Breast Lift Approaches
	By Dr. Frank Lista M.D., F.R.C.S.C. www.theplasticsurgeryclinic.com View Dr. Lista's profile

  The problem of breast ptosis, or droopiness of the breast, is a very common one. This problem is commonly seen in patients who have had children or who have breast fed or who experience a significant weight loss. Other patients just seem to develop breasts which are droopy and require more volume.

  There are three basic surgical approaches to correcting this problem. The exact method of correction that is right for any patient depends on the severity of the problem and the patient's wishes in terms of how much scarring she is willing to accept.

  The first way to deal with a droopy breast is to perform a breast lift. In a breast lift the excess skin is removed, the nipple is slid up to a higher position and the remaining breast skin is tightened. The classic way of doing this procedure is with the typical anchor scar. This scar has three components: around the edge of the areola, a vertical scar from the bottom edge of the nipple down to the bra crease, and then along the bra crease horizontally. This give the typical "anchor" shaped scar.

  A newer technique has been developed that significantly reduces the scarring associated with breast lifting. This is called the vertical scar technique ('lollipop' incision). In this method the long horizontal scar is eliminated and the only remaining scar is the scar around the edge of the areola and the vertical scar down to the bra crease. This is an important improvement over the older anchor technique because there is no scar in the bra crease.

Breast lift using a lollipop incision resulting in no scar under the breast
Photo courtesy of Dr. Frank Lista

Breast lift using a lollipop incision resulting in no scar under the breast
Photo courtesy of Dr. Frank Lista

  In patients with very mild breast droopiness, a Benelli or peri-areolar mastopexy is possible. In this technique the only scar is around the edge of the areola. This method of breast lifting is only suitable with minor breast droopiness.

  Patients who have breast droopiness and are thinking of having a lift may also choose to add an implant at the same time. There are many reasons for adding an implant at the same time as a breast lift. The most obvious reason is a desire for a larger breast. The other reason is that an implant can improve the look of a breast lift by giving more fullness in the upper part of the breast and in the cleavage area. An implant also helps give the breast a firmer feel.

  The last and most important consideration when thinking about a breast lift is the possibility of using a cohesive gel implant to augment and lift the breast. In mild to moderate cases of breast droopiness, a cohesive gel breast implant can successfully serve to lift the breast as well as giving the patient an augmentation. This occurs because cohesive gel implants are solid. Their solid nature gives the breast the shape of the solid anatomic (tear drop) shape of the implant. In addition, the implants are textured meaning they have a rough coat to them. This rough coat acts as Velcro and lifts the breast up. The advantage to this technique is that it eliminates the need for the lift in many patients. This means that the patient does not require all the scars associated with a lift. In order for the implant to lift the breast, the cohesive implant needs to placed above the muscle. This position is perfectly acceptable when using cohesive gel implants because they are actually designed for use in this position. They feel natural and soft and usually give a great result.

Cohesive gel implants placed over the muscle to give a scarless breast lift: a subtle breast lift without the scars of a full lift
Photo courtesy of Dr. Frank Lista

Cohesive gel implants placed over the muscle to give a scarless breast lift: a subtle breast lift without the scars of a full lift
Photo courtesy of Dr. Frank Lista

  Patients should be aware that using cohesive gel implants to give a breast lift will never lift the breast as much as a surgical lift. But using a cohesive implant to give a lift does save the patient from a lot of the scarring which many patients are eager to avoid. Most patients choose to accept a slightly lower but minimally scarred breast, especially when the implant not only lifts the breast but also makes the breast fuller, firmer and more attractive. The results patients achieve with this technique is very natural both in terms of the look and feel of the breast. And that, after all, is what we are all striving to achieve in cosmetic breast surgery.