Breast Lift

Pregnancy

The most common reason patients come Dr. Cook for breast lift surgery is to restore a pleasing breast shape after pregnancy and breastfeeding a baby. Dr. Cook recommends that his patients hold off on breast lift surgery until they are reasonably certain that they are not going to have any more children. If a patient becomes pregnant after she has had a breast lift, the breasts will typically go through the normal cycle of pregnancy, but the lift may have to be repeated in order to restore the desired breast shape.

Significant Weight Loss

Dr. Cook sees an increasing number of patients who seek him out to restore the tone of their breasts after major weight loss. These patients frequently have a very significant loss of breast volume, so that he may recommend the use of breast implants or fat grafting along with the lift to restore the internal breast structure. The structural breast lift technique allows him to rearrange the breast structure so that, in some patients, he is able to return enough volume to the upper portion of the breast with natural breast tissue that he can avoid the use of implants.

Gravity and Hormonal Changes

Even without pregnancy and weight loss, most breasts will settle over time because of the effect of gravity and changes in the hormonal environment. To a degree, supportive bras will help to delay this process. There is a wide variation from one person to another in the structure of collagen and other molecules that make up the support of our bodies. This variation is one of the reasons that some breast lift patients will come in after experiencing significant breast settling in their 20s, while others will still have a tight breast structure in their 50s and 60s.

Breast Ptosis

Some patients experience severe drooping of the breasts from the time the breasts begin to develop. Plastic surgeons refer to this as congenital breast ptosis. There may be other changes with this type of breast, such as a restriction of the breast base or herniation of breast structure through the areola. Various names are attached to these changes, such as Poland’s Syndrome and constricted breast syndrome. In general, patients who experience this breast shape in their high school years tend to be very self-conscious. For these patients, corrective surgery can be a wonderfully liberating experience. Many will need a combination of implants, some type of breast lift, and other advanced techniques to get the best possible breast shape.

Large, Weighty Implants

If a large breast implant is placed beneath a breast that has already developed significant drooping, the device may provide a bit of a temporary breast lift, but the breast will eventually droop even more due to the weight of the implant pulling it downward. Dr. Cook sees a good number of these patients every year. His solution is to reduce the size of the implant and carry out a breast lift, sometimes in combination with other techniques.

Periareolar Breast Lift Surgery (Donut)

This operation is appealing in concept because it limits the scar to a line that runs around the border of the areola. The idea is to remove an oval shaped area of skin from around the areola so that when the skin at the edge of the oval is sewed to the smaller circle formed by the areola, a tightening and lifting will occur. The big problem with this breast lift technique was that the scars tended to spread because of tension.

Dr. Louis Benelli of Paris made a wonderful breast lift contribution when he suggested weaving a purse-string suture under the skin at the border of the oval. When this is tightened and a knot is placed, it brings the big oval down to the size of the smaller circle, so that healing can occur without excessive tension.

This breast lift technique is well-suited to patients with smaller to midsize breasts that have developed a mild degree of settling after pregnancy or weight loss. The result is often enhanced by the placement of a saline or silicone gel breast implant in the plane that is appropriate for that patient’s needs (under the breast or under the breast and the pectoral muscle).

There are some patients who just want a mild breast lift result and don’t want any scars except those around the areola. For them, the periareolar breast lift can be a reasonable option. It is possible to extend the power of this operation with a wider undermining of the skin and a tightening of the breast structure in the lower portion of the breast, but even then the operation is not as powerful as other types of breast lift. For some patients, the power of this approach can be enhanced with the BodyTite^® procedure.

There is one other aspect of the periareolar breast lift that deserves mention: In breasts that have an overly pointed shape, the operation naturally diminishes the projection of the central part of the breast and rounds out the breast shape. For some patients, this is a significant benefit. One situation where Dr. Cook takes advantage of this aspect of the periareolar mastopexy is when he is trying to match the shape of a reconstructed breast by sculpting the opposite natural breast, since a reconstructed breast does not project as much as a natural breast.

In Dr. Cook’s experience, this breast lift technique provides a reasonable degree of long-term satisfaction when the breast is not too large and where an extremely powerful lift is not desired.

Structural Breast Lift (Structural Mastopexy)

The structural breast lift is Dr. Cook’s preferred breast lift technique. As breasts droop, they tend to spread out and lose their structure. A breast that was once firm and beautifully shaped becomes wide, hollow, and settled. Because of the lack of underlying structure, the skin of the ptotic breast also loses its tone.

The structural mastopexy addresses these issues head on. One of the most appealing aspects of the structural breast lift is that it recompacts the breast structure. It is also possible to narrow the base of the breast to a degree and raise the level of the fold under the breast, which is difficult to accomplish with other techniques.

The structural breast lift is close in technique to the vertical breast lift, but there are some important differences. Rather than going straight down to the fold, the scar curves in its lower portion toward the outer aspect of the breast. This eliminates the bunching seen at the lower end of a vertical mastopexy. More important, this breast lift pattern provides Dr. Cook with an unprecedented ability to sculpt and narrow the base of the breast.

The structural technique provides a multi-level anchoring of the breast in its new position. This is a significant feature, since breast lift techniques that merely tighten the skin tend to settle and stretch. The technique involves a structural rearrangement of the breast tissue to replenish upper pole volume. In many cases, this allows Dr. Cook to avoid using a breast implant to fill out the upper portions of the breast with a breast lift.

Patients are particularly pleased by the way this breast lift operation restores a degree of fullness to the upper portions of the breast in a way that still looks natural.

Vertical Breast Lift (Lollipop)

This breast lift procedure was developed largely in France and Brazil. American surgeons were reluctant to accept it, but the technique has become much more popular in recent years.

Skin is tightened along a vertical line that runs from below the areola to the lower portion of the breast. A circle of skin is removed from around the areola. The resultant scar to some people resembles a lollipop, hence the term “lollipop breast lift.”

This technique tends to create a bunching up at the bottom end of the scar. This is either allowed to “settle in,” or a circle of skin is removed and tightened down with a purse string suture. What confuses many patients is that the scar is only part of the procedure. Sometimes the breast lift just consists of skin removal, in which the procedure is conceptually similar to the classical mastopexy—using skin to lift the breast. Sometimes internal work is done on the breast to provide reinforcement of the lift. If you are considering this type of lift, make sure you understand what is being done beneath the surface.

In Dr. Cook’s practice, the vertical breast lift was a predecessor to the structural breast lift. Most variations of this operation do not provide as powerful an anchoring of the breast tissue as the structural operation accomplishes.

Vertical breast lifts also do not typically allow for an effective restoration of volume in the upper portion of the breast. The appeal of the vertical lift is that it largely avoids the scar that runs along the fold under the breast.

In one variant of this breast lift operation, Dr. Cook can utilize a portion of the breast structure to restore volume in the upper pole of the breast. In select patients, this can allow for the restoration of a pleasing breast form without the use of implants. With more significant loss of upper pole structure or with patients who desire an increase in breast volume, a saline or silicone gel implant can be used as part of the breast lift procedure.

With greater degrees of lifting, there may be the disadvantage of a puckering of tissue at the lower end of the vertical scar. With the structural breast lift, the tone of the lower aspect of the breast is better controlled.

Classical Breast Lift (Anchor)

For patients who have severely settled breasts, the classical operation may offer significant benefit. As with the other types of breast lifts, this surgery may be combined with a breast implant to provide better upper pole structure and increased volume.

For many years, this was the dominant breast lift technique in the United States—and still is probably the most commonly performed technique for breast lift. Essentially, the skin is used as a brassiere to lift the breast by removing excess skin from along the fold under the breast, as well as around the areola and along a line that runs from the fold under the breast to the bottom edge of the areola. This produces a scar that somewhat looks like an anchor.

The classical breast lift operation is a good alternative for some patients, although Dr. Cook now uses it much less frequently than he did in the past. It has two main disadvantages: relatively long scars along the fold under the breast and its reliance on tightening the skin as the main mechanism for lifting the breast. With this operation, the skin is tightened in vertical and horizontal directions.

Like tailoring an outfit, this breast lift surgery involves taking a vertical “dart” by removing a segment of skin in the midline of the breast and a horizontal “dart” by removing skin along the fold under the breast. The nipple and areola are moved to a higher position on this tightened breast. Many very good plastic surgeons use this breast lift technique, although Dr. Cook has noticed a trend toward an increasing number of vertical lifts.

There are some patients for whom Dr. Cook recommends variations of the classical breast lift. In patients with an extreme degree of looseness of the skin, such as might occur with massive weight loss, the combined horizontal and vertical tightening can be of benefit—even though it means accepting the scar along the fold in the inner portion of the breast.

1. The lower portion of the breast settles and overhangs the skin that sits beneath the lower edge of the breast.
2. The nipples descend, so that there is a long visual distance between the collar bone and the breast.
3. As the breast structure descends, the upper part of the breast loses its natural fullness.
4. The breast loses its internal support, so the breast loses its projection and tends to spread out.
5. As the breast settles, the skin of the lower portion of the breast is stretched out.

1. Restore the breast to where it used to be.
2. What Dr. Cook calls a recompation of the breast structure. In other words, take a breast that has been spread out and make it firm again.
3. Bring the nipples back to a higher position and reduce the size of the areolae if they have been stretched out.
4. Restore a pleasing volume balance to the breasts so that there is a nice fullness in the upper portions of the breast.
5. As much as possible, produce results that last a good long time.

Dr. Cook performs the surgery at a high-quality private surgery center near his Gold Coast office. The surgery is performed with the breast lift patient under a light anesthetic that generally does not require full intubation (breathing tube through the vocal cords).

Dr. Cook makes generous use of a long-acting local anesthetic, so most patients awaken with a reasonable degree of comfort. If structural mastopexy is combined with breast implants, your discomfort will be a little more for the first few days, but it is easily managed with common pain pills and a medication that relaxes the pectoral muscle. You will be protected by a supportive dressing for the first few days after surgery. Most patients return to see us three or four days after surgery, at which time we remove the dressing and provide a gentle support bra. Most patients are able to return to work four to five days after surgery.

Patients can return to normal light activity as soon as they are comfortable. We encourage moderate amounts of light exercise during the recovery, but it is important for the patient to avoid heavy exercise for four to six weeks. Dr. Cook and his team will provide specific guidelines for athletes about when it is OK to return to specific activities of their sport.

All forms of breast lift and breast reduction carry the possibility of interfering with breastfeeding. Dr. Cook and his team will discuss this with you in specific detail at the time of your consultation.

Dr. Cook recommends that your breasts be imaged at a high-quality mammographic center. Mammographic changes can occur after all forms of breast lift and breast reduction, but—in general—the changes are distinguishable from those that suggest breast cancer.

A breast lift (mastopexy) is almost never covered by insurance. Insurance companies are generally more restrictive about coverage of breast reduction than they were in the past, and the degree of restriction increases with each year. The Whole Beauty^® Institute team has extensive experience with breast reduction surgery, and if we think there is a chance of coverage, we will work with you in the process known as predetermination. In this process, we submit information as to why this should be a medically indicated procedure.

Complications after this procedure are relatively uncommon and are similar to those encountered with other forms of breast reduction and breast lift. These include a collection of tissue fluid or blood (seroma or hematoma) that requires drainage, less than ideal scars, interruption of circulation to the nipple, disruption of sensation, and poor healing along the incisions. The risk of these complications diminishes significantly if you follow our pre- and postoperative instructions to the letter.

Dr. Cook has extensive experience with all major techniques of breast surgery, including breast lifts. The majority of patients who come to us in consultation are good candidates for the structural technique. Some patients with massively enlarged breasts or with extreme stretching of the skin will require different techniques. Dr. Cook will make this determination during your consultation.