Breast Lifts Part 1 – The Assessment
Blog | Dr Eddy Dona
Wed 22nd Jan 2020
This is Part 1 of 3 in my series covering breast lift surgery. In Part 1 I’m going to discuss the assessment and things I need to consider when planning your surgery.
A breast lift, especially if combined with an implant, is the most difficult cosmetic breast procedure to perform and junior or inexperienced surgeons have troubles performing this surgery well because there are so many issues, or variables, that need to be considered. And the greater the number of variables you have in an equation, then the greater the difficulty in solving that problem.
A breast lift procedure simply means lifting up the breast tissue and nipple area to create a better breast shape. This can be done with or without the use of an implant.
There are numerous things that I must consider before contemplating and planning a surgical breast lift. In addition to all the planning typically required for a breast augmentation, other vital issues need to be considered to determine how to work with those variables to give you the best result, and to determine what results are realistically possible.
- Your Skin quality– is the skin loose with many stretch marks or thick and firm without stretch marks. Often the skin in someone requiring a lift has lost much of its elasticity. Thin skin with loss of elasticity means things have a much greater risk of re sagging
- Degree of sagging of the breast and how much does the nipple need to be lifted. Is it sitting below the level of the lower breast fold and by how much? The lower they are sitting, the greater the degree of difficulty in lifting it and keeping it up.
- The nipple direction – is it pointing downwards or just droopy but still pointing forwards.
- The skin distance from the nipple to the lower breast fold – if it’s too long that’s a slight problem. But if it’s very short then that’s potentially a greater problem.
- Nipple areolar size – a very large areolar size can be a potential problem with surgery.
- Breast tissue quality – is it firm or soft. Soft breast tissue is very difficult to handle and typically always wants to sag! Another extremely important thing to understand is that soft breast tissue will always be soft – nothing can be done to make soft breast tissue firm again. Surgery simply redistributes or repositions the breast tissue. Even with an implant it will still be soft, and it has a much greater risk of re-sagging.
- Breast tissue volume– the greater the amount of natural breast tissue the greater the degree of difficulty with the surgery. Lifting a large volume of breast tissue and trying to keep it up is difficult and indeed often not possible. The more natural weight the more that gravity is going to affect it!
Furthermore, the greater the amount of natural breast tissue the greater the amount of changes that occur over time. Having a lot of breast tissue can be considered a blessing when it’s all sitting right, but over time it’s going to change far more compared to those with minimal breast tissue.
- How “detached” your breast tissue is from the chest wall muscles is another issue that’s often difficult to explain. Sometimes the breast tissue is very mobile with loose attachments to the underlying muscle and effectively your breast tissue is sliding around over your chest wall. This makes the breast tissue extremely difficult to handle and therefore difficult to effectively lift.
- Your desires – what look is the person wanting?
- Time – the final variable which is impossible to work with is time. How much your natural breast tissue changes after surgery based on your genetics and personal circumstances is impossible to know. Often times women will achieve an excellent result early after surgery, but within a relatively short period of time their breast have continued to sag or change. This can be due to natural breast tissue volume fluctuations, weight changes, hormonal changes etc, and these things will negatively affect the results.
As stated previously, the greater the number of variables an equation has, the harder it is to solve the problem, and that is why the problem of breast lift surgery is so very difficult.
Perhaps the hardest thing for patients to accept is that they are needing a breast lift because they have weak and poor-quality breast tissue which has sagged – yet that same breast tissue and skin still exists after surgery, and it’s therefore still wanting to sag. No surgery and no surgeon can change the quality or consistency of the breast tissue and skin. All the surgeon can do is try to reposition and sculpt the breast tissue on that day of surgery.
As you can appreciate, there are numerous natural anatomical variables that I must assess and work with when planning your breast lift surgery. Of course, due to the persons pre-existing breast state, it’s often not possible to achieve the results that person desires. This is when painting a clear picture of realistic expectations is required.
In Part 2 of my Breast Lift Series, I’ll cover the different types of surgical options available.