Northern Virginia – Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
Over time, a woman’s breasts can sag, lose their youthful shape, or both. Several factors can affect the shape and firmness of a woman’s breast such as genes, as in “I inherited my mother’s breasts”, weight fluctuation, pregnancy, breastfeeding, aging, and gravity.
Breasts that have sagged can be lifted to recreate that “perky” look, by removing the excess skin and repositioning the breast volume higher on the chest wall. Reshaping and tightening of the breast occurs in the process creating a more youthful looking breast. If the areola (the pigmented skin around the nipple) has enlarged with time and you would like it to be reduced, that can easily be done with a lift.
The degree of breast sagging can be a factor in what type of breast lift you desire, or whether you would like to have a breast implant performed with the lift to give the breast a lift as well as added fullness that only can be achieved with an implant. Depending on the degree of lift desired, skin will have to be removed from the breast to achieve the lift. Although a lift will render the breast more perky and repositions the breast in a more elevated and youthful position; nevertheless, the breast may lose about 10%-15% of its volume because of the skin removed. In this situation, you have a choice to try on implants and see whether you would like an implant to be done at the same time as the lift, or have the procedures done separately. For breast augmentation information please refer to that section.
Very rarely are a woman’s breasts perfectly even, or symmetrical. Sometimes, the lack of symmetry can cause a woman to be distressed, adding prosthetic implants in her bra to achieve symmetry. This is a common situation that women do not like to discuss. The solution is straight-forward. If a woman with uneven breasts seeks a breast augmentation, it is simple to fill one breast implant more than the other to make the breasts as symmetrical as possible. Sometimes a breast augmentation is performed on one breast and a breast augmentation and lift, or a breast lift alone, or even a breast reduction is performed on the opposite breast simultaneously. The treatment plan is agreed upon during the consultation.
Preparing for Surgery
An initial consultation is set-up where we will discuss the breast lift procedure and to decide whether you are a good candidate for the surgery. Your medical history is reviewed and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Breast Lift Procedure
The breast lift scar undoubtedly causes a lot of women who seek this operation some anxiety, and that is understandable. The location of the scar will depend on the degree of breast sagging, and therefore how much skin needs to be excised.
- Minor Lift: A periareolar, Benelli, or “donut” lift is performed where a “donut” shaped segment of skin is removed from around the areola and the scar is only around the areola.
- Moderate Lift: A “lollipop” lift is performed where skin around the areola and from the lower aspect of the breast is removed with the resulting scar being around the areola and a vertical extension from the areola to the bottom of the breast at the midline, shaped like a lollipop.
- Major lift: A “wise pattern” lift is performed with an anchor incision. Skin is removed from around the areola and a significant portion of the lower half of the breast leaving a scar that is shaped like a lollipop plus horizontal scars extending part or the total lower crease of the breast forming a scar that looks like an anchor.
Benefits of the Breast Lift Procedure
The major concern of women having a breast lift is scarring. There is a trade-off between the amount of scarring on the breast and how long the lift will last. If a minimal lift is performed, the scars may be less, but the breasts will be more likely to sag sooner, since not enough skin is removed, and another lift may need to be performed in the future.
We get asked a lot of questions about scars. Usually, scars will heal very nicely. We also offer women a unique scar tape and cream system proven in a study on 800 patients to optimize scar healing. The vast majority of patients is very happy with their lift and is eventually very accepting of the scars as a good trade-off.
How We Minimize Complications of Breast Lifts:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
- General Complications
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after breast lift is very rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. In our practice the rate of hematomas is less than 1%.
The most important step in avoiding infections, in my opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after a breast lift is extremely rare. It may occur at the superficial incision level where the tension is highest, and a small open wound may occur which will usually heal nicely with dressing changes and antibiotic ointment. The scar usually heals very well. Very rarely, we will do a scar revision to improve the appearance of that scar.
- Ability to Breastfeed
Women are sometimes concerned that if they get a breast lift, they will not be able to breastfeed afterwards. The likelihood of losing the ability to breastfeed after a breast lift is very small. With the techniques that are described above, inability to breastfeed after breast lifts that we have performed has not occurred with any of our patients to our knowledge.
- Loss of Nipple Sensation
Similar to what has been said about ability to breastfeed, loss of nipple sensation is a potential complication that due to the technique with which we perform this procedure is a minimal complication, with less than 1% occurrence. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks.
- Smoking is an absolute contraindication in breast lift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, loss of nipple tissue, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure, please visit our website at www.bitarinstitute.com, or call our office and speak to our friendly staff member at 703-206-0506.