Breast Lift - with implants or not? (Ep. 47)

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This file was generated by Descript

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Jason: One of the most popular

procedures year over year in my

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office is a breast lift with implants.

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Most of my patients are

kind of in my demographic.

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They're women that are done having kids.

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Kind of want to improve and

get back the shapes that they

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had before kids stole that.

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That typically means lifting the

breast back up on the chest, reshaping

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it, and adding a little bit more

volume in the shape of an implant.

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I want to talk a little bit about that

procedure, what it is, what it isn't.

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recovery time off of work and

all of that to give you a good

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understanding of what that is.

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So breast lift with

implants, what are the goals?

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Well, the goals of a breast lift are to

improve the nipple position on your chest.

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We want to get that nipple back up above

the breast crease to a more youthful spot.

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We want to reshape the breast around

that nipple that's now in a new spot.

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We want to reduce areola that

get large with pregnancy.

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That's one of the things when we're

talking about lifts and implants,

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that's typically one of the first

questions like are you going to

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make my nipples a little smaller?

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And the answer to that is yes,

is that is a part of a lift

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with or without an implant.

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And then lastly is to remove excess

breast skin that kind of sits between

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the nipple and the breast crease.

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That skin and breast tissue

that can get stretched out

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over time and drop and descend.

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So we want to remove that.

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Just as important though to know what

a breast lift with an implant does do,

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Let's talk about what a breast lift

doesn't do because it's important to

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understand that and we spend a lot

of time in our consultations talking

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about what doesn't happen so that we

can make plans if that's something

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that you're interested in to improve.

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So that we can make plans if one

of the things that it doesn't do.

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is one of the things that you're after,

that we can make plans to accomplish

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those goals because you don't want

to go through all of this surgery and

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then look and say, well, I thought

that it did this and it doesn't.

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So what does a breast lift not do?

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Big thing is a breast lift

doesn't improve hollowness in

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the upper pole of the breast.

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Most women Will require some sort of

volume augmentation, either in the

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form of an implant or in the form

of fat grafting to be able to fill

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out that upper pole of the breast.

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Upper pole hollowness isn't corrected

with a breast lift by itself.

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You have to have an implant for that.

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The second thing that it doesn't do is a

breast lift won't improve stretch marks.

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If you've got stretch marks in

your breast, that is the result

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of damage to the dermis or the

underlying part of the skin.

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That will not get better

with a breast lift.

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And if we add an implant, it may

actually make that a little bit worse.

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So that's something that

you have to be ready for.

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The other thing that it

won't fix is side boob.

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If you've got breast tissue or fat

that's accumulated under your arms.

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Typically, a lift will help improve that.

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Oftentimes, we have to add liposuction

or some other treatment to your

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chest to help improve that side boob

and get rid of that when we do our

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breast lift or lifting implants.

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Likewise, poor skin quality

, kind of loose, saggy skin.

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Is actually something that we talk a

lot about because that is largely what

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causes you to need a breast implant.

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We don't change that skin

or tissue quality over time.

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And so that's something we have

to talk about how we're going to

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handle that both in our initial

surgery and planning for later.

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And then lastly, if you're someone who

has a long torso and your breasts sit

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down at the bottom part of your torso,

your breast crease is fairly low.

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That will not change.

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Your breasts will still

sit low on your chest.

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You'll still have a long distance

between your collarbone and

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the top part of your breast.

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Even if we add an implant.

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Your breast kind of has a footprint

like your foot does, and we

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can't change that footprint.

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So if you're a woman who has breasts that

sit low on our chest, they're still going

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to sit low on your chest when we're done.

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So now that we know what a breast

lift accomplishes, what a breast lift

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doesn't accomplish, let's talk about

how the procedure is actually done.

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With breast lifts, there are three

incision types that you'll see if

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you're digging around on the internet.

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You can call them the

small, medium, and large.

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There is the donut or

just around the areola.

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incision, which really is a

bad incision for a breast lift.

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It doesn't accomplish much

in the way of lifting.

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It's more used when we're using an

implant to just tighten up a little bit

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of skin around that area, maybe move it

a centimeter or two, but not getting a

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whole lot of lift out of that incision.

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Then you move up to

the medium or lollipop.

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style incision where we

add a vertical incision.

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So around the areola and then down from

the areola to the breast crease, that is

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the second type of incision that is for

women who need a little bit more lift

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to recenter that nipple on your chest.

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And then the third incision and probably

the one that people are the most familiar

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with is the teddy bear or ship's anchor

incision where we take that lollipop

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incision and then add an incision in

the breast crease of variable lengths

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depending on how much extra tissue there

is in that lower part of the breast

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between the nipple and the breast crease.

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Those incisions typically heal well.

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The incision that everybody seems to be

worried about is that vertical incision.

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And those heal fairly well, provided

there's not a lot of tension on them.

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Tension is really the enemy

of good wound healing.

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And that's why during our consultation

and When we're talking about adding

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a lift and implants, that procedure

can be done in a single stage, but

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we're kind of walking a tightrope.

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You're walking a tightrope between

too little tension and breasts

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being sag, still being a little bit

saggy, too much tension and scars

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getting wide or worse coming apart.

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And so we want to navigate

that balance beam just right.

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And plan for later, if things are

a little bit loose, to revise that

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scar, do a little bit of tightening

later once everything is healed.

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Because falling off the other side

of that balance beam where things

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are too tight, you can get into

some really long term problems.

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The other option there is doing

it in two stages, which a lot of

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women don't want to do, but we talk

about that during consultations

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because that is another option.

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Surgery for breast lift with an

implant or breast lift alone takes

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between three and four hours.

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In my practice, I'm operating by myself.

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I don't have somebody cutting and

sewing and, you know, I'm doing one

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side and they're doing the other.

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It's all me.

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So it takes between three or four hours.

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You're at home the same day.

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We typically don't use

drains for these anymore.

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nObody wants them.

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And drain tubes are typically

not something that we

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use for these procedures.

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I operate here in our

private surgery center.

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Once surgery is over we, you

spend about 30 minutes in the

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recovery room, go home the same day.

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I tell patients, you're

going to lose the morning.

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You're You get a little bit of medication

before surgery, you, last thing you really

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remember is talking to me and having

me mark things right before surgery.

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Next thing you know, you

wake up on your couch.

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For women that have had other procedures,

hospitals and other surgery centers

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the surgery day is fairly pleasant.

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You don't really remember a whole lot.

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Recovery in plastic surgery

is very surgeon dependent.

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There's a lot of, what works for

me that surgeons get into during

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their post op recovery time.

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For my patients with a breast lift,

breast lift with implants, there's

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Surgical tape that covers your incisions.

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There's no stitches that have to come out.

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You can shower the next morning.

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Actually, I encourage you to shower

the next morning because you want to

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be clean, but you feel more human once

you've kind of been able to take a

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shower, wash some of the funk off and

freshen up a little bit that next day.

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There are no restrictions in terms

of what you can and can't do from

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a range of motion standpoint.

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A lot of women ask me if

they can wash their hair the

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next day, the answer is yes.

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What I don't want you doing is

lifting anything, is doing any

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movement where your chest muscles or

arm muscles are loaded, and you're

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trying to reach up, you're lifting

something heavy up above your head.

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or trying to pick things up off

the floor, that includes kids.

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So for moms who are having this, who

have young kids, you either want help, or

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you want to let your children climb into

your lap, stand up with them, instead

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of trying to pick them up off the floor.

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Things are going to look weird

that first week after surgery.

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There's no two ways around it.

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Things swell.

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Things swell.

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You may have a teeny bit of

bruising if we're doing some

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liposuction but you, they look weird.

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If we're using implants, the top

part of your breast can swell.

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It can make your nipples look like

they're pointed down a little bit.

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All of that is normal.

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Obviously if it's something

you're concerned about, I want my

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patients to let me know about it.

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If you're somebody else's

patient, let them know about it.

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that is relatively normal right after

surgery in terms of working and return

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to work kind of depends on what you do.

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If you have a desk job, you work at

a computer, you can work remotely.

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Typically after a week, , you're

not taking narcotic medication.

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You're able to kind of go

back to your normal routine.

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If you've got a very physical

job, I recommend people

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taking about two weeks off.

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You can always go back early if you feel

great and you want to but depending on the

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nature of your work, one to two weeks off.

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Now, I don't want anybody

doing any exercise.

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So lifting more than about 10 pounds or

bouncing, those are the two restrictions,

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lifting and bouncing for six weeks.

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Really want those implants to heal before

we start stressing those implants at all.

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There's a I did a podcast back in a couple

of months ago about sex after surgery.

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You can listen to that one.

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That's always a question.

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The bouncing really comes in there.

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In terms of new clothes, wait

three to four months until you

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start going swimsuit shopping.

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You start going bra shopping,

things are going to be swollen.

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You don't want to buy a bunch of

new stuff when you're still swollen.

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Especially if it's expensive stuff.

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And then the swelling goes down

and your new stuff doesn't fit.

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So wait three to four months

before you start going shopping.

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Scar treatments are variable.

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Now that's kind of the next thing

is what do we do about scars?

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We can start topical scar treatments

as early as a week after surgery.

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aNd that's topical scar treatments.

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We recommend a silicone tape or

silicone gel over your scars.

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We can also start laser

treatments as early as a week.

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So as soon as our surgical tape comes

off, we can start treating scars.

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If you have had problems with scarring

in the past or just want to be super

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aggressive we can start that pretty early.

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So a common thing that comes up is,

why would I not want to do this?

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And this is really where we get

into the reason that you shouldn't

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have a lift and or implants.

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We talk in terms of relative

and absolute contraindications.

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So relative contraindications mean,

eh, probably not the greatest idea.

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You run the risk of either some

medical problems or a cosmetic

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outcome that's less than perfect.

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And then you've got absolute

contraindications, which

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means it's really not a good

idea to have surgery at all.

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So, relative contraindications

to a lift, certainly a lift with

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implants, is poor tissue quality.

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And, thin, saggy, sad breast tissue.

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Thin skin with lots of stretch marks.

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The chances that you are going

to need a revision later, no

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matter what we do, is pretty high.

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Like I said at the very beginning,

we can't treat poor quality tissue.

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If you've got, collagen that

has kind of melted away.

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If your skin is thin, there's nothing

that we're going to do for that.

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And so going into that, if that's,

if you're kind of in that camp, it

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doesn't mean we can't do surgery.

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It doesn't mean we can't

get you a good result.

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It means that we have to be careful

and plan for the fact that your skin

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is going to relax after surgery.

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Once the swelling goes

away, it is going to relax.

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And so that means being conservative

in implant choices, not putting a

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huge implant in trying to stretch

things out because that's just

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going to make the problem worse

means not pulling things too tight.

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It means accepting that there's a

possibility that Six months a year down

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the road, we're gonna want to come back.

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That tissue will have sagged a little

bit and we're gonna want to come

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back and tighten that up a little bit

more to get the result that we want.

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So does it mean no surgery?

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No.

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It just means we need to

understand that a second little

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tuck up may be needed at a year.

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If you have medical problems.

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that make anesthesia dangerous.

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And this is a relative

contraindication to everything.

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If you've got medical problems

that make anesthesia dangerous,

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we need to think about that.

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This is surgery that you want,

not surgery that you need.

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And so we don't want to take medical

risks with your health just to

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give you better looking breasts

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smoking.

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And this is one that comes up a lot is it

causes problems with microcirculation and

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when we're doing a breast lift, certainly

when we're doing a breast lift with

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implants, nicotine impairs the ability

for your body to heal those incisions that

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we need to heal to get you a nice result.

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A lift with implants is typically

in my book, a no no for having

00:14:46.051 --> 00:14:47.651

cosmetic breast surgery like this.

00:14:47.651 --> 00:14:49.201

You have to be nicotine free.

00:14:49.231 --> 00:14:51.231

We want to optimize your results.

00:14:51.631 --> 00:14:57.251

So six weeks before, six weeks

after surgery, no nicotine at all.

00:14:57.251 --> 00:15:01.641

That includes nicotine gum,

nicotine pouches, things like

00:15:01.641 --> 00:15:05.451

that., Cigarette smoking, nicotine

is a no for this kind of surgery.

00:15:05.451 --> 00:15:09.891

So we'll wait until you're T we

can get you off before we proceed.

00:15:10.931 --> 00:15:12.201

In a new relative country.

00:15:12.201 --> 00:15:17.291

And it's certainly something we have to

talk about is Ozempic and these Monjaro

00:15:17.291 --> 00:15:19.511

and Tizipatide and all these other things.

00:15:20.331 --> 00:15:23.421

And the reason that those are

problematic is not for healing

00:15:23.421 --> 00:15:26.331

necessarily, but is for anesthesia.

00:15:26.331 --> 00:15:28.171

They cause your gut to slow down.

00:15:28.211 --> 00:15:31.981

When our anesthetist are putting you

to sleep, your stomach has to be empty.

00:15:32.041 --> 00:15:35.721

Otherwise we run the risk of,

essentially vomiting with you asleep,

00:15:35.731 --> 00:15:40.261

which can get in your lungs and cause

really nasty inflammatory problems.

00:15:40.471 --> 00:15:42.301

It can land you in the

hospital and the ICU.

00:15:42.896 --> 00:15:47.076

Ozympic, we really need to stop those

things about six weeks before surgery.

00:15:47.166 --> 00:15:53.756

Let your gut kind of come back online,

start functioning properly so that we

00:15:53.766 --> 00:15:56.386

don't run the risk of anesthesia problems.

00:15:56.386 --> 00:15:59.726

Now that we've gotten through

the kind of contraindications for

00:15:59.726 --> 00:16:01.496

surgery, talk about some of the risks.

00:16:02.241 --> 00:16:06.131

Typically in cosmetic surgery,

the idea is that we want to get

00:16:06.131 --> 00:16:08.121

our complications down to zero.

00:16:08.131 --> 00:16:12.781

Now as surgeons, we understand

that can't happen as patients.

00:16:12.811 --> 00:16:16.951

You need to understand that there

is a chance you will have a problem

00:16:16.951 --> 00:16:22.171

after surgery, but we try and

minimize those as much as possible.

00:16:22.411 --> 00:16:26.291

So what are the bad ones?

00:16:27.456 --> 00:16:28.706

What's the worst thing that can happen?

00:16:28.776 --> 00:16:32.256

It's kind of how my parents brought me up

with think about what's the worst thing

00:16:32.266 --> 00:16:33.876

that can happen before you do anything.

00:16:34.916 --> 00:16:39.316

The worst thing that can happen is that

we do a breast lift with implants and

00:16:39.316 --> 00:16:41.836

we either have dead tissue, things die.

00:16:41.936 --> 00:16:46.176

We get too aggressive and stretch

things too far and they die.

00:16:47.296 --> 00:16:53.766

oR we get an infection and end up losing

implants, get infected, exposed, and we

00:16:53.766 --> 00:16:55.656

have to take them out and start over.

00:16:56.156 --> 00:17:00.586

And so fortunately those

complications are really rare.

00:17:00.666 --> 00:17:02.956

They do happen, but they're really rare.

00:17:03.796 --> 00:17:08.756

And they're more common in

patients who have healing problems.

00:17:08.756 --> 00:17:12.756

So things like diabetes, patients who

smoke, which is one of the reasons that.

00:17:13.606 --> 00:17:18.166

Smoking is kind of a foreboding thing

around the time of surgery, or patients

00:17:18.166 --> 00:17:20.386

who are on some immune modulators.

00:17:20.396 --> 00:17:25.626

So taking medications for

rheumatoid arthritis or ulcerative

00:17:25.676 --> 00:17:28.526

colitis or inflammatory bowel

disease or things like that.

00:17:28.846 --> 00:17:31.816

Those are things that we have to

really be careful with because they

00:17:31.816 --> 00:17:35.766

can cause healing problems that can

result in some really disastrous

00:17:35.766 --> 00:17:37.896

complications from a cosmetic standpoint.

00:17:38.296 --> 00:17:40.916

Blood clots around the

implants, a hematoma.

00:17:41.236 --> 00:17:43.366

Those are really also very rare.

00:17:43.366 --> 00:17:45.976

Fortunately, those require a trip

to the operating room to drain.

00:17:46.896 --> 00:17:49.666

The more kind of annoying problems.

00:17:49.986 --> 00:17:52.756

that can happen after

surgery is sensory loss.

00:17:52.946 --> 00:17:55.516

Around the nipple sensory loss can happen.

00:17:55.686 --> 00:18:00.206

Typically, the likelihood of that

happening goes up the further

00:18:00.206 --> 00:18:01.316

we have to move the nipple.

00:18:01.376 --> 00:18:05.556

So the more we have to do to kind

of move the nipple around and get

00:18:05.556 --> 00:18:07.056

it re centered back on your chest.

00:18:07.056 --> 00:18:09.646

the more likelihood you are

to have some sensory changes.

00:18:10.026 --> 00:18:11.566

Now we don't take the nipple off.

00:18:11.566 --> 00:18:12.716

That's another common question.

00:18:12.716 --> 00:18:14.746

People do you take the nipple

off and put it back on?

00:18:15.026 --> 00:18:16.106

It stays attached.

00:18:16.106 --> 00:18:19.466

And that's why what we really have

to be careful with is that kind of

00:18:19.516 --> 00:18:22.676

keeping the nipple on that leash

to move it around on the inside.

00:18:23.096 --> 00:18:25.536

That's where some of the

nerves and blood vessels live.

00:18:25.816 --> 00:18:30.646

And the smaller we make that

leash, the more, chances of

00:18:30.646 --> 00:18:32.956

problems we're going to have.

00:18:33.016 --> 00:18:36.286

And some patients with, you know, we

have to make that leash really long.

00:18:36.816 --> 00:18:38.036

It can be a real issue.

00:18:38.036 --> 00:18:39.936

And we talk about that before surgery.

00:18:40.736 --> 00:18:43.996

Scar healing is another one that

we kind of touched on earlier.

00:18:44.366 --> 00:18:46.396

And scar healing is one of those things.

00:18:46.786 --> 00:18:48.996

If we want to be aggressive,

we can start early.

00:18:49.286 --> 00:18:53.796

Otherwise, we watch mother nature

take a course and can course correct

00:18:53.796 --> 00:18:55.536

if we see things going the wrong way.

00:18:55.916 --> 00:19:00.286

That is breast lift and

implant surgery in a nutshell.

00:19:01.426 --> 00:19:06.116

I tried to be as thorough about this and

let you know what to expect as possible.

00:19:06.446 --> 00:19:08.116

Obviously, with medicine.

00:19:08.116 --> 00:19:12.186

surgery, cosmetic surgery,

everybody's different, everybody's

00:19:12.196 --> 00:19:13.356

plans a little different.

00:19:13.886 --> 00:19:17.976

And if this is something that you are

interested in, we will go through all of

00:19:17.976 --> 00:19:21.536

this in detail at your consultation, but

wanted to give you an overview of things.

00:19:21.846 --> 00:19:25.436

So you know what you're getting into

before you go in for your consultation.

00:19:25.826 --> 00:19:29.356

If you have any questions, as always,

shoot me a DM, shoot me an email.

00:19:29.576 --> 00:19:30.446

Thanks for listening.

00:19:30.456 --> 00:19:31.586

And we'll talk to you soon.