Background: Sagging of the breasts is a very common cosmetic problem that eventually affects most women. While time, gravity, and pregnancy accounts for much of the breast sagging that occurs, some women have it naturally even when they are young. Breast lifts, also known as a mastopexy, is a well-established plastic surgery operation used for a sagging and misshapen breast. While breast lifts can achieve an uplifted and reshaped breast mound with nipple elevation, it is fraught with some long-term recurrence of some sagging or bottoming out.
When a breast lift is done, it is always ‘overcorrected’. This means that the upper pole of the breast is excessively full (stuffed up too high) and the bottom pole of the breast looks ‘cut off’. In essence, the breast can look like an inverted teardrop in cross-section. This is done this way knowing that the bottom pole or half of the breast will stretch out to some degree. This common phenomenon is built into the operation. While this helps prevent some of the bottoming out thata can be seen, it does not prevent it completely
For this reason, the laser bra lift was developed as another solution to recurrent breast sagging. The concept of this technique is based on the cause of recurrent sagging that occurs…the thin skin on the bottom half of the breast is what is holding the shape of the breast mound. It is not thick or stout enough to avoid being stretched out. It undergoes rebound relaxation because it is very thin.
Case Study: This is a classic case of breast sagging in a 42 year-old female There actually is a reasonable amount of breast tissue but there is too much skin so the breast sags. One of the most important steps in performing a breast lift (or reduction) is the preoperative markings. These lines and angles determine how much and how well the breast ends up being reshaped.
In surgery, the initial step is to make all the incisions based on the preoperative markings. The next step is what defines the laser bra lift. Rather then removing the skin that lies above the mound of breast skin that lies underneath and around the nipple down to the lower breast fold, it is largely preserved. Using a high-energy CO2 laser, the top layer of skin (epithelium) is removed through a resurfacing technique. Since the epithelium only makes up about 5% of the skin’s thickness, the rest of the skin (dermis) is left which is thick collagen like cowhide. The epithelium must be removed because it will make cysts and wound breakdown if any is left behind.
Leaving this dermis attached to the breast mound leaves an extra layer of support that ends up being closed over by the surrounding skin flaps in the breast reshaping. This effectively doubles the thickness of the skin on the lower pole of the breast for extra support. In short, this makes for an ‘internal bra’ by using your own natural tissue. Hence, the name laser (how it is done) bra (retained portion of the skin) lift.
After a laser bra lift, the postoperative management and what to expect is the same as a regular breast lift. Leaving an internal skin bra does not cause any extra pain or care. The breast incisions are taped and only internal dissolving sutures are used. In some cases, a drain may be left in place to be removed the following day. One goes home in just a surgical bra. Once can remove the bra and shower the next day.
The proven benefit of the laser bra lift is the better long-term maintenance of breast shape. Another benefit, in my Indianapolis plastic surgery experience, is that there are fewer separations at the junction of the vertical and horizontal incisions (inverted T) that are commonly seen about three weeks after surgery. While these separations do go on to heal on their own, they are certainly aggravating for patients.
Case Highlights:
1) Some recurrent sagging and bottoming out of the breast is a common cosmetic problems in many forms of breast lifting.
2) Lack of adequate skin thickness and quality on the lower pole of the breast is the culprit for this problem. The laser bra lift leaves behind an internal bra of dermal skin that provides extra support and better long-term breast shape maintenance.
3) The laser bra lift uses your own natural tissue and adds no extra surgical time or postoperative care.
Dr. Barry Eppley
Indianapolis, Indiana