Background: The combination of pregnancies, weight loss and gravity change most every woman’s breasts.All of these undesired changes are classic, the breasts change shape and they sag downward. The combination of more skin and less volume allows the breasts to lose their once uplifted and rounder appearance. Some women undergo involution only (breast tissue shrinkage)and develop no sag but this is not common.
The sagging breast may be able to be improved by implant augmentation alone but that depends on the degree of sagging. Only the most minimal of sagging can be improved by expanding the breast volume. If this is tried in more significant sagging, it not only is not improved but may actually become worse. For this reason, lifts need to be considered in many cases of breast reshaping regardless of whether implants are used or not.
Breast lifting can be accomplished by different types of lifts which are fundamentally differentiated by how much lifting they do and the length of scar they create. With the exception of the most minor degrees of sagging, only two types of breasts lifts really make a significant change. They are the vertical (lollipop) and combined vertical-horizontal (anchor) breast lifts which are so named based on their resultant scar patterns. Their degrees of lifting are impacted by the use of an implant and its size.
Case Study: This 45 year-old female wanted an improved breast shape after having children and losing a little weight. She has some mild breast asymmetry with one breast having some more sag and less volume than the other. More relevantly, the location of her nipples was slightly below the level of the inframammary folds on both breasts. While her initial request was for breast implants, it was pointed out to her that this would not produce the results she was hoping to achieve.
Under general anesthesia, a lower breast fold incision was made and an implant sizer (450cc) placed in a partial submuscular position. A vertical ellipitical skin pattern was then de-epitheliazed and the existing areolar size maintained. The nipple-areolar complex was then raised to the top of the lift excision and the breast skin tailor-tacked around it. Additional vertical breast skin was then removed and the vertical incisions closed after also removing extra skin around the areola to make sure it was circular and not distorted. in shape. All incisions were taped and she was placed in a bra. No drains were used.
Her tapes were removed one week after surgery and she returned to all normal activities two weeks later. She developed a few spitting sutures at one month after surgery which were removed. She went on to heal uneventfully. When seen at four months her breasts had a good shape with a near central nipple-areolar position. Her scars will take up to a year after surgery to fully mature.
While the breast lift implant combination procedure is needed for many deflated and sagging breasts, it is not an easy operation in which to achieve optimal breast shape, symmetry and a centralized nipple position on the newly created mound. There are many challenges to achieving what most women expect to occur without incident. In reality, this breast reshaping operation has a high rate of the need for revisional surgery to correct implant position or size, the amount of lifting and tightening, a good areolar shape, or revision of wide scars. This patient was able to achieve her breast goals in a single procedure which is fortunate for her although not always common.
Case Highlights:
1) Breasts that have lost volume and sag after pregnancy need a combination of volume augmentation and a lift.
2) The placement of implants with a concurrent vertical lift (lollipop) provide adequate reshaping when the amounkt of breast sagging is mild to moderate. (nipple at or just below the lower breast fold)
3) Breast lifts with implants has a higher need for revisional surgery than when either procedure is performed alone.
Dr. Barry Eppley
Indianapolis, Indiana