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Archive for the ‘breast lift’ Category

Case Study: Avoiding Breast Scars in Augmentation with A Superior Nipple Lift

Thursday, August 28th, 2014

 

Background: Women that want breast augmentation present with a wide array of breast shapes and sizes. The post-pregnancy breast that has become deflated (lost volume) and has some sagging is one of the common ‘abnormal’ breast types seen. But even within this type of breast shape there are subtypes or different variations within this general category. The lean bodied female with thin skin and stretch marks is one of these subtypes that has essentially a loose deflated sac of skin that just hangs over the lower breast fold.

What makes this type of breast augmentation challenging is how to avoid the need for a breast lift. No woman really wants a breast lift and in cases of significant breast sagging it would be unavoidable. But it is the mild breast sagging cases that can pose a dilemma. It is the size of implant chosen that can determine how to manage the breast sagging. If a small breast implant size is used, then a vertical breast lift will be needed. If a moderate implant is placed, a periareolar or donut lift could be adequate. If a larger implant is used, then a superior nipple lift may be all that is needed.

The definition of what constitutes a small, medium and large breast implant will be different for each patient and it is open to interpretation. But that can be determined based on the patient’s natural breast base width and how the implant’s dimensions compare to it. Larger breast implants in women with thin breast tissues may risk loss of support and bottoming out later but can potentially avoid scars on the breast.

Case Study: This 40 year-old female wanted to reshape her breasts with a much bigger size as well as correct her sagging. She had a very thin body frame with small deflated breasts with thin skin and a narrow breast base width. (12 cms) While the potential need for a lift was discussed with her, she did not want any breast scars and opted for an implant size that was at the perimeter of her breast base width. The potential lower nipple position was felt to be better than any scars.

Stacey Norman Breast Augmentation results front viewStacey Norman Breast Augmentation results oblique viewUnder general anesthesia, 450cc high profile silicone implants were placed through a lower breast fold incision. (the location of the incision was placed lower than her natural breast crease to accomodate the implant size and provide a bit of a ‘nipple lift’) After the placement of the implants, a superior crescent mastopexy (upper nipple lift) of 1 cm was done to help center the nipple on the new enlarged breast mounds.

Stacey Norman Breast Augmentation results side viewAvoiding  a breast lift in a sagging breast is always challenging and can really only be accomplished in one with minimal to moderate sag. The slightly sagging breast with thin skin and little volume does get a bit of a lift with larger implants. The volume addition is particularly enhanced when the inframammary crease is lowered. (although this maneuver does increase the risk of bottoming out and the creation of a lower pole double bubble) It is usually necessary to add a superior nipple lift as part of the breast reshaping procedure to help center the nipple on the breast as best as possible. Even with the combined implant and nipple lift technique, some women may still have to accept a breast that is slightly ‘tilted’. (nipple slightly off center/low on the mound) But this trade-off may still be better than breast skin scars from a more formal lift.

Case Highlights:

1) Deflated breasts that have thin skin and a moderate amount of sagging pose  a challenge in breast augmentation surgery.

2) Vertical breast lift scars can be avoided in some mildly sagging breasts if large enough implants are used with an upper nipple lift.

3) There is a balance between the implant size used and the ability of the breast tissue/skin to support it.

Dr. Barry Eppley

Indianapolis, Indiana

Breast Lifts Cause A Drop In Bra Cup Size

Sunday, July 13th, 2014

 

Breast Sagging and Involution Dr Barry Eppley IndianapolisSagging of the breasts is a common development for most women due to aging, pregnancy or weight loss. It is most severe with multiple pregnancies or significant amounts of weight loss. While corrective breast lifting is most frequently performed with  implants to restore and even increase original breast volume, it can also be done alone when the woman requests to just ‘put them back where they once were’.

Many women assume that a breast lift will also make their breasts more perky as well as fuller in the deficient upper pole. While this may be true for some women who have more sagging than breast tissue loss or a lot of volume that has fallen over the inframammary fold, this is not necessarily so for most women with breast sagging.

Breast Lifts Make Breast Appear Smaller Dr Barry Eppley IndianapolisIn the July 2014 issue of the Plastic and Reconstructive Surgery journal, an article was published entitled ‘The Impact of Mastopexy On Brassiere Cup Size’. This article was a clinical study that evaluated the change in bra cup size in women who had undergone breast lifts. Over a nine year period from the perspective of a single surgeon, twenty women who had underwent mastopexy alone (breast removed less than 150 grams per side) were surveyed regarding before and after surgery cup size, changes in bra manufacturer and weight gain/loss. The majority (80%) had grade II ptosis while the remainder had Grade III. Average breast tissue removed was almost 60 grams. (minimal) Average change in bra cup size was a decrease of 1.05 cup sizes.

This study demonstrates what plastic surgeons know based on a lot of observational experience…a breast lift will make one’s breasts look smaller. They will be more uplifted and have variable degrees of perkiness but they will be smaller both by appearance and in actual bra cup size. This occurs because in most cases of breast sagging the actual breast volume is less than the actual cup size a woman is wearing. This phenomenon is often called the ‘rock in the sock’ effect as the skin sleeve is bigger than what is inside of it. But when the breast is lifted and tightened, the bra cup size usually decreases despite teh fact that little to no breast volume has been removed.

As this study shows, breast lift surgery alone results in an average drop of one bra cup size. This is important to preoperatively appreciate as maintaining the same breast volume (or to even end up slightly bigger) may require an implant to be combined with the lift.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Breast Lift with Implants for Postpartum Sagging

Monday, May 19th, 2014

 

Breast Sagging after Pregnancy Dr Barry Eppley IndianapolisBackground: Loss of breast volume and resultant sagging is a common sequelae of pregnancy. The more pregnancies a woman has the more the breasts will sag. The sag is a function of loss of volume (like a balloon deflating) and increased skin and loss of its elasticity. (the lining of a balloon gets bigger) Such breast effects are magnified in the woman who initially had fairly large breasts during her teenage and early adult years. In essence, the bigger the breasts the more they can deflate and sag.

It is a common misconception amongst some women that implants can lift up a sagging breast. This is true if the breast sag is more inward than downward. If the nipple remains just at or above the inframammary fold (IMF, lower breast fold), then an implant will truly lift it up through a volume expansion effect. However if the nipple is at or below the inframammary fold (lower breast fold), volume expansion will actually make the sag worse because it drives the nipple downward not up.

Breast lifts are needed when implants are placed to move the nipple and the attached breast mound up onto the face (in front of) the implants. The only two lifts that are truly effective in the sagging breast are the lollipop (vertical) and anchor (combined vertical and horizontal) type breast lifts. Which one is needed depends on the degree of sagging and how much volume (implant size) is being added. Often the need for the horizontal excision and scar line is not known until the surgery is being done through the tailor tack method of executing the lift.

Case Study: This 31 year-old female wanted to improve the size and shape of her breasts. She had D cup breasts when she was younger but that changed after having two children. Her breasts had become nearly two sacs of hanging skin with less than 1/3 of their original breast volume. She wanted her breast volume restored with a good implant size.

Breast Lift with Implants result front view Dr Barry Eppley IndianapolisUnder general anesthesia, a vertical breast lift outline was initially incised and de-epitheliazed. Through the lower end of this excision, a tunnel was made into the submuscular plane and implant sizers were inserted and inflated to 550ccs. The nipple and the breast mound was then lifted up to the center of the recreated mound and the surrounding breast skin tacked together with staples beneath it into a completely vertical line down to the fold with a small horizontal extension. The skin within the staple line was then excised and closed. Prior to the closure near the fold, the sizers were replaced with 550cc silicone gel high profile implants.

HD Breast Lifty with Implants result oblique view Dr Barry Eppley IndianapolisHer recovery was no different than that of the typical breast augmentation patient. A breast lift adds no extra pain or swelling to the recovery process. It does longer for complete incisional healing due to their length and the number of sutures needed to close it beneath the skin.

Breast Lift with Implants result side view Dr Barry Eppley IndianapolisThe combination of a breast lift with an implant (known as an augmentation mastopexy) is commonly needed when many women present with sagging breasts. While it is a very effective breast reshaping procedure, it combines the risks of both separate operations. This makes the need for revision as high as 30% in most large studies that have evaluated the outcomes for this operation. It is a very artistic operation that requires judgments during surgery balancing implant size with the amount of lifting needed.

Case Highlights:

1) Significant loss of breast tissue with sagging after multiple pregnancies is a common result in women that initially had large breasts.

2) An implant alone in severe breast sagging will actually aggravate the sagging not help it.

3) Combination breast lifts with implants is a challenging operation that must balance the patient’s desire between volume augmentation and the amount of lift needed to correct the sagging.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Breast Augmentation without a Lift in Sagging Breasts

Monday, March 31st, 2014

 

Background: One often under appreciated aspect of breast augmentation with implants in some patients is that what will occur is that the existing shape of the breast merely gets bigger. Breast implants do not possess magical properties and they can not cure all ills of one’s breast shape issues. This is why it is critical to carefully assess the breasts before surgery to point out and plan any concomitant techniques to address what an implant can not do or to provide a realistic understanding of what the outcome will be.

Breast Sagging classification Dr Barry Eppley IndianapolisThe biggest patient misconception about breast implants is that they are capable of lifting up sagging breasts. The reality is that nothing could be further from the truth. A minor lifting effect can occur if the nipples are at the level of the inframammary folds. But in real breast sagging or ptosis, where the nipples are below the inframammary folds, breast implants will actually exacerbate the problem not make it better. (type 1 or 2 breast ptosis)

But many women understandably do not want the scars from a breast lift even if they may really need it for their breast augmentation. There is certainly no harm in not doing a breast lift in implant augmentation of sagging breasts as long as one has a full appreciation of what the breasts will look like afterwards. The nipples will not be centered on the breast mound, the implants will look too ‘high’ and the breast tissue may appear to be hanging off of the lower half of the implant.

Case Study: This 26 year-old female came in for breast augmentation after having had two children. She had a grade I/II breast ptosis with a low positioned breast mound and nipples that were just below the inframammary fold. She was offered a vertical breast lift with her augmentation but she did not want the scars that would result from it. She stated she only cared how she would look in a bra or swim suit.

Breast Augmentation without Lift result front viewUnder general anesthesia, she had 550cc high profile silicone implants placed through incisions below her existing folds. The implants were placed in a partial submuscular dual plane location. It could be seen on the operating table that her nipples were not centered on the breast mounds after the implants were placed even though the inframammary fold was lowered as much as possible.

Breast Augmentation without lift result oblique viewHer postoperative result showed what was expected…the implants looked ‘high’ because the nipples and the breast mounds were more on the lower half of the implant rather than centered over it.

Breast Augmentation without Lift result side viewThe relevance of this breast augmentation case is to demonstrate the consequences of not doing a breast lift with implants when one is really needed. One has to choose between a better shaped breast with scars or a scarless breast augmentation result that is far from an ideal shape. The good news is that one can always do a lift later if one eventually decides that scars are a better aesthetic trade-off than this type of augmented breast shape result.

Case Highlights:

1) The shape of the breast, particularly sagging, can adversely affect the outcome of breast augmentation surgery.

2) Contrary to popular perception, breast implants do not have any substantial lifting effect on a sagging breast.

3) The aesthetic tradeoff for augmenting a saggy breast without a lift is a very full upper pole and a low nipple position.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Full Breast Lifts To Uplift and Reshape Sagging Breasts

Monday, December 23rd, 2013

 

Background: Sagging of the breasts is an almost expected sequelae for most women as they go through life. The effects of gravity and body changes of pregnancy and weight loss will make just about any breast mound drop. This is particularly so when one starts out with some significant breast volume making it very prone to sagging even early in life.

In correcting breast sagging, some type of breast lift is needed. There are several types of breast lifts that can be used which differ in the amount of scar created and how much the breast is lifted. The type of breast lift used can also be influenced by whether an implant is going to be simultaneously placed for volume improvement as less of a breast lift may be needed.

Breast lifts can be classified into four types, crescent nipple lifts (I), periareolar donut lift (II), vertical lollipop lift (III) and a full anchor lift. (IV) Like lifts, the amount of breast sagging is also classified into types (I – IV) based on where the position of the nipple sits relative to the inframammary fold. In theory, the type of breast lift matches the type (degree) of breast ptosis. (sagging)

Case Study: This 38 year-old female wanted to improve the shape of her sagging breasts. She had always had large breasts since she was a teenager but, after two pregnancies, they had fallen with the nipples well below the inframammary folds. She was not interested in a bigger breast size, just a better uplifted breast shape.

AncrraesPrior to surgery, a full breast lift design was marked out on the breasts which would elevate the nipple from a 26 cm vertical position (from the sternal notch) to an 18 cm vertical position. Under general anesthesia, all skin within the preoperative marks  and around the areola was removed. (de-epithelized) Skin flaps were raised by going along the breast mound down to the chest in a near circumferential fashion around the breast mound. The breast mound was then elevated upwards and the skin flaps wrapped around and underneath it and closed. The new position of the nipple was marked out at 5 cms above the inframammary fold, the overlying skin removed, and the nipple-areolar complex delivered and closed. This created a full full upper pole of the reshaped breast and a lower pole that seemed short and blunt.

btasertThe breast mound settled into a more natural shape (less upper pole fullness and a rounder lower pole) by six weeks after surgery. Final healing of all incisions, including any extrusions of sutures and a well healed inverted T junction took a full seven weeks after surgery.

;iqwjfA full Type IV breast lift can significantly lift and reshape a sagging breast at the expense of the scars that it creates. When there is adequate breast volume, such a breast lift can create both an uplifted and fuller breast that has greater upper pole volume. It is necessary to ‘over correct’ the lift to factor in some expected breast mound settling.

Case Highlights:

1) Significant sagging of the breasts requires a full breast lift which can be done without the removal of any breast volume.

2) A full Type IV breast lift creates the classic anchor scar pattern which is necessary to get a maximal breast lift and reshaping result.

3) While a full breast lift creates considerable scar lengths, half of the scare remains hidden along the inframammary crease.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Full Anchor Pattern Breast Lifts

Sunday, November 3rd, 2013

 

Background: A change in a woman’s breasts is an assured phenomenon over her lifetime. Through pregnancies, weight gain/loss and gravity, breasts usually drop or sag with age.  The amount of sag is often exaggerated by the concomitant loss of breast volume as well. While many women want larger breasts, just as many want or need a breast lift as well.

The amount of breast sagging determines the type of breast lift that is needed for optimal correction. Breast sagging has a well known classification system which grades its degree based on the position of the nipple relative to the inframammary (lower breast) fold in the profile view. While breast implants may provide some degree of lifting in grade 1 or 2 breast sagging, once the nipple and breast tissue hangs below the fold  (grade 3 and 4) a real breast lift is needed.

Breast lifts come in a variety of types that fundamentally differ by how much skin is removed, the resultant scar patterns that are created on the breast mound and how much lift is created. There are four types, 1 (crescent nipple lift), 2 (donut or periareolar lift), 3 (lollipop or vertical lift) and 4 (anchor or full lift) When done as a stand alone procedure without an implant, a full or anchor breast lift is almost always needed for significant sagging. At the same time a reduction in the size of the areola can be done as well.

Case Study: This 26 year-old female had good breast size but they were too saggy. They hung well below her lower breast folds and the areolas were quite wide. She had neck, shoulder and back pain which she felt, probably correctly, that it was from the sag of her breasts.

Under general anesthesia, a keyhole pattern design as marked on her breasts with a reduced areolar size. The intervening skin was removed by de-epithelization and surrounding skin flaps were raised down to the pectoralis fascia. The entire underlying breast mound with reduced areolas was then lifted upward and wrapped around by the skin flaps and then closed, created the anchor pattern closure lines. No breast tissue or volume was removed. The new position of the nipples was marked 5 cms above the lower breast fold, skin removed and the nipple-areolar complex brought out and closed. This was done as an outpatient procedure that took about 2 hours to complete.

Her breast lift healing was uneventful even though she a small amount of wound separation a few weeks after surgery at the inverted T junction, which is extremely common. At three months after surgery, her scars has matured significantly at the lollipop portion but not yet at the horizontal fold incision yet.

The most effective breast lift is still the anchor pattern or full breast lift. While no woman wants breast scars, significant breast sagging can only be corrected by such a lift. When well done, the resultant scars can be very acceptable.

Case Highlights:

1) Significant breast sagging can only be lifted to any degree by an excisional breast lifting procedure

2) While there are different types of breast lifts, the best lifting effect comes from a full or anchor scar pattern breast lift.

3) Maintaining persistent upper pole fullness is a problem in any type of breast lift.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review – Refine Soft Tissue Suspension System

Wednesday, September 11th, 2013

 

The ideal youthful breast has fullness in the upper pole, does not sag, and has a slightly pendulous lower pole. The slope of the upper pole should be slightly convex, straight, or slightly concave. With time, and gravity, many women lose that nice fullness in the upper pole, aging the breast and making it less attractive. In order to combat this problem, plastic surgeons have tried many different techniques in order to reestablish or make upper pole fullness.

The Refine internal suspension system is a new device that has been developed an use with this problem in mind. The Refine system is a soft and flexible suture-mesh-anchor system that provides the soft tissue with internal support. It is made from medical grade polyester. It has been FDA approved and is indicated for the reinforcement of soft tissue.  The Refine system is placed percutaneously using specialized needles and is a two part system. The first part is the anchor utilizing a small piece of flexible mesh which is placed just deep to the pectoralis fascia. The second part using anchors which engage into the soft tissue, lifting the tissue up.  The two parts are then secured together, burying the knots deep in the soft tissue of the breast.

The most common use of the Refine system is for breast lifts in order to maintain upper pole fullness. When performing a breast lift or a breast reduction, with time, the breast tissue settlesor bottoms out and loses that upper pole fullness that many women want. By using the Refine system, plastic surgeons can permanently lift the breast tissue, maintaining that fullness for a more youthful look. The Refine system is not palpable and cannot be seen on mammography.

Plastic surgical experiences with the Refine suspension system in the breast have been promising and results have been maintained. Overall complications from this device seem to very low and patients report minimal discomfort after placement. This is an exciting new tool for plastic surgeons that is optimally used in conjunction with other breast procedures such as reductions, lifts and with fat injection breast augmentations.

Dr. Barry Eppley

Dr. Jane Namkung

Indianapolis, Indiana

Case Study: Breast Implant Revision and Lift for Recurrent Capsular Contractures

Sunday, August 25th, 2013

 

Background: While breast augmentation will produce an immediate and significant change in the size of the breasts, it is important to remember that it does so with the implantation of a medical device. As such there are always the risk of complications with any implanted device. One of the most well known complication risks of breast implants is capsular contracture. This is the excessive development of scar tissue around the implant that can create variable degrees of breast firmness and implant malpositioning.

While there are several known factors that can cause breast implant contractures (hematoma and infection), many cases have no known identifiable cause. It is known that the risk of capsular contracture is higher when the implants are placed above the muscle as opposed to a submuscular pocket. It is presumed that the regular motion of the overlying pectoralis muscles acts as a form of massage on the implant capsule that prevents excessive thickening of it.

The successful treatment of breast implant contractures is known to be difficult and fraught with a significant risk of recurrence. Release or removal of the breast implant scar through capsulotomies and capsulectomies does not always prevent recurrence as new excessive scar formation may occur in its place. Implant repositioning to an under the muscle location can be very effective for subglandular breast implant contractures.

Case Study: This 33 year-old female was seen with a history of seven prior breast implant procedures. She originally had saline implants placed above the muscle combined with a periareolar lift. Her subsequent six surgeries were done for implant enlargement, capsulectomies for contractures and areolar scar revisions. Despite these efforts she was left with wide periareolar scars, hard breasts (Grade III capsular contractures) and breast mounds that hung unnaturally off of her chest wall.

Under general anesthesia, breast implant revisions and a vertical breast lift were done. Initially, the periareolar scars were excised and the diameter of the areolas reduced.  A vertical breast lift skin pattern was subsequently removed. The saline breast implants were taken and a submuscular implant pocket developed. Due to the thinness of the overlying breast tissue, the capsule was not removed. New silicone implants were placed in a submuscular pocket and the lateral border of the muscle sewn to the capsule to close down the upper portion of the subfascial pocket. The vertical breast lift closure was then completed.

Her after surgery result showed a significant improvement in the breast shape and feel. Six months later the breasts remained soft with no signs of recurrent contracture. The areolas were smaller and the periareolar scars improved. The breast mounds were higher up on the chest wall and no longer sagged.

The vertical breast lift scars were virtually undetectable. While the periareolar lift is usually done to avoid the risk of unfavorable scarring below the nipple, vertical breast lift scars in light-skinned females can heal quite well and provides a more visible breast lifting effect.

Case Highlights:

1) Recurrent capsular contracture is a difficult breast implant problem for which there is no one single treatment method that cures it every time.

2) One successful capsular treatment method for subglandular breast implant contractures  is repositioning the implants to a submuscular position.

3) Minor amounts of breast lifting are more successfully done by a vertical lift than a periareolar technique.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: The Pseudolifting Effect of Breast Implants

Tuesday, August 13th, 2013

 

Background: There is a common perception that an implant can lift up a sagging breast. The reality is that nothing could be further from the truth. In most cases of sagging breasts (breast ptosis) an implant will actually making the breast shape worse. It will fill out the upper pole of the breast while having no positive shape effect on the downturned breast tissue which contains the nipple. This is why a lift with an implant is almost always needed for reshaping and lifting of the sagging breast.

There are a few instances of apparent breast sagging, however, in which an implant can have a breast lifting effect. If the breast mound is small and the sagging is largely restricted to the nipple, implant enlargement can create the perception of an uplifted breast. By making the breast base diameter bigger in both a vertical and horizontal dimension, the location of the nipple on the mound is changed as the mound is expanded.

Such positive benefits of an implant alone on a sagging breast almost always occurs when the initial breast size is small. Large breasts create a big sleeve of overhanging breast tissue as it has shrunken due to pregnancy or weight loss. This type breast already has a small base diameter and the droop is more nipple-related than mound-related. With careful assessment one can see that the low hanging nipple position does not fall below the level of the inframammary fold. (lower breast crease)

Case Study: This 40 year-old Hispanic female wanted breast enlargement after having had two children. She never had large breasts even though she had a wide chest. She wanted silicone implants and wanted at least a D cup breast size afterwards.

Under general anesthesia she had 550cc high profile gummy bear silicone implants placed through lower breast fold incisions. Using a no-touch funnel device technique, the implants were inserted through 3.5 cm long incisions in a dual-plane submuscular position. At least half of her mound expansion was on the lower pole with the creation of a new lower breast fold.

With implant augmentation in the smaller droopy breast, the entire lower pole of the breast is expanded lower. This makes a new inframammary fold location well below the location of the presurgical smaller breast mound. This is how the breast becomes ‘lifted’. The nipple position actually stays relatively the same, it is the breast mound around that changes. With a larger and lower breast mound the nipple ends up acquiring a central position. This could really be called a pseudolifting effect.

The expansion in the breast mound also creates an important issue for the actual placement of the breast implants. Since the breast mound will lower the existing inframammary fold, it is important to make that consideration into the incision location. The inframammary fold incision will need to be made at 2 cms. lower than the existing breast fold. If this is not done the incision will end up above the fold and on the actual lower pole of the breast is a more visible location.

Case Highlights:

1) It is a common belief that breast implants can lift a sagging breast which is rarely true.

2) Very small breasts that have a little droop due to involution, however, can be effectively ‘lifted’ with breast augmentation alone.

3) Larger breast implants achieve their lift by enlarging the lower pole of the breast making the nipple appear higher on the new breast mound.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Superior Crescent Nipple Lifts in Breast Augmentation

Tuesday, August 6th, 2013

 

Background: One of the most vexing problems in breast augmentation for the plastic surgeon is the women with breasts that has some sagging. No woman electively wants the scars from a breast lift unless their breasts have severe sagging and even they know it is an unavoidable issue. It is the women that wants only breast implants and feels (justifiably or not) that augmentation alone will lift up the amount of sagging that they have.

In these more mild cases of breast ptosis (Grade I or even II), there are two treatment options. Breast implants can be placed alone and the patient can gamble that a lifting effect will occur. A formal breast lift can always be done secondarily if the breasts still have some sag off the front of the implants. The patient can just concede that a breast lift is needed and then choose between a type of breast lift where the scars stay restricted to the areolar-skin junction.

Breast lifts where the skin that is removed around the areola probably should not be called true breast lifts. They really change the nipple position slightly upward but have no true breast mound lifting effect. Only skin that is removed from the breast mound and leaves skin scars can truly reshape and lift the breast. Of the two areolar lifts, they include the superior crescent and the periareolar excisions/lifts. The nipple lift will move the nipple upward for about 10 to 15mms but may elongate the nipple as well. Its scar is restricted to the upper half of the areola. The periareolar may lift the areolar up slightly more also has some skin tightening around it s well. It does do at the expense of an incision entirely around the areola and the subsequent risk of scar widening, particularly when done with implant mound enlargement.

Case Study: This 45 year-old female wanted to enlarge her breasts and suspected that a breast lift may be involved in doing so. She was adamently opposed to any breast lift that created visible skin scars. She wanted the least scarring as possible and was willing to accept that a skin scar breast lift may be needed later.

Under general anesthesia in the prone position, 550cc high profile silicone gel breast implants were placed in the submuscular dual plane position through inframammary incisions. To help move the nipple slightly higher on the breast mound, a superior crescent nipple lift was performed with the new implants in place with a 15mm curved skin excision.

Her results show that even with implant enlargement and an upward nipple adjustment  that ideal nipple position on the breast mound is not achieved. But for those women willing to make that trade-off without excessive breast sagging, the adjunctive use of a superior nipple lift can be helpful. Whether that may be enough to eventually avoid a breast lift can not always be accurately predicted. The scars from an upper nipple lift does not fade considerably but remain evident in the first few months after surgery.

Case Highlights:

1) The saggy breast (ptosis) poses a challenge that breast implants alone often can not completely overcome.

2) Many women need a breast lift with their implant augmentation but do not want the resultant scars.

3) A nipple lift (superior crescent lift) can provide the illusion of some lifting by nipple adjustment that may be enough in cases of mild sagging to avoid further scars around the areola and down vertically on the lower pole of the breasts.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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