Breast Lift 101 (San Antonio, TX)

Introduction

If you are contemplating a breast lift, it can be intimidating to meet with a plastic surgeon to discuss something so personal. At Alamo Plastic Surgery our mission is fully educate patients so they are empowered to make great decisions for themselves. In this blog article, we strive to walk you through the process and different options. Please contact us at hello@alamoplasticsurgery.com or 210-670-5302 if you have additional questions or comments.

Initial Consultation

First we will obtain a past medical history and surgical history. As a breast lift is a cosmetic procedure, it is important to make sure there are no medical risks associated with the surgery and we can meet your cosmetic goals.  All of these things we will discuss in depth when you come for a visit. In addition, we will conduct a physical exam which will include several measurements to assess the skin quality and the breast tissue volume. These will dictate which procedures are best for you.

Breast Lift Surgery Explained

For a traditional breast lift, we strive to correct two issues:

1. Excess skin and potentially low nipple position

2  Breast tissue that has slid off the chest

1. Skin - To address the excess skin and low nipple, the most common skin incision pattern in the US is a Wise pattern, also called an 'inverted T' or 'Anchor scar'. During this procedure, I will also cut into the areola (pigmented skin around the nipple) to make it smaller, if it has become stretched. Immediately after surgery, the areola will appear to be a little too small but, don't worry, it will stretch out over time like it did the first time. Utilizing this pattern, the nipple is raised and inset into position at the center of the repositioned breast mound. The skin below the new nipple position is then sewn together to create a nice straight vertical line. The side to side scar at the bottom fold of the breast is variable in length depending on the magnitude of extra breast skin (a smaller lift will result in a shorter scar as less skin needs to be removed). As you can see from the diagram, the scar pattern looks like an upside down letter 'T' or anchor.

2. Breast Tissue - Now to address the sagging breast mound. This has to do with what is being changed on the inside (under the skin). I utilize a "superomedial pedicle with a caudally based 'auto augmentation' flap technique". To start, you can think of it as cleaving the breast in two. This sounds dramatic, but just below the nipple and areola there is an incision through the breast. The nipple is going to stay attached from a blood supply from upper inner part of the breast or 'superomedial' (definition is above and towards the sternum). This is going to supply blood to nipple and areola. The nipple will move upward and rotate slightly into its new position. The lower portion of the breast (not attached to the nipple) is analogous to an inferior pedicle. But, in this case, the lower part of the breast is only used to provide additional bulk and function like an implant; it will be moved up to the new mound position underneath the new nipple. Thus, "auto augmentation" flap just means using your own breast tissue like an implant. However, it is not an implant as the shape produced is a teardrop shape, not round like most breast implants. A full profile implant associated with a breast augmentation creates superior pole fullness (rounded at top of the breast). To have more superior pole fullness with a breast lift, breast fat grafting can improve the contour and volume. Many patients are happy with this approach to avoid a breast implant.

For a breast lift, I try to keep as much of your breast tissue as possible. With a breast reduction, I would remove some breast tissue to reduce the overall size and weight of the breast.

For breast lifts, the immediate result after surgery, the breast shape may look a little like a breast augmentation (round full top), but this is temporary and due to postop swelling. Also immediatly after surgery, the nipple position will look artificially low and maybe even pointing down. As the breast ultimately settles lower, the nipple will be in an ideal position.

Breast Lift Risks

Immediate Risks

• Bleeding - Could lead to a hematoma (collection of blood) or an expanding hematoma (ongoing bleeding) which could limit blood flow to the skin and nipple which may require a return to the operating room. An expanded hematoma is very rare.
• Poor Blood Flow to the Nipple - As mentioned in the previous section, the blood flow to and from (venous outflow) the nipple in order for the tissue to survive. If either of these break down (blood flow in or out), the tissue may ultimately heal poorly. If there is compromised blood flow, there are certain things Dr. Albright will do in the operating room to try and improve the flow. However, if these do not work, then a free nipple graft may need to be done. A free nipple graft involves physically removing the nipple and then suturing it back on like a skin graft. When this happens, we cut the nerves and milk ducts. Therefore, the major consequences of free nipple graft are loss of sensation, and inability to breastfeed. This is extremely rare and I have never had to do this for a breast lift.

Intermediate Risks

• Wound Healing - The most common area of wound healing is at the T point (bottom of the anchor where the scars meet). "T" also stand for tension. Tension decreases blood flow and any tissue without blood flow creates dead tissue so it can result in a small area of skin necrosis resulting in a small scab (typically <1 cm^2). Only about a third of patients will have this occur and most commonly only on one breast. This is not a serious issue, and we treat these wounds with regular dressing changes. It may result in a slightly larger scar but this is typically hidden by the breast.
• Infection - Rare with breast lift.
• Seroma - Rare with breast lift.

Long Term Consequences

Scars (8-12 months to mature) after Breast Lift

Scars may widen and stretch over time. There is potential for hypertrophic scars (thickened, wide, often raised scar that develops where skin is injured) to develop if you are predisposed to them. These may be treated with steroid injections and they are only a cosmetic issue. If you have a family history of keloid scarring or know you develop keloid scars (enlarging raised scars). During the initial consultation, we will discuss any concerns you may have about scarring.

Nipple Sensation after Breast Lift

For some women, this is very important. About a third of my patients will have some decreased sensation in one nipple. It is very rare to have it in both nipples.

Breast Feeding after Breast Lift

Usually women interested in breast lift have already had children so this is not a concern. There is no guarantee you will be able to breast feed, but most women who want to can.

Impermanence

The result that you see after surgery will not last a lifetime. I recommend bra support all the time and avoiding activities that prematurely age the skin like tanning and smoking. This will help improve the longevity of the breast lift. Still the breast will undergo the normal aging process and is subject to gravity and genetics.

Breast Lift Recovery

For a specific event, please allow 4 - 6 months after surgery before breasts are perfect out of clothes.

First Four Weeks

Wear a bra all the time, no intense exercise, sleeping on your side, and any big travel plans.

• 1-2 weeks - No lifting more than 20 pounds, and avoid reaching and pulling with your arms as this might put undue tension on your breasts. Most patients will return to work after 1-2 weeks from surgery.
• 3-4 weeks - Light lifting (<45 lbs) and you may start reaching and pulling with your arms.

2 Months after Breast Lift

Most of the swelling should disappear by 2 months after the surgery. At this time, you may buy new bras (even with underwire) and new clothing for your new breast shape.

3 - 4 Months after Breast Lift

Breast lift shape should be well established with potential for minor changes up to six months.

8 - 12 Months after Breast Lift

Scars should stabilize and heal by around 8 - 12 months. After this, options to tattoo or laser the scars to reduce their visibility are available.

Breast Lift Cost

Breast lifts cost between $4700 - $7500. The main cost variables are duration of the procedure (larger breasts may take slightly more time) and whether or not fat grafting (fat transfer) is also being performed. Alamo Plastic Surgery offers Care Credit with 6 or 12 months of interest free credit.