loss breast volume, and trying to minimize the amount of scars necessary to do accomplish all these tasks.
The real challenge in making a better breast in the bariatric surgery patient is that lifting and reshaping the breast and adding volume through an implant (which is almost always necessary) makes it very difficult to predict an exact final result. Then when you factor in the important task of keeping the nipple alive through these manuevers (removing excess skin and putting in an implant can inadvertently knock off the blood supply to the nipple), raises the risk of further complications.
Based on these concerns, I advise patients that I will do my best to get a good result in one operation, but my experience has shown that it usually takes two separate procedures to get the best outcome. In other words, the revision rate in these types of breasts is quite high. Whether more skin needs to be tightened, the implants need to be repositioned or adjusted in volume, or the nipple needs to be lifted even higher, it is very difficult to get two, fairly symmetric breasts that match. Inevitably, some aspect of one breast or the other is ‘off”. Therefore, I advise my patients to think of their breast procedure as a two-staged operation with the hope that we do good enough that some patients will get by needing only one procedure. None of this has factored in the issue of scars and how they look which poses another risk. Fortunately, most breast scars turn out fairly well although it takes a considerable amount of time until they blend in well.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Breast Lift (Mastopexy) with and without Implants in Indianapolis by Dr Barry Eppley

Many women, usually after pregnancy, desire improvement from the resultant change that has occurred in their breasts. Usually the resultant breast involution (shrinking) that occurs after most pregnancies results in sagging or ptosis of the breast. the breasts may appear deflated but the problem is really one of too much skin now for the amount of breast tissue that remains. (yes, you will have less breast tissue after pregnancy)

While breast augmentation and breast reduction are highly successful procedures that achieve the goals of most patients and have acceptable tradeoffs for the benefits (augmentation = use of a synthetic implant, reduction = scars), the breast lift or mastopexy procedure is a different matter. Most mastopexies of significance result in breast scars but, unlike a breast reduction, the breast lift is a pure cosmetic procedure. Excessive scarring for the cosmetic patient may not be an acceptable tradeoff. Scars are very acceptable in breast reductions because the patient’s goal is primarily relief of back, shoulder, and neck pain. The dilemma in the potential mastopexy patient is a cosmetic one. Which is going to look better…..a saggy breast with no scars or an uplifted breast with scars. While it is true that some small mastopexies involve only a scar around the areola, breasts that require significant lifting involve vertical and vertical-horizontal scars.

Many mastopexy patients, and in about 80 - 90% of my mastopexy patients here in my practice in Indianapolis, are also candidates for an implant with their mastopexy procedure. A breast implant will provide volume and, most importantly, provide fullness in the upper pole of the breast. A breast lift alone will not in most patients result in restoration of fullness to the upper part of the breast. It may do so in the early postoperative period, but this fullness will be lost in the first few months. For this reason, a breast implant (even if small) can be very helpful. I have observed that one of the goals of most potential breast lift patients is a fuller breast as well. A breast lift tightens and lifts a breast but will not make a breast bigger or fuller.

If a patient elects to have a combined mastopexy-implant procedure, the next question is whether they should be done at the same time. I have always done these two procedures together but it can be a very difficult operation to get a symmetric and optimal result. The two procedures actually work against each other, tightening and lifting and increasing the size of the breast…..all at the same time. This can be artistically challenging. For this reason, I advise my patients that there is a very high revision rate with combined mastopexy-implant procedures. Whether it be to adjust the position of the implants, revise the scars, or do some fine-tuning of the breast shapes, the patient will frequently desire a revision. Conversely, however, staging the two procedures guarantees a 100% likelihood of two procedures.

The breast lift (mastopexy) procedure presents several challenging issues; Are breast scars worth the improvement in the breast shape? Do I need an implant with my breast lift? Can I live with the concept that a second surgery may be needed to get the best result?

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Saggy Breasts after Breast Feeding ??

It is a near universally-held concept amongst women that their breasts may sag because they had breast feed. I hear this frequently said during consults with women who want to improve their breast shape or size. The sagginess of their breasts, what we call ptosis, is due to stretched out skin and loss of breast tissue (post-partum breast involution). The combination of more skin and less breast tissue, deflating the balloon so to speak, creates the altered shape of the breasts. The question is…..does breast feeding make this happen?

In a recent study published in the flagship journal of plastic surgery, Plastic and Reconstructive Surgery, their findings refute this longheld belief. Based on an assessment of 136 women, the authors found that other factors, such as smoking and number of childbirths that a woman has, were more significant causes of breast sagging. Breast feeding did not turn out to be a cause.

On the surface, this seems to make biologic sense. How would a child sucking on a nipple stretch out the entire breast? However, it is clear that breastfeeding does prolong the engorged size of the breast for a time period much loner than pregnancy. Does a longer engorgement phase ultimately sag the breast more than the pregnancy phase alone? Apparently not….at least according to this new study.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis