Lifting and reduction techniques are common methods of cosmetic breast reshaping. Whether it is to lift up a smaller sagging breast or to reduce a large and pendulous breast, pushing up breast tissue and encasing it in a smaller and tight skin envelope is the basic approach. It would seem logical that by so doing the upper pole of the breast would be made fuller. There is no doubt that this is initially true but what happens long term?
There have been numerous breast lifting and reduction techniques that claim improved and persistent long-term upper pole fullness. Some use sutures to sew breast tissue pillars up to the fascia while others move breast fat flaps upward to replicate the effect of an ‘implant’. While short-term pictures appear encouraging, there has been no objective measurements to assess the validity of these breast reshaping claims.
In the December 2011 issue of Plastic and Reconstructive Surgery, a well-crafted photometric study was reported on how well breast lifts and breast reductions work for creating upper pole fullness. The author looked at 82 international publications using a wide variety of breast reshaping techniques. Measurements were made on a variety of breast landmarks, including upper and lower pole fullness and projection. The study found that no method of lifting or reduction increased upper pole fullness significantly. In fact, nipple overelevation occurred in a significant number of studies (42%) undoubtably due to an initially full upper pole that went on to bottom out later. In over half of the studies, a tear drop nipple deformity was seen with a less than round areolar shape.
This study and other findings not mentioned here bring forth many breast reshaping misconceptions. The first as already mentioned is that no method of breast reshaping will enhance upper pole fullness long-term. Many patients think it will but it does not. This is why implants are often suggested as part of a breast lifting procedure to do exactly what it doesn’t…create long-term fullness in the upper pole. Secondly, breast lifts do not make a breast look bigger. Rather a breast lift or mastopexy is really a bit of a breast reduction as well. The breast may be uplifted but it will appear smaller. Again, another reason why an implant may be needed in a breast lift to overcome this ‘downsizing effect.’
Dr. Barry Eppley
Indianapolis, Indiana