#27: Everything You Need to Know About Breast Lifts

Podcast #27 Everything You Need to Know About Breast Lifts

On this episode of The Natural Plastic Surgeon…

Dr. Barrett: That's the landmarks that you have to look at in the mirror. Is your areola, is your nipple higher, at the level of the inframammary fold, or lower than your inframammary fold? If it's lower than your inframammary fold, you need a lift.

You are listening to The Natural Plastic Surgeon Podcast. I'm Dr. Daniel Barrett,

Board-Certified Plastic and Reconstructive Surgeon located right here in Beverly Hills. I specialize in cosmetic surgery of the face, nose, breast and body. This podcast is dedicated to those deciding if plastic surgery is right for them and revealing all the latest beauty secrets. Let’s get started.

Dr. Barrett: Everyone, this is Episode 27 of The Natural Plastic Surgeon Podcast and we get to talk about an exciting topic that I do all the time, and I want to share this information with you guys. It’s gonna be a lot of information, and a quick concise podcast. But if you are thinking about a breast lift, you guys, you gotta check this out. You gotta listen to this whole thing because it's gonna answer a lot of the questions that

you might have about a breast lift procedure. Some hints, some tips that I think are

really important if you're looking for a plastic surgeon to get this done, and to see whether or not you're a good candidate for this operation.

01:10 BREAST AUGMENTATION OR BREAST LIFT

I can't tell you how many times I get someone who's had five children, big-time weight gain, weight loss, and they come into the office, and it's like, I just want a breast augmentation.

Well, okay, that may be.

But most of the time, if you've had five children and you've had significant weight gain, weight loss, you might need something just a little bit more than an augmentation. And, and not everybody knows that and that's okay. But, but what, what happens to the breast when you go through a lot of weight gain or pregnancies and breastfeeding is sometimes it gets very big and the skin stretches out. And then it relaxes back down and you get dropping of the nipple and the areola below your inframammary fold. Okay, now that's the, that's the physical thing that happens. It’s called breast ptosis and there's varying degrees of breast ptosis.

02:00 LANDMARKS TO LOOK FOR

But that's the landmarks that you have to look at in the mirror. Is your areola, is your nipple higher, at the level of inframammary fold, or lower than your inframammary fold. If it's lower than your inframammary fold, you need a lift.

I, because if you just did an augmentation, guess what? You will have a Snoopy deformity of your breasts and they will be like a ball-in-sock deformity. It just doesn't look good. That's why surgeons don't do it all the time. I get some people that are, like, I've been to three other surgeons and they all see, all say I need a lift. I’m, like okay, you probably need a lift.

A straightforward breast augmentation isn't going to work for you. It isn’t gonna look good ‘cause guess what? We've tried it guys, we've tried it. We've bent over backwards for some people and we've made a mistake. And we're like, you know what, we shouldn't have done that. Because the patient was like, you know what, I'm unhappy now, this doesn't look any better. And you did this to me. And I'm like, okay, well, you're right, I shouldn't have done this. And next time I won't, so we don't. So that's, that's, that's how you know if you need a breast lift or other, also known as a mastopexy.

02:53 PENCIL TEST

And the way you can tell is to take a Q-tip, go in the mirror, put the Q-tip right in the breast fold, or a pencil, it’s called a pencil test. Does it stay there? If it stays there, all right, that's one sign that you have a little bit of extra skin. Now you're in a gray zone. Look at the areola. Look at your nipple position. Is that nipple below that level of that

pencil, that Q-tip? Or is it higher? Or is it at the level? If it's at the level or higher, you're in a gray zone, you're probably okay. But if it's below, completely below that pencil or that Q-tip, chances are you might need a breast lift. Okay, so it's also known as a mastopexy. Basically, it's surgery to change the shape of the breast. An augmentation alone just increases volume in the breast. There are some little tricks and things that we can do to kind of, you know, increase certain things or create better symmetry with the fold. But our hands are really, kind of, tied behind our back unless you let us do a mastopexy, or a breast lift.

03:45 TYPES OF BREAST LIFTS

Now, there are many different kinds of breast lifts out there. And depending on how much skin laxity you have, in terms of how, where your position is, if you need more than two centimeter, if you need less than two centimeter lift, if you need more than two centimeter lift, there's different types of breast lifts that I recommend, okay? Now the ones that are out there, I have a diagram here, there's about four main ones, okay?

04:10 CRESCENT AND CIRCUMAREOLAR LIFT

There's a crescent, which is just a little bit of an incision right above the nipple that gives you a tiny bit, a little bit of a lift. I don't like that operation because it creates a scar on the top part of the areola. If you're going to make that, you just might as well do the

complete donut or circumareolar incision, and that's an incision right around the areola completely.

So crescent is just on the top and a doughnut or circumareolar is all the way around the areola. It’s also known as a Benelli mastopexy. And that gives us the ability to lift the breast about two centimeters. It's great for people that are in that gray zone area that just have a little bit of ptosis. Nothing too dramatic. If you try to do this lift on somebody who has more than two centimeters of, of discrepancy, you're going to get a very flattened and pancaked version of the breast. So...and the scarring won't, won't look very good. So that's why that operation is, kind of, good for certain people only.

05:00 ANCHOR LIFT

Now the next one, when we get beyond two centimeters of needed lift, a lot of surgeons recommend the anchor pattern, or inferior pedicle Wise pattern breast lift, okay? I'm not a fan of this operation, it is an old school operation. It's what we all learned in residency. And think of a boat anchor, okay? So a boat anchor, upside down. So you have an incision around the areola, a vertical line going down, and then a horizontal line going sometimes into the axilla, all the way to the medial cleavage line. That is completely unnecessary.

It looks great on paper, two-dimensional, you know, diagrammatic Point A to Point B, works really well, that's why we all learn it. It works. It does lift the breast, it does sit the inframammary fold but you have a major trade off with the amount of scarring that you

get. And it treats the breast as a two-dimensional structure, so it's flat and boxy looking long-term. So I get a lot of women who come to see me because they had this anchor pattern done and they're super unhappy.

06:08 LOLLIPOP LIFT

Now along came a doctor named Elizabeth Hall-Findlay up in Banff, Canada, who designed a vertical breast reduction and this technique has been, kind of, adapted to breast lifts as well. And that involves an incision around the areola and a little line that goes down. So it's called it's like in the shape of a lollipop so incision around the areola and a little line that goes down. That, to me, is my preferred breast lift. And I actually learned from this doctor, believe it or not. A female doctor, of course, of all people, is like “hey, you don't need all these scars.”

And she really, kind of, changed the, the attitude towards breast lifts. And getting away from using all of these scars and these big incisions to lift breasts. And in fact, she combines, you comb, sometimes you can combine liposuction with that so you avoid having to make these incisions that go from, all the way to the middle cleavage line, all the way into the armpit. That show in certain types of bikinis and stuff like that.

So if your surgeon is recommending an anchor pattern, you may want to consider another option, maybe find out if your doctor does a lollipop incision. I just think it's a, it’s a far superior type of breast lift. And uses a breast parenchyma to hold itself together, versus the skin. And it doesn't look like a two-dimensional boxy structure, it looks like a

three-dimensional, beautiful breast. So on multiple different levels, less scarring, better shape, better perkiness. The lollipop type of breast lift incision is the way to go, in my opinion.

Now, there's lots of different doctors out there that disagree with me. But I feel like a lot of doctors, kind of, are used to using that anchor pattern, and they're not comfortable with using any different type of incision or they don't want to learn something new, and it hasn't been tried and tested like they've learned over the years. But when faced with the data and how things look, I think that a good plastic surgeon should at least have an understanding and know how to do this operation.

08:05 HOW LONG DOES SURGERY LAST?

All right, so moving on. Next question. These are questions that we've gotten from so, a lot of our patients and a lot of our, our viewers and, and listeners.

How long does the surgery take?

Well, the surgery takes anywhere from two-and-a-half hours to four-and-a-half hours. And it depends again, whether or not you need an augmentation with that as well. Or fat transfer. Or a, or all you need is just a mastopexy. Okay, mastopexy would be no augmentation, we're just lifting the breast. So, this is all determined with a great consultation. The advantages of an implant is you get that upper pole fullness, that

perkiness to the breast back, it doesn't take a very big implant to do that. So you can use a very small implant and then do a lift on top of that.

Alternatively, you can use fat transfer. Fat is a just little more predict-, a little more unpredictable ver-, ver-, versus an implant. An implant, if we put a 200 cc implant, 10 years from now, it's gonna be 200 cc's. If we transfer fat, some of it may die right off the bat. And it may fluctuate over the 10 years, so that it, it's just a little less predictable.

However, you don't have an implant to worry about. So if you're really against having an implant, you may want to look into seeing if fat transfer is a good option for you. If you're just looking for that little bit of perkiness, that little bit of boost. Especially at the top pole of the breast when we're thinking about doing a breast lift.

09:22 WHAT MAKES A GOOD CANDIDATE FOR A BREAST LIFT?

So who's a good candidate for breast lift?

Well, I, I feel like any woman that's had children and has done breastfeeding, most likely, is a good candidate. However, that's not the case for everybody. Some women just have small breasts or they didn't breastfeed, or they didn't gain a whole bunch of weight, and those people just might be fine for breast augmentation.

However, if you gained a bunch of weight and you lost 50 pounds, chances are your breasts have stretched out and have, kind of, deflated. That’s, that's the number one thing I get. I feel like my, my breasts have disappeared. Or they’ve deflated.

Women who've been on birth control. They've gotten off of it, stuff like that, where the breasts are kind of a deflated appearance. There might be an excess skin issue that might need to be addressed with the mastopexy.

10:05 A GOOD CONSULTATION IS IMPORTANT

So how is a breast lift performed? Well, it all starts with a really good consultation with a board-certified plastic surgeon. I do measurements. There's asymmet-, asymmetries that I'm trying to, to correct with the, with the, and that's why I do these measurements in the, in the consultation. So sometimes I have to lift one side versus the other.

Sometimes I have to remove a little bit of tissue from one breast versus the other. Sometimes I need to augment one breast bigger than the other.

So it's, it's basically a very complex plan, and it's all customized for each particular patient. But if we are gonna do an augmentation with the lift, I would do the augmentation first. And then on the table in the operating room, I would simulate the lift to get exactly how I want it and then make those cuts and make those markings there. So that's why if you ever watched any of my videos online, you can see that I sit all my patients up, see how things look, adjust the skin as needed. And then, and then finally make those incisions for the final result.

Now this, we, this can be done with fat transfer too, however I leave a little bit of room for the fat to, to be placed. And that's, kind of, a little more guesswork. It takes a lot of experience to do that. Because an implant, again, we know that size is gonna be, in 10

years, is gonna be the same size. Fat may go up or down, we may lose 30% or we may lose 40% of your fat graft. So the, the fat grafting gets a little tricky, and takes a little more experience. You got to have a little bit of flexibility in terms of your expectations for those types of operations.

11:35 RECOVERY PROCESS

How long is the recovery process for a breast lift?

Well, that depends a lot on whether or not we use an implant. If we use an implant that goes underneath the muscle, it, it, it stretches out your recovery time a little bit, in terms of the amount of heavy lifting you can do. Because we place the implant partially underneath the muscle. And if you have significant downward pressure of that muscle, it can displace the implant. So no heavy lifting for six weeks if we use an implant. If we don't use an implant, just no heavy lifting for two weeks.

Most everybody can go back to work within a week of this operation whether or not we use an implant or not, so I would plan to take at least a week off. Two weeks would probably be more than enough. But I think a week off from, from whatever, kind of, work you do, would be plenty.

12:10 TIPS FOR OPTIMAL RECOVERY

What tips do I have for optimal recovery?

Well, we actually went over that in another podcast just a few episodes ago, where we talked about things like red light therapy, optimizing probiotics afterwards, nutrition, vitamins, things like that. Check out that podcast for more information.

But really, it's, it’s all about just, is, is giving yourself enough time to heal. Not being too stressed out, especially when you have an implant. Too much stress will increase your risk for capsular contracture. And that's when you can get that scar tissue that forms around the implant...gets hard, thick, firm over time and sometimes needs to have surgery to correct that again. So that’s last thing you want to do. You just recovered from surgery, you healed, and then you have this problem happen. So I recommend that you, you optimize your stress level after surgery by giving yourself enough time off to heal.

13:00 WILL A BREAST LIFT MAKE BREASTS SMALLER?

Will a lift make my breasts smaller?

Well, not really. They can, we can do, we can do a reduction if we, if it's requested. If they're just a little bit on the bigger side. That would be more of a breast reduction. It can totally be done.

And, but they don't, they don't really make your breasts smaller. A lot of times it's, you have really good breast tissue, but it's down on your ribcage. So getting those breasts back in position actually makes your breasts appear to be bigger even though the

volumetric size of your breast is the same, okay? So it's just, it's a matter of positioning, they'll actually look a lot bigger and fuller, when they're brought back up to correct position.

13:38 BREAST FULLNESS

Does a lift to restore fullness?

Yes, absolutely. And a lift alone can, but if you combine it with an implant and combine it with fat, you can get that upper pole fullness that really looks good in clothing, better in cleavage, revealing clothes. If that's not what you're interested in, you don't need to do that. You can just do the breast lift and yes, you will get a boost there as well.

But I, you know, I get a lot of people that just go for that home run, they want that gorgeous, perky breast look, and that typically happens with the combination of fat or implant to that upper pole.

14:10 BREAST LIFT WITH IMPLANTS VERSUS FAT TRANSFER

What is the difference between breast lift with implants versus fat transfer without implants?

Well, I, I think it goes back to that predictability, you know? You have way more predictability with an implant versus fat transfer. Fat transfer, some may survive, others, other parts of that fat may not. So if you're looking for that long-term, perky result, an

implant is probably gonna give you a, a better result. But again, you have to deal with having an implant and swapping it out every 10 years.

14:35 IS REVISION BREAST LIFT NEEDED EVERY 10 YEARS

Will I need to have a breast, additional breast lift performed in 10 years?

Well, the answer is yes and no. If you gain a bunch of weight, or you...a really bad lifestyle, yes, you might need to do an additional lift. But, you know, these lifts are designed to be lifelong.

Okay, so, with the exception of using an implant, you're gonna have to swap out the implant, but that doesn't necessarily mean you need a new lift. Now if you have children after, if you have children after your breast lift, they might stretch out and you might need a, a tune-up, or you might need to take it in. If you don't gain more than 30 pounds during pregnancy, you're probably not gonna have that problem. That's easier than said than done. When my, when my wife got pregnant, I gained weight. So you know, it, it's okay. And that's why we're in business because if you do, if that does happen, you gain weight and things stretch out, that's okay. We can, we can fix things. We can tune things up, and it's totally fine.

15:30 BREASTFEEDING ABILITY

Will it affect my breastfeeding ability?

Yes, yeah, it, it can. Using an implant alone affects breastfeeding ability by about 7%. Now with a lift, it varies anywhere from 10 to 30 to 40% affecting breastfeeding ability. I don't really mess with the glandular and nipple apparatus very much with the breast lift. However, statistically, results say that, nationwide, that breastfeeding ability can be affected.

My recommendation is if you're thinking about a breast lift, wait till you have kids and you're done having kids. If you're not sure, it's no big deal. It doesn't preclude you from breastfeeding. It just might make it slightly difficult for you to, to breastfeed.

16:10 POSSIBLE COMPLICATIONS

What are the complications of, of breast lift?

Well, there are the implant-associated complications if you do use an implant. And the main one there is capsular contracture. Happens nationwide, one in 20. My rate’s about one in 100. I do a lot of things to help prevent capsular contracture like using the Keller funnel, triple antibiotic irrigation, changing gloves, no-touch technique. I’ve got all kinds of videos on that on my website, BreastsByBarrett.com. But other risks include infection...a lot of times you can get a little bit of spitting sutures or wound breakdown, especially on big lifts. That's to be expected. I would, I would expect going into this operation, something like at least a spitting suture or a tiny little bit of wound breakdown to happen.

Now the bigger, bigger complications that are still out there are nipple necrosis. That's a big one, hasn't happened to me, knock on wood...somewhere...right here on this chair. And, and I pray that it never happens.

But that is a known risk that happens less than 1% out there, around 1% or one or 2%, where you can get partial or full nipple necrosis, where the nipple actually dies. This happens with these radical cowboy operations where surgeons have just gone way too much in terms of their dissection and cautery. Or going too fast, in my opinion, and disrupting the blood supply to the nipple.

Because if you think about it, you're kind of, you're kind of, cutting off the surrounding blood supply to the areola and the nipple. And then if you go underneath it too aggressively when you're placing your implant, you can cut off the bottom blood supply. So it takes a really good surgeon to understand that, especially a board-certified plastic surgeon to understand that and avoid that complication from happening.

Other additional risks, or with any surgery, risks with anesthesia, which is actually pretty low. And hyperpigmentation can happen in certain Asian patients or, or patients prone to hyperpigmentation. It generally can be treated with a little bit of skin bleaching cream and so forth. Asymmetry, definitely. Risk of asymmetry with this operation. Breasts are sisters, not twins. I don't even get perfect symmetrical breasts. I try really hard to get them as symmetrical as possible but I tell people, I'm not going to make them 100% symmetrical. It's important to know that breasts are sisters, they're not twins.

It is one of the most, it is one of my favorite, one of my more favorite operations because they are challenging. But they do restore women's confidence. They come in and--my patients--they find themselves going out in bikinis, especially when combined with a Mommy Makeover. This is a great option to restore the youthfulness and appearance of the breasts.

My advice to you is do your research. Know what type of incision your surgeon is gonna be using. Check out their before and afters. Check out their online reviews. And then go from there, and go and visit, and see if it's a good fit. Because there's people that come to see me it's not a good fit. They want something that doesn't really mesh well, or vibe well, with me. And, and, and I don't feel comfortable doing that.

And so you want to make sure that you're on the right page. And you have a really good sense that your surgeon is listening to you in terms of what your goals are. Because if they don't know what your goals are, they're going to kind of give you a one size fits all. And one size doesn't fit all. We customize every one of our operations. This is an actual, I have a sizing chart right here in front of me. And it's, this is just one implant company. And has six different pages of implants.

And this is the, kind of, the level the detail that we go to, to kind of, perfect the appearance of our breast lift patients and our breast augmentation patients. And this is just the foundation. The implant is the foundation. It's like you're building a house for your breast lift. You put in your implant first, and then that's your foundation of your

house. And then once that’s set, then you build and you, you, you adjust the breast on top of that. It's, kind of, like the icing on the cake, and, and, and it has to be done in sequential order. If you don't get the implant right, the breast is never gonna look good. So that's how I look at the implants and that first step of a breast lift.

That's it for our podcast, you guys, I hope you enjoyed it. If you have any other questions, just check out my website, BreastsByBarrett.com or DrDanielBarrett.com. We’ve got lots of information about breast augmentation, breast lifts. And feel free to reach out and ask us any questions that you have and we'll get back to you. Thank you guys for tuning in.

Thank you for tuning into our podcast. If you liked today's podcast, don't forget to share, rate, review and subscribe. Also, find out if plastic surgery is right for you by using our virtual consultation at DrDanielBarrett.com/virtual-consultation. See you soon.

Show Notes

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