Explore Plastic Surgery - Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

Background: Breast augmentation is based on the principle of expanding one’s natural breast tissue by placing an implant behind it. Regardless of whether the implant is placed within the breast tissue above the muscle (subglandular) or beneath the muscle (submuscular), how it works is the same. As a result, how well most breast augmentations will look in the end has a lot to do with what the quality of the breast tissue was originally on top of it.

One of the most common complicating factors that affects many potential breast implant patients is breast ptosis. Known as sagging, and defined by where the nipple sits in reference to the lower breast fold, it creates concerns about how the breast augmentation should be performed and whether some form of a breast lift should be done at the same time.

On the long-term side of breast augmentation, the effects of aging, gravity and pregnancy can create ‘implant ptosis’. This is when the breast tissue has essentially slid off of the implant over time resulting in a nipple which is now on the ‘southside’ of the implant. This can occur when one has a fair amount of breast tissue to begin with and there was marginal or a grade 1 amount of ptosis initially present. A breast lift may have been initially avoided but eventually the tissues may stretch out, creating a need for such a procedure.

Case: This is a 60 year-old female who had saline breast implants placed over twenty years ago. She came in because she thought her implants were slowly deflating over time. In addition, she felt that her breasts had gotten more saggy over the years. On examination, it was not obvious that her breast implants were deflated. But her breasts did have significant ptosis. I suspected that she had breast implants that were initially placed too high or were done in the setting of some breast ptosis. With time, the breast tissue stretched out and sagged further off of the implants. With loss of upper breast fullness due to the sagging, it would be understandable to believe that the implants were ‘deflating’.

She subsequently underwent implant replacements with a change to silicone gel. The size of the implants was kept the same as her original volume. (and she did not have any deflation of her saline implants) A vertical breast lift was performed at the same time to get the nipples back up higher onto the implant and reshape the bottom pole of the breast. Unlike her first breast augmentation procedure, this second surgery decades later was virtually painless with very little recovery. (the hard work of making the implant pocket had already been done)

She had a rapid recovery and was very pleased with the change in the shape and appearance of her breasts. At three months, the lift scars were still maturing and are red. But the redness will fade over the course of the next six months.

Case Highlights:

1) After breast augmentation, ptosis of the breast can develop over time if the tissues become stretched and loose. This can potentially give the appearance of breast implant deflation or rupture.

2) Whether the original breast implant is replaced or not, a breast lift is needed to reposition the nipple and put the tissues back up on top of the implant.

3) Breast lifts done with the placement of a breast implant or done secondarily with implant exchange or replacement result in scars. Breast lifts are about accepting the trade-off of scars for improving the appearance of ptosis.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

While all breasts naturally sag as a result of aging, this problem is significantly exaggerated by extreme weight loss. Much like letting air out of a balloon, the breast deflates with weight loss and the breast mound and nipple sag and, in many cases, end up with the breast pointing south and the nipple pointing to the floor. This breast deflation from weight loss creates a condition known as breast ptosis, or the standard plastic surgery term for sagging. (it also occurs in the upper eyelid and is known as lid ptosis)

Understanding breast ptosis and how to classify it is important for all patients to understand, because the degree of breast ptosis determines the appropriate plastic surgery treatment. Does the breast need a lift, a breast implant or both? If it needs a breast lift, what type of breast lift….vertical or extended? These type of treatment decisions are guided completely by whether breast ptosis exists and , if so, to what degree?

Breast ptosis is defined by where the nipple sits relative to the lower breast crease or inframammary fold. (where the underside of the breast meets the rib cage) In a normal youthful breast, the nipple and the entire breast mound sit above the lower breast crease.  Breast ptosis occurs in four degrees of severity as follows; 1^st degree (the nipple sits at the level of the fold), 2^nd degree (the nipple sits below the fold but some breast tissue is still below the nipple, 3^rd degree (the nipple sits below the fold and at the bottom of the breast), and pseudoptosis. (the nipple is above the fold but most of the breast sits below the fold)

Knowing the degree of breast ptosis determines breast reshaping options. For 1^st degree ptosis, a breast implant alone or in conjunction with a small breast lift will work well.  For 2^nd and 3^rd degree ptosis, vertical and extended breast lifts with implants for volume are needed. The lower the nipple sits, the greater the amount of breast lifting that is needed. Breast implants can never lift a nipple that is too low, that is what breast lifts do.

Dr, Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis