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| Breast Reduction,
Breast Lift
and
Breast Lift and Augmentation Surgery
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Many women are uneasy and insecure with their breasts. Millions are unhappy with the size and shape of their breasts. Some have seen their breast sag and or shrunk after losing weight, having children and getting older. Many other women are bothered by breasts which are very uneven or too large and associated with shoulder and neck pain. But each such condition could be corrected. Let us review what Dr. Aldea and Dr. Eby may offer you in each such case.
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Large breasts are commonly the topic of jokes and sexual innuendo which many women and most plastic surgeons find tiresome. Yet - All but the very uninformed fail to understand that very large breasts can be a physical handicap and emotional liability.
Large breasts frequently sag and are associated with chronic shoulder, breast and neck pain, severe indentation of the bra straps into the shoulders, poor posture with chafing and rashes under the breasts. They often result in an inability to participate in an exercise program, certain sports or wear fashionable clothes.
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What’s the DIFFERENCE between
Breast LIFT Surgery and Breast REDUCTION Surgery?
The common feature shared by both breast lift and breast reduction patients is sagging breasts (or as Plastic surgeons refer to it, breast ptosis).
The youthful breast position, aka “perkiness” of the breast on your chest wall is determined by the relationship of the breast skin envelope to the volume of breast tissue inside.
Breast sagging is seen with either
- Deflation of the breast volume (loss of breast fill as is seen with pregnancy, aging etc) WITH either the breast skin envelope staying the same or, worse yet, with the breast skin envelope becoming stretched out (as in pregnancy or as result of having large breast implants, etc)
Or with
- Large increase in breast volume (very large breasts or large implants) associated with a larger increase in the breast skin envelope (due to stretching as in pregnancy or with large implants).
As the balance between skin envelope and volume is shifted to MORE breast skin (regardless of the cause), the breasts will sag.
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Similar to wind filling a boat’s sails or a windsock, as long as the air fills the existing shape, the sail and sock remain upright – the moment there is less wind (and more unfilled envelope) there will be sagging. (see on Right).
Common Causes of Breast Sagging
Breasts Sagging breasts are associated with aging, pregnancy and breast feeding, dramatic weight loss (as is seen with gastric bypass and lap band surgery), heredity, having had large breast implants and, or the removal of breast implants. All of these processes stretch and weaken Cooper’s Suspensory Ligaments of the breast which normally anchor the breasts to the chest wall allowing sagging.
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WHICH OPERATION needs to be done
would depend on whether you like your current breast cup size or not
If you like the way your breasts fill your bra but do not like the sagging – a breast lift without implants is the operation for you. In a breast lifting operation, the plastic surgeons removes excess breast skin envelope, tightening it and lifting the breast to a higher more perky position on the chest wall. Since the excess skin removed contributed to the total fill of your bra cup, there may be a small decrease in the size of your breasts. If you would be happy with a slight decrease in breast size as a trade off of having them lifted then a breast lift without breast implants is the operation for you.
If you are bothered by breast sagging and wish your breasts were larger, a breast lift and augmentation (Breast Lift with implants, Augmentation Mastopexy or Augmentopexy) would need to be done.
On the other hand, if you feel your breasts are too big and painful and would like to have both smaller and perkier breasts then a breast reduction surgery is what is called for. Here, the breast reduction surgeon removes both excess breast volume and the excess breast skin envelope thereby creating smaller and perkier breasts.
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Breast Lift Scars
No one likes scars, least of all Plastic surgeons who, more than any other surgical group, is judged by the quality and visibility of its scars. Plastic surgeons painstakingly pick the procedure which would deliver the best result with the most acceptable scar.
The goal of the operation is to create a youthful breast mound higher on the chest with the nipple complex as its center. (see Right)
The choice of breast lift procedure (and resulting scar) would depend on the extent of breast sag. Plastic surgeons classify the extent of breast sagging into three
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different groups based on the positions of the nipple compared to the level of the breast (inframammary) fold, where the bra wire touches.
The nipple of a non-sagging, young breast is located above the level of the Inframammary fold. When the sag is minimal (Grade 1 ptosis, see below), the nipples can be lifted back with a Nipple Lift, Periareolar or Crescent Lift (Mastopexy). The excess skin above the nipple and areola is removed as a crescent shape. As the wound is closed, the nipple-areola complex is lifted to the desired position leaving a well-hidden semi-circular scar around the upper part of the areola.
When the sagging is slightly more advanced, the breast is lifted by removing excess skin around the areola leaving only a circular scar. This is called a Donut Breast lift (aka Concentric or Periareolar Breast Lift). A Benelli Breast Lift is a variant of this lift. In this technique, two concentric circular incisions are placed around the areola. The center of this bulls’ eye or donut is placed eccentrically higher than the inner circle where the intended future location of the nipple will be. The incised skin is removed and as the outer circle is stitched to the edge of the areola it is lifted to the desired position leaving a circular scar (see below).
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With moderate breast sagging (see Grade 2 ptosis on Right), excess breast skin both above and below the areola needs to be removed. In many women this can be done with either a short or NO horizontal scar under the breast.
These surgical procedures originated with the work of Dr. Claude Lassus of Nice, France. His technique was modified and popularized by Dr. Madeleine LeJour of Brussels, Belgium (“Short-Scar Mammoplasty”) and further modified and popularized by Dr. Elizabeth Hall-Findlay of Banff, Canada.
These breast lift or breast reduction techniques are often termed a Short Scar Breast Lift or Reduction, a Lollipop lift or Reduction after its scar or a Vertical Scar Lift (Mastopexy) or Reduction.
The Short Scar breast lift / Reduction techniques have two HUGE advantages over the traditional Anchor / Inverted – T breast Lift / Reductions (see below). First, they are done without a transverse scar. Second, breast lifting is not done by tightening and
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shaping the breast skin envelope which is prone to re-sagging. Instead, the lifting is done by coning and shaping the breast tissue itself. This gives much longer lasting perky results.
Longer lasting attractive results with lesser scars – What’s not to love?
Lifting or reducing very saggy or large breasts, may require only removal of skin from both the central portion (vertical plane) of the breast as well as from the inferior horizontal plane as well. For breast lifting (mastopexy) procedures or breast reduction procedures involving significant sagging (grade 3 ptosis, see above) we often use Anchor, inverted – T, Wise pattern, Keyhole, Inferior Pedicle Breast Lift and Breast Reduction.
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The anchor-shaped incision circles the areola (pigmented skin around the nipple) reducing stretched out areolas, extends vertically downward, and then follows the natural curve of the crease beneath the breast. The excess skin (lift) and in breast reductions, excess breast tissue is removed and a new breast is created and moved higher on the chest wall by moving skin from both sides of the breast down and around the areola. When needed, liposuction may be used to remove excess fat from the arm pit areas.
“Scarless” Breast Reduction – Breast Liposuction Scarless Breast Reduction consists of removal of breast volume by breast liposuction. With the exceptions for the few small openings for the liposuction tubes, no other scars are placed.
The young breast is made mostly of breast glandular tissue and varying degree of fat which gives the breast its softness. As the woman grows older, the amount of glandular tissue decreases while the amount of fatty tissue increases.
Liposuction can remove breast fat but cannot remove breast gland tissue. Furthermore, as the fat volume is decreased, the overlying skin envelope will loosen. The amount of subsequent breast skin envelope shrinkage depends on the woman, her age and the elasticity of her breast skin.
Unfortunately, while younger women with large breasts have great elastic skin, their breasts do not contain as much fat which could be liposuctioned. On the other hand, as women age and their breasts do come to contain more fat, unfortunately, their breast skin is much less elastic. In the latter group, liposuction would result in smaller but potentially more sagging breasts. Consequently, the use of the “No Scar’ (liposuction only) breast reduction operation is limited to women with only a minimal excess size of the breasts with great skin elasticity.
Breast Lift Procedure Animation Video Tto see an excellent 3D video of the breast lifting by The American Society of Plastic Surgeons
please click HERE. (Once there, scroll to the VIDEOS button - and click on Breast Lift Video)
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The MYTH of Breast Symmetry
N ature is not symmetrical. Our faces are not perfectly symmetric. Neither are our eyes or anything else; Minor asymmetry dominates in nature. The vast majority of women have asymmetrical breasts (different size, shape and volume) and in some, the asymmetry is striking. Most surgeons would not recommend surgery for volume differences of less than a bra cup.
If surgical scarring is acceptable, depending on the individual woman, various combinations of breast lifting without or with an implant and with or without a contra-lateral breast reduction surgery on the other side, may be needed to make the breasts appear more alike.
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Breast Reduction Before and After photos
You may see other Before-and-After pictures of breast lift and breast reduction procedures HERE
Breast Lift and Breast Reduction Recovery Depending on the size of the breasts, the operation may last 3 to 4 hours and is usually performed under general anesthesia in an outpatient surgery facility. You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Pain medication prescribed by your surgeon will effectively lessen the pain. Most patients are able to return to work within 2 weeks of surgery and to resume strenuous physical activities in 4-6 weeks. Among the commonest side effects of the procedure are temporary swelling, bruising or nipple numbness.
The vast majority of patients are extremely happy with their results. Of all plastic surgery procedures, breast lift and breast reduction result in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better. For many women, whose breast size prevented them from enjoying an active life style and fashionable clothes, the operation literally gives them a second chance to enjoy life.
The only trade-offs associated with this operation are its permanent surgical scars. The procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. Your surgeon will make every effort to make your scars as inconspicuous as possible and place them can so that you can even wear low-cut tops.
Potential Complications of Breast Lift and Breast Reduction As with any surgery, there is always a possibility of complications. With breast reduction (not lifting), since the surgery removes many of the milk ducts leading to the nipples, there may be future difficulties with breast-feeding. The procedure may also leave you with slightly mismatched breasts or unevenly positioned nipples. Potential complications may include bleeding, infection (under 2%), breast asymmetry, small areas of fat within the breast might die (fat necrosis), slow healing or separation of surgical incisions, widened or raised surgical scars, “spitting” deep stitches, permanent nipple numbness (under 15%), and very rarely loss of nipple tissue. The highest rate of complications are seen in breast lifting with implants or in patients who undergo either implant removal or exchange with breast lifting due to decreased blood supply to skin envelope and nipples. Some complications may require additional medical and or surgical care. Poor healing, fat necrosis and wider scars are much more common in smokers.
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Breast Surgery and Insurance
Does insurance “cover” Breast Reduction and Breast Lift?
Cost of Breast Reduction As a rule, insurance companies will NOT pay for, nor “cover” (not the same as pay for) procedures which are solely meant to make you look or feel better about yourself – cosmetic
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procedures. They will not pay for Breast Lift procedures. But - if your breast reduction meets their approval requirements, and your policy has breast reduction surgery benefits (see below) your insurance company may partially pay for your breast reduction surgery (after you paid your deductible and co-payments).
Breast Reduction Benefits - We have thousands of insurance companies in the US and insurance coverage for breast reduction surgery is very variable.
Each insurance company sells multiple policies (aka "products) with different coverage. Some employers buy the all-options, very expensive insurance policies, while many save money by leaving out coverage or “benefit” for multiple items. Your breast reduction MAY be one of them. There is no way of knowing if your policy would pay for breast reduction surgery or not unless you carefully read the insurance booklet that came with your last card renewal. Read it looking for the excluded items. IF your policy does not pay for breast reduction surgery - you will not be able to change their mind by writing letters. The law is on their side and frankly you are wasting your time.
Participating Plastic Surgeons - If your policy does offer breast reduction benefits, look and see which plastic surgeons in your area work with that insurance company. Not all doctors work with all policies and all insurance companies in every area. Unless you want to pay out of pocket and then take your chances being repaid by your insurance company, you would need to be operated on by a participating surgeon.
Breast Reduction Approval Requirements - The surgeons who do work with each insurance company will be familiar with what each insurance company requires for it to approve and hopefully pay for your breast reduction surgery.
Breast reduction is performed for back and neck pain relief not for cosmetic surgery improvement. Women who have the surgery are bothered by very large, sagging breasts that restrict their activities and cause them pain. Although we increasingly see restrictions and denials by insurance companies, many insurance companies still cover the operation as a "medically necessary" procedure.
Until a few years ago, most insurers required that at least 500 grams (1.102 pounds) be removed from each breast in addition to your having multiple symptoms related to the breasts’ size. These days, most have moved away from this simple standard by either raising the weight threshold (which is grossly unfair to shorter women) or, by adopting The Schnur Classification which relates the amount of breast tissue that needs to be removed from each breast to a formula relating height and weight - more fair in my opinion. (The latter is the way Blue Cross Blue Shield of Tennessee operates. You can get an idea HERE)
“Coverage” – The average English speaking, high school educated American, naturally assumes that “covered” means “paid for”. That is NOT the case.
In the words of Billy Joel, “Welcome to the Age of Jive…” The way our insurance companies re-defined it, “covered” refers to your policy including the benefit in question (in our case, breast reduction surgery) NOT the insurance company’s promise to pay the Plastic surgeon for the delivery of the benefit to you, the insured.
In this clever way, it is not rare for surgeons to operate on women with very symptomatic breasts (or for other medical conditions) and then be denied their compensation with a variety of excuses. One of the commonest is that the full amount of weight was not reduced from each breast (for example removing 450 grams instead of 500 grams) even though the removal of excessive volume would have rendered the woman’s breast TOO small. Every other conceivable excuse has been and continues to be used. In this scenario, you would then be fully liable for the costs of your surgery.
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Dr. Aldea and Dr. Eby are expert Breast Lift and Breast Reduction surgeons who are committed to perfection with emphasis on unmatched individualized care. Our goal is to provide you with the highest quality cosmetic surgery and to exceed your expectations.
We are the Memphis Short Scar Breast Lift and Reduction EXPERTS. Unlike many practices in Memphis, the majority of breast lifts and breast reductions patients in our practice choose to undergo this, less scarring and longer lasting procedure, instead of the shorter lasting and more scarring, anchor / inverted T procedures.
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The vast majority of our breast lifting and breast reduction patients are extremely happy with their results and many wish they had done it earlier. Please, see a few such testimonials.
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This web site has been prepared to give you a basic understanding of this type of cosmetic procedure. If you want to learn more or have any further questions, please call us at (901) 752-1412 to arrange a consultation with one of our doctors. You will be under no obligation to undergo surgery by attending a consultation with either Dr. Aldea or Dr. Eby.
Please, call 752-1412 for your appointment today!
Cosmetic surgery is an investment in yourself.
An investment which could make a world of
difference in your outlook.
Peter A. Aldea, M.D. Patricia L. Eby, M.D.
Certified and Re-Certified by The American Board of Plastic Surgery
Members of the American Society of Plastic Surgeons
Fellows of The American College of Surgeons
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Cosmetic Surgery Specialists of Memphis, PLLC
6401 Poplar Avenue, Suite 360, Memphis, Tennessee 38119
Telephone (901) 752-1412
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