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Archive for the ‘breast lift’ Category

Correction of Tuberous Breasts

Monday, August 3rd, 2015

 

Tuberous breasts are a well known congenital breast problem that presents in varying degrees of deformity. It has its greatest impact with the patient who presents for breast augmentation and often adjunctive strategies must be done at the time of implant placement to get a good breast shape result. Women often recognize that their breast(s) are misshapen but don’t know the exact name of the deformity.

Tuberous breasts are characterized by a breast base constriction (narrow diameter), small breast development, a high inframammary fold and inferior pole skin shortage and the classic areolar herniation presentation. Since it presents as a spectrum of deformity several classification systems have been devised which can be used to help with matching the deformity with the type of corrective breast procedure needed.

In the January 2015 issue of the journal Plastic and Reconstructive Surgery the article entitled ‘Tuberous Breast Deformity: Classification and Treatment Strategy for Improving Consistency in Aesthetic Correction’ was published. Using 26 patients (51 breasts) a three-tiered classification system was used based on the degree of base constriction, level of the inframammary fold, breast volume, amount of skin envelope, degree of ptosis and amount of areolar herniation. What differentiates their classification system are the added descriptors of ptosis and areolar herniation. The surgical technique included periareolar incisions, glandular dissection down to the level of the new inframammary fold, radial scoring of the inferior dermoglandular flap, submuscular release and dual plane tissue expander or implant placements. Circumareolar lifts are performed lastly to correct ant ptosis and enlarged areolas.

Of the tuberous breasts treated, 12 type 1, 26 type 2 and 13 type 3s were treated. MOst patients (92%) had a one-stage correction while a two-stage approach using a tissue expander was needed in the remaining 8%. A periareolar mastopexy was used in almost every patient (96%) with the addition of a vertical mastopexy in a limited few. (8%) Few complications occurred (8%) which were capsular contractures or implant malposition.

Tuberous Breast Augmentation result Dr Barry Eppley IndianapolisSurgical treatment of the tuberous breast is a challenging problem that often defies consistent and reliable correction. In very minor cases, a breast implant alone with or without areolar reduction may be all that is needed. But this represents the exception and not the rule. One of the keys in the correction of the tuberous breast is using the periareolar incisional approach. This provides access to a variety of the anatomic problems that the tuberous breast presents, not the least of which is the glandular dissection and release. While it has been historically taught that a subglandular breast implant should be used to help expand the lower breast pole this need is obviated by the glandular dissection and release technique. Dual plane breast implant placement can then be used and the long-term higher risks of subglandular breast implants are avoided.

This article provides a logical and thoughtful approach to the treatment of  tuberous breasts that can be done as a single stage correction in most cases.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Breast Implants with Periareolar Lift

Wednesday, July 29th, 2015

Background: Loss of breast volume is very common amongst women usually caused by pregnancies or weight loss. As the breast deflates sagging of the breast mound often occurs. As long as the nipple remains positioned at or above the inframammary fold (lower breast crease) augmentation with breast implants will adequately fill up and out the deflated breast creating a more pleasing breast size and shape.
But with increased degrees of breast sagging (nipple at or below the inframammary fold), an inplant alone will not be satisfactory solution. While it will expand the breast volume the nipple will likely be driven downward not upward creating a breast look that few would desire or accept as an improved breast shape outcome.
The need for a breast lift at the time of breast augmentation is very common. While no woman wants a breast lift and the skin scars that result they may have little choice. The options for true breast lifting are three fold. The most common and effective are the vertical breast lift (lollipop lift) and the combined vertical and horizontal breast lift. (anchor lift) But the breast lift that creates the least scar and also has the least lifting benefit is that of the periareolar or donut pattern breast lift.
Case Study: This 42 year-old female presented for breast augmentation. She had lost some weight, and between that and having had children, had a bit of a breast sag. Her nipples were exactly at the level of the inframammary fold. The dilemma was whether just getting breast implants would create a nipple positioning problem on the enlarged mound or whether she should just have a breast lift at the time of her implants. She was adamantly opposed to any type of breast skin scar on the mound itself.
MM Bam results front viewUnder general anesthesia she had silicone gel breast implants (475cc) placed in a dual plane position through a small inframammary incision. At the same time she had an eccentric ring of skin removed from around her areolas. (donut breast lift)
MM Bam results oblique viewMM BAM result side viewAt three months after surgery, her breasts show an acceptable breast mound enlargement and nipples that were in good orientation on the breast mound. There was no appreciable sag of the breasts although her breast mounds remained in the same overall position as that before surgery. Her areolar diameters were increased.
Of all the types of breast lifts, the donut lift is the ‘weakest’ of the group. It really has a very limited breast lifting effect and this could be seen if it was ever just done on its own. It does provide a bit of a lift when combined with implants although the implants really do the heavy lifting in the final result. But the donut lift does have a role to play in the woman who is questionable if she really needs a lift or not. It may be just enough in some women to allow them to get by without having to get scars on the skin portion of the breast mound. It is hard to say whether the increase in areolar diameter seen is due to the natural stretch of it from the underlying implant expansion or from the combined tension of the periareolar skin reduction.
Highlights:
1) Minimal to modest amounts of breast sagging can be improved with a perirareolar or donut style breast lift procedure.
2) A periareolar breast lift works best when combined with breast implants.
3) A periareolar breast lift almost always enlarges the diameter of the areola, particularly when used in combination with breast implants.
Dr. Barry Eppley
Indianapolis, Indiana

Case Study – Breast Reduction with Breast Lift

Sunday, July 12th, 2015

 

Background: Breast reduction persists as one of the most common of all body plastic surgery procedures. Breasts that are too large  and heavy are common and ultimately the back shoulder and neck pain that they create is best relieved by making the breasts smaller and more uplifted. The improvement is musculoskeletal symptoms is as much the  result of the lift as it is from the volume of breast tissue removed…contrary to popular perception.

Many patients ask whether there is a lift that is done with the breast reduction or whether the breast reduction leaves the breasts smaller but still hanging. When looking at the design of how a breast reduction is done, the marked skin pattern that is drawn on the breasts represents the lift that will result. Thus a breast reduction can not be done without a breast lift but a breast lift can be done without a breast reduction.

Case Study: This 44 year-old male had always had large breasts since she was a teenager. But with getting older and having children her breasts actually became somewhat larger but had fallen and gotten very heavy. They were now so large that she was embarrassed to wear a swimsuit and would not do any water sports which her family loved to do.

Large Breast Reduction results front viewLarge Breast Reduction result oblique viewUnder general anesthesia, an inferior pedicle breast reduction was performed. The amount of breast tissue removed was 450 grams per side. The amount of skin removal and tightening exceeded visually the amount of breast tissue removed. The areoalas were reduced in diameter from 65 mms to 40 mms in diamater.

Large Breast Reduction result side view Dr Barry Eppley IndianapolisHer postoperative results showed much smaller and more uplifted breasts. She was thrilled with the result as she felt more comfortable with her breast size and could now resume all water sport activities with her family. Like all breast reductions and/or full breast lifts the scar burden is significant but well worth the tradeoff for the psychological and pain relief benefits.

Highlights:

1) Every breast reduction is a breast lift also. Thee relief of musculoskeletal symptoms is a result of a combination of both effects.

2) Breast reduction produces a fair amount of breast scarring but is usually viewed as a worthwhile tradeoff.

3) Nipple sensation preservation through retained attachment and mound relocation is usually successful.

Dr. Barry Eppley

Indianapolis, Indiana

GalaFLEX Mesh Use In Breast Lift Surgery

Saturday, December 27th, 2014

 

Early Breast Lift results Dr. Barry Eppley IndianapolisBreast lift surgery has been around for almost a hundred years in a variety of different excisional patterns based on the amount of breast sagging. While the initial breast lift results can be very satisfying, many long-term results have lost some of that early luster. This is caused by the so called ‘bottoming out’ effect due to loss of tissue support from the lower pole of the breast. What holds up the breast tissue is the skin envelope which is very prone to stretching on the lower half of the breast. This can allow the breast mound to relax or fall over the lower lower breast fold. This always results in loss of upper pole fullness which will mar any long-term breast lift result.

Adding support to the lower pole of the breasts during a breast lift procedure has been done with a wide variety of methods. These have included autologous methods using sutures to resuspend and support the lifted breast mound as well as repositioning/reshaping the breast mound itself. A number of mesh or slings of various materials have also been used, most recently allogeneic dermis (e.g., Alloderm) and synthetic fibers. (e.g., Siri) All have been associated with a variety of successes and also complications. (e.g, infection) The perfect breast lift material/method remains to be developed and/or determined.

Galaflex Mesh in Breast Lifts Dr Barry Eppley IndianapolisGalaflex Mesh Indianapolis Dr Barry Eppley Plastic SurgeryGalaFLEX mesh is the newest material that has become available for use in breast lift surgery. It is an FDA-approved material for soft tissue reinforcement. While synthetic meshes are not new, GalaFLEX is unique because it is completely resorbable. It is a knitted mesh that is composed of P4HB (poly-4-hydroxybutyrate) which is a synthetic polymer that is broken down by hydrolysis (water absorption) and eliminated as natural breakdown products of carbon dioxide and water over a time period of 12 to 18 months after implantation. But as it is resorbed it is replaced by collagen ingrowth that has been demonstrated to persist as a supporting scaffold long after the material has been absorbed. This has been reported to make the lower breast pole tissues up to 4 to 5 times stronger than they were before surgery.

GalaFLEX is currently available in typical mesh configurations which must be cut and shaped to provide the desired lower pole sling effect. Once shaped it is sutured into position onto the chest wall and acts like a cradle to support the lifted breast tissue. But new GalaFLEX shapes specifically for breast lift and/or breast reduction surgery are being developed that will make it more of an ‘out-of-the-box’ device that requires minimal manipulation of the material for proper placement.

The concept of adding support to maintain upper pole fullness and prevent/reduce secondary breast sagging has long been recognized as being needed for some breast lift patients. This support is always done the easiest by adding a graft or implant to achieve it. Whether GalaFLEX is the best choice out of all our current material options will ultimately be determined by the proverbial test of time.

Dr. Barry Eppley

Indianapolis, Indiana

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


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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