Breast Lift

BREAST LIFT

Many women, particularly those who have had children, will notice that their breast tissue will droop and “deflate” following breast-feeding. This phenomenon is not limited to mothers, however, as changes in weight as well as hormone fluctuations can cause these same issues. Some women, in fact, are born with breasts that may not be as “perky” as they would like. Many patients who complain of this breast deflation, or “breast ptosis” in medical terms, benefit from an elevation of the breast tissue, known as a breast lift or 





mastopexy 

Breast lift achieves the following:

  Brings the breast to a more attractive position 
  Reduces the size of Areola 
  Helps the breast to become more perky . 

There are several ways to go about providing true or apparent lifting of the breast tissue.

 Wise Pattern Breast Lift: 
The standard and effective technique to lift the breast is known as a Wise pattern mastopexy Classically, breast lifts were done through a pattern similar to classical breast reductions, resulting in a scar around the nipple, down the center, and underneath of the breast, which you can think of as an anchor type of configuration. While this operation works well for many patients, it provides a lot of scarring, and can, in certain patients, give rise to a breast that lacks proper projection. Efforts were subsequently made to try and improve the deficiencies of this operation, and a plastic surgeon named Dr. Lejour developed a breast surgery that eliminated the scar under the breast and improved postoperative breast form. This is called the vertical mastopexy.

 Vertical Breast Lift:
 The vertical mastopexy has become one of the mainstays of the breast lift here in my practice. This operation works well for most women who do not have massive breasts, and allows some degree in reduction of the size of the breast if this is what you are looking for. Alternatively, the vertical breast lift can be combined with a breast implant in order to increase the breast size. In either situation, the scars from this vertical breast lift look like a lollipop- around the nipple and down the center of the breast. The concept behind the vertical mastopexy is the rearrangement of the breast tissue itself to a higher position, rather than creating a skin sling to suspend the breast tissue. This breast tissue rearrangement is felt to give a more pleasing shape and a longer lasting result.

 Benelli Breast Lift:
 For those patients that require only minimal lifting and who may be adverse to the longitudinal scar of the vertical breast lift, an alternative may be what is called a purse-string, or Benelli mastopexy. This operation is performed by resection of an eccentric area of skin around the nipple, which can be thought of as an oval shaped doughnut where more skin is resected above the nipple than below it. Following a small amount of dissection in the breast tissue to strengthen the breast lift, this incision is closed with a purse-string suture that “cinches” the breast envelope centrally and upward to provide a lift. The scar resulting from this breast lift operation is only around the nipple along the transition between the pigmented areola and the skin of the breast. This operation does have the limitation of lifting the breast tissue only one to two centimeters, however, and so only patients with minimal ptosis may be candidates for this procedure.

 The Use of Breast Implants With Your Breast Lift: 
With any breast lift procedure, the result may be enhanced with the ancillary use of a breast implant to increase volume and fullness. 
A breast implant may be used with the classic breast lift, the vertical breast lift, or the Benelli breast lift procedure. Placement of large breast implants during these procedures is discouraged because of the following safety issue. When dissection of the breast tissue is performed in order to achieve a higher and more youthful appearance, careful attention must be given to the blood flow to the breast tissue that is being rearranged. Large implants placed under this dissection can put undue tension on the lifted breast tissue, causing compromise of the nipple. breast implants that are not excessively large may be used at the time of your initial breast lift operation as a single procedure. Discussion regarding your individual anatomy and expectations will allow a plastic surgery plan to be tailored to your specific situation. The quality of scar can also be improved if your surgeon is committed and places deep suture to avoid widening of the scars

Scarless Breast Lift

Scarless Breast Lift

I'm sort of on the verge of needing a breast lift and wondering if the scars are not worth the trade-off... what kind of incisions or techniques leave the least amount of scarring?

Marian

Answer :

This is a great, and very common question. The principle thing that I would recommend to you is to avoid compromising the form of your breast for fear of the scarring. Any qualified plastic surgeon will be able to minimize the scarring with suture techniques, and although there are no guarantees, you should hopefully end up with fine white lines for your scars that progressively fade with time. You are better off having a great breast form and a little more scarring than a breast shape that is inadequate or unattractive with one scar less.

If you are indeed borderline, it is likely that you will require less, rather than more incisions to re-create a youthful breast form. Several options with or without breast implants are available to you, with varying degrees of correction and size changes. The key is choosing the right operation for you, and that involves a careful discussion with a caring and qualified plastic surgeon.

There is not some thing as a scarless breast lift.  The real question is do you need a lift and if so how much. Some patients with very minor or grade one ptosis with obtain a lift and increased fullness with breast augmentation alone. Others require minimal lift which can sometimes be done with only a periareolar incision and and implant. In the majority of cases a better lift is achieved with  the addition of at least a vertical incision

This is a brief outline of the scars that can be expected after a breast lift, in order of increasing amounts of preoperative breast sagging:

1.  Scar Around the Top Half of the Areola:  this is best for patients with no more than an inch of nipple/breast sagging and no need for entire breast reshaping

2.  Scar Around the Entire Areola:  this is best for patients with about an inch of nipple/breast sagging and need for minimal tightening of the breast skin

3.  Scar Around the Areola and a Vertical Scar Down the Breast:  this is best for patients with a moderate degree of breast/nipple sagging, some loss of superior breast fullnes, and need for moderate reshaping of the breast. 

4.  Scar Around the Areola, Down the Breast, and in the Breast Crease:  this is best for patients with significant breast/nipple sagging, total loss of fullness of the superior breast, and need for total reshaping of the breast.

In select patients, the scar burden necessary to perform a breast lift can be minimized by simultaneous placement of a breast implant.  A breast implant is able to affect a small degree of breast lift and restore superior breast fullness without the need for larger scars associated with a traditional breast lift.

Breast lift achieves the following:

·        Brings the breast to a more attractive position

·        Reduces the size of Areola

·        Helps the breast to become more perky(Agile)

It is important to know  If the skin and fat above the nipple in the upper poles of the chest are adequate then a subglandular placement with silicone implant would probably give you the most natural look and feel  . Subglandular placement is acceptable if you have at least 2cm of tissue pinch in the upper pole.

If you have minimal ptosis (or sagging) of your breast, a subglandular placement might give a nice result with fewer scar lines or incision lines, If you have significant sag then I would  typically recommend a submuscular implant with a complete breast lift, though you will have more scars.

   A dual plane mastopexy with a reasonable size implant can give your nipple a lift and move your breasts off your chest wall.  It will also give you fullness in the upper quadrant. 

Why do breasts sag?                                                                                                                                                      There is too little volume or too much skin. Many women, particularly those  who have had children, will notice that their breast tissue will droop and “deflate” following breast-feeding. This phenomenon is not limited to mothers, however, as changes in weight as well as hormone fluctuations can cause these same issues. Some women, in fact, are born with breasts that may not be as “perky” as they would like.

Greater degrees of excess skin require greater amounts of skin removal, resulting in larger scars. 

I believe  in taking an aggressive approach to scars in this situation, with progressive suturing techniques and postoperative scar treatments as a complimentary service to my breast lift patients, so that they will never feel like the improved shape was not worth the scars they have.

 I also strongly believe that the technique for breast lifting should be determined by the patient's goals for breast shape, and the shape they are starting with. Each different technique (I do 4 different types) will tend to produce a characteristic change in the shape of a breast, and so the technique needs to be matched appropriately to the patient, using her examination and her goals as guides- otherwise you may end up with a small scar, but a funny or unfavorable breast shape.

The degree of lifting and the amount of scars required to restore to you a youthful and toned breast depends on how much droopiness you have. The key relationships are where the nipple lives relative to the crease under the breast and whether it points forward or downward. The farther down, the farther it needs to come up to look good and the more incisions it takes to get there. The other key issue is the degree of horizontal skin laxity or excess skin present.

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Some patients have a periareolar or "Benelli" lift, with an incision just around the areola, in hopes of avoid the incisions of a conventional Wise pattern lift. When a large breast lift is attempted through such an incision, characteristic problems can occur, with gathering of the incision, decreased areolar circulation (some patients can actually have nipple death), and large resultant nipple-areolar complexes. It is in my opinion a mistake to attempt too great a lift through too small an incision Periareolar.When lifts require an implant , They are good for patients whose needs for lifting are less with their nipples above the crease and pointing forward to start with. If overextended, this lift will result in a flat, baggy looking breast with a large areola with poor scars around it. Vertical lifts, "L" lifts, short"T" lifts and full"T" lifts are the next level and can be done with or without implants. They have more scar but provide a better looking conical projecting breast in the hands of an excellent sculpting surgeon. Nobody wants scars but everybody wants the best shape and the scars are a trade-off for that. They fade with time and generally most all patients will trade their best shape for the scars to get there

here simply is no way to perform a breast lift surgery without some type of scar. The only thing that can be done is to try to optimize the position or quality of the scars that are made. In general, the best scars are seen when incisions are placed under the least amount of tension.The good news is that most of the scars fade nicely and are specifically placed to be as inconspicuous as possible

The idea of a scarless surgery is an attractive one ,  It is better to think of it as minimizing the length of any scar and optimizing its position in order to obtain the best result.

Liposuction, Liposculpture , Liposelection - What's the Difference?!

Liposuction, Liposculpture , Liposelection - What's the Difference?!

Question

What is the difference between all of these types of lipo: Liposuction, Liposelection, Liposculpture? What type works the best?

Helen

Answer:

Liposuction is the basic technique, the simultaneous mechanical breaking down of fat together with suctioning using a tube attached to a vacuum device (aspirator) .But We sometimes use the word  liposculpture, because we are focusing on shape more than on volume (we always focus on both) which suggest superior results.

Liposuction is formally referred to as Suction Assisted Lipectomy, whereby fat cells are removed using a small cannula and a vacuum assisted device. The technique is well recognized, safe, and commonly used by most plastic surgeons. Recent advances have changed the scope of liposuction to include an added benefit of not only removing the fat through suction, but also dissolving the fat with energy. The energy types are ultrasound energy (VASER) or laser.

The process of ultrasound assisted liposuction is well documented and involves a process of cavitation, whereby sound waves are used to break open and kill fat cells prior to the liposuction. This results in improvement in contour for patients. Basically the result you will get depends far more on the nature of your skin and its ability to shrink , A small amount of heat can have the beneficial effect of causing more contraction of tissues. Heat also increases the chance that the body may respond by making more fluid (called a seroma, which may need to be drained). Then in the 90's, ultrasonic liposuction was introduced from Europe with the idea of breaking down the fat first and then removing it. This was thought to be less traumatic to other tissues like blood vessels and fibrous supporting tissue.

Liposelection i
s a name coined by the makers of one current generation of ultrasonic-assisted liposuction machines , They call it Vaser ultrasonic liposelection. The reason for the name is that the way the ultrasonic energy is generated both at the tip and along the shaft of the probe makes the fat cells split apart from each other .,Vaser is useful for treatment of areas that are densly fibrous such as the back and male breasts ,gynecomastia ,. When used for a lipo-abdominoplasty, it is great because it allows "lipo-sculpting" of the abdomen and torso at the same time.

 You can also have laser-assisted liposuction, such as the SmartLipo Triplex. SmartLipo is a machine that has a laser to melt the fat.  The fat has to be suctioned out in addition to the fat melting part. The devil is in the details here - if the surgeon that is doing the liposuction doesn't do a good job getting the patient numbed up or doesn't do a good job getting the fat out, you can end up with a mess on your hands.

"Liposculpture" is just a usage that connotes an artistic approach to contouring. You might say it means that what is most important is what is left behind, the final shape. Since the underlying body is obscured by excessive fat, the removal of that fat to reveal the body shape can be called lipo-sculpting , either with the aid of ultrasound or with laser energy (Smart Lipo, etc).

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