Breast Lift

Drs. Janssen and Doubek perform breast lifts with a variety of incision patterns and techniques. There are many factors that determine the best technique for the patient, including breast size and shape, size and position of areolas, degree of skin sagging, skin quality and elasticity, and the amount of extra skin.

The anesthesiologist administers anesthesia during the surgical procedure for the patient’s comfort. Anesthesia options include intravenous sedation or general anesthesia, and the anesthesiologist will select the best option.

Incision Patterns

There are three common incision patterns that best suit the patient’s anatomy: around the areola, around the areola and vertically down from the areola to the breast crease, and around the areola, vertically down from the breast crease and horizontally along the breast crease.

The surgeon will make an incision to begin the surgery. After the incision is made, the surgeon will lift and reshape the underlying breast tissue to improve breast contour and firmness. Next, the surgeon will reposition the nipple and areola to a natural, more youthful height. If necessary, the surgeon will excise skin at the perimeter to reduce enlarged areolas. To compensate for a loss of elasticity, the surgeon will remove excess breast skin. Finally, the surgeon will close the incisions as they tighten the remaining skin.

Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.

To create and support the newly shapes breasts, your Fox Valley Plastic Surgeon will layer sutures deep within the breast tissue. The surgeon will close the skin using sutures, skin adhesives and/or surgical tape.

Interested in a Breast Lift?

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The degree of breast sagging and the degree of enlargement desired by the patient will help the surgeon determine the technique best used to achieve the breast lift and augmentation. In general, most women want large implants with their breast lifts. However, this is challenging for the surgeon. For example, comparing breasts to an envelope, combining a breast augmentation with a breast lift is similar to wanting to overstuff the envelope while also decreasing the size of the envelope. Hence, it is difficult for the surgeon to complete both procedures in one operation.

However, our surgeons have devised several techniques combine a breast lift with implants. A lot of combinations are possible between muscle, gland and skin, but the basic principles are the same.

One Stage Approach

The most common problem encountered in a breast lift with implants done in one stage is the effect of the implant on the tissue. Patients can expect an optimal result when the tissues are very good and a small implant is used. In cases where the muscle is thin, the sheer pressure of the implant will further stretch, thin, and deform the skin.

However, it is difficult to know definitively the condition of the tissues before the surgery. Surgeons cannot predict how the tissues will tolerate and support the implant. The bigger the implant, the more difficult the procedure becomes. In a one stage breast augmentation/breast lift approach, the rate of touch-up or secondary procedure an be as high as 30%.

Two Stage Approach

For the reasons outlined above, the two stage approach is the most reliable method. However, women can be hesitant about the idea of a two stage procedure. It is two surgeries, two recovery periods and costs significantly more. Even so, there is a big upside: much higher chance of good results, less scarring, a minimization of tissue damage and complications. Additionally, the surgeon can make any adjustment to fine-tune the shape, size, level, and symmetry between the two breasts at the time of the second surgery.

In the first stage, the surgeon will place the implants under the muscle (the breast augmentation). Two months later, the surgeon performs the second stage (the breast lift). The surgeon can perform a more predictable and stable breast lift because the  scar tissue has formed around the implant. Most of the reshaping of the breast is achieved intraoperatively. The surgeon will use a submuscular pocket to minimize the dissection and the risk of complications.

One Stage Approach with Planned Revision

Watch Dr. Janssen’s video regarding the complexity of performing a good, tight breast lift with breast augmentation in one surgery. It is extremely difficult to both increase the content of the pocket while decreasing the size of the pocket, the envelope concept discussed above. To combat this challenge, Fox Valley Plastic Surgery has devised a unique method in which the surgeon performs the breast augmentation and breast lift in one procedure, but with a planned minor revision in 4-6 months. The position and size of the implant are the most important considerations for this method.

The surgeons are conservative on the excision of the skin and the lower pole of the breast. The method that Dr. Janssen has developed, leaves the skin loose in the lower pole of the breast and allows it to heal for 4-6 months, making it a very safe method of tackling the difficult procedure. The revision is an office-based visit under local anesthesia. The surgeon will tighten the skin to give the patient a wonderful long-term result without risk to the implants. Not only does this method present less risk of complications than trying to do the procedure in one stage, but it also saves the patient thousands of dollars over the two stage method.

For more information regarding breast augmentation with a breast lift, please watch Dr. Janssen’s video “Surgical Challenge of a Breast Lift with Implants.”