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This is probably the number one question I get from patients who come to see me for Breast Procedures. A Breast Lift will place additional scars on the breasts and, let’s face it, no one wants more scars than they need. But the goal with any plastic surgery procedure is to get the best outcome, not necessarily to take the least invasive approach. The determination as to whether or not you need a Breast Lift is not black or white, and even more confusingly, can vary depending on which surgeon you ask. I like to think of it as 80% based on your specific anatomy and about 20% based on your aesthetic goals. Let’s break it down:
Volume vs. Shape:
It’s helpful to distinguish between these two procedures based on the relative goals each of them strives to achieve. Breast Augmentation traditionally involves the addition of an implant to the breast to either add additional volume or to replace volume that has been lost over time, with pregnancy and breast-feeding, or with weight loss. A Breast Lift, on the other hand, involves a re-shaping of all breast components-- elevation of the nipple and areola, removing extra skin, and re-structuring the glandular breast tissue itself into a more youthful, perky shape.
Anatomy, Anatomy, Anatomy:
When it comes to surgery, everything ultimately boils down to patient anatomy. The three pertinent anatomic features that I evaluate during a breast examination are (1) the nipple position (2) location of the breast tissue and (3) the breast fold (Inframammary fold). Once I’ve identified and quantified these features, I look at how the nipple and the breast tissue relate to the Inframammary fold (IMF). Is the nipple above, at, or below the Inframammary fold? Is the majority of the breast tissue above, at, or below the Inframammary fold? In youthful, perky breasts the nipples and the majority of the breast tissue are well above the Inframammary fold. With age, babies, or weight changes, our skin stretches out and the elements of the breast start to creep lower and lower on the chest. In some patients, they have none of the above factors but just naturally developed breasts with a low nipple position and/or lower breast gland.
What are your Goals?
So what’s this other 20% I mentioned earlier? Well, in my practice I find that a good handful of my patients (mostly but not exclusively mothers who breastfeed) fall into this middle ground category where the breasts are obviously deflated from breastfeeding and their nipples are lower than “ideal” but certainly not pointing down to the floor. An implant will obviously be needed in order to “re-inflate” the breasts, but do they need a breast lift as well? This is where communication is key. What are the patient’s goals? Is it to have the breasts they had when they were 20 years old? If so, then yes a Breast Lift is the right choice to get them the outcome they desire. On the other hand, if their goal is just to fill out a bra again and feel proportional but they are totally happy with their slightly lower nipple position, then an implant alone might get them the outcome they desire. Now, it's important to keep in mind that while goals are imperative to surgical planning, they are only part of the equation. These goals also have to be supported by the realistic limitations of anatomy and what surgery can achieve. In patients with very low nipple positions, very ptotic breasts or lots of extra skin, placing an implant alone will make the breasts look exponentially worse.
Turning Back the Clock?
It’s not always about the “restoration” of breast shape. Some patients didn’t lose it, they never had it to begin with. While we have traditionally counseled patients to postpone a Breast Lift until they were either certain they weren’t having kids or were done having kids, I am seeing more and more pre-kid patients seeking this procedure. And quite frankly, I think it’s awesome. In my humble opinion, the absolute best time to enjoy your youthful breasts is...shocker....in your youth!
So why not fix it if it bothers you, regardless of where you are in your foreseeable life plan?
Dr. Megan Dreveskracht is a Seattle-based Female Plastic Surgeon who specializes in Aesthetic Surgeries of the Breast, Body & Face. To schedule your consultation, call 206.860.5582 or fill out a contact form here.