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Breast Lifts: With Implants or Not? - All You Need to Know (Ep. 63)

american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association International Society of Aesthetic Plastic Surgery
american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons american board of surgery The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association International Society of Aesthetic Plastic Surgery

The Trillium Show Podcast with Dr. Jason Hall

Breast Lifts: With Implants or Not? - All You Need to Know (Ep. 63)

Disclaimer: The discussions on this podcast do not constitute medical advice, an evaluation, or a consultation. Nothing in the podcast episodes should be considered a replacement or substitute for a formal in-office evaluation by Dr. Hall or his associates. Explanation of off-label services and/or products do not constitute promotion and/or endorsement. Information and opinions presented here do not create a formal doctor-patient relationship. Discuss any potential medical procedures or interventions with your physician or surgeon first.

Show Notes

This week, we're diving into one of the hottest topics in my practice: breast lifts. Whether you're considering a lift with implants, without implants, or even thinking about fat grafting, I've got all the insights you need! We'll debunk some common misconceptions about what a breast lift can and can't do. Does it magically fill out the top part of your breasts? Can it wave away stretch marks? I'll break it all down for you. We'll also talk goals—like improving nipple position, enhancing breast shape, and eliminating excess skin. Plus, I’ll give you the scoop on what to expect before, during, and after surgery. Whether you’re looking to rejuvenate your breasts post-pregnancy or just lift things up a notch, this episode will arm you with the knowledge to make an informed decision. So hit that play button, and let’s make your surgical journey as smooth as possible. And hey, if you enjoy this show, don't forget to leave us a review on Apple Podcasts. Your feedback helps others discover the show!

Welcome to The Trillium Show, where each week we discuss different tips and tricks to help you improve your mind, your body, and your life. I'm your host, board certified plastic surgeon and medical director of Trillium Plastic Surgery and Trillium Aesthetics, Dr. Jason Hall. A breast lift. With or without a breast implant is probably one of the most requested procedures in my practice year over year.

Between that on one hand and deep plane face and neck lift on the other hand, they kind of jockey back and forth between the number one and number two procedures I do year over year for about the last five years. However, there is a lot of misconception about what a breast lift can and can't do. Does it lift?

Does it fill? Does it do both? Does it do neither? In this episode we'll discuss breast lift surgery with and without an implant or fat grafting. You'll learn what to expect, what not to expect, and how surgery can help you get the look that you're after. So the first thing and probably the most important thing when we're talking about surgery is what the goals are.

So with a breast lift, the main goal is to a improve the nipple position on your chest. We want that nipple to move from pointing towards the floor or down below way below your breast crease to being back up around the same vertical height of your breast crease, aiming forward at the kind of apex of the breast mound.

The second is to improve the breast shape. So when I'm talking to patients in the office, When we talk about what goals of a breast lift are, is to improve the nipple position and then shape the breast around that improved nipple position. An ancillary benefit, a side benefit to that, is that in doing that, we're going to reduce enlarged areola, or the, the breast area.

Pigmented skin around the nipple that stretches out with pregnancy and childbearing or is just large to begin with and remove excess skin on the lower pole of the breast. So, the four goals, improve the nipple position, improve the shape, reduce enlarged areola, and remove excess lower pole breast skin.

It's equally important though to note what a breast lift doesn't do. So the most common thing that women who have had kids come in requesting is a breast lift because they want more volume at the top part of their breast, which seems to hollow out after having kids. It's just a natural way that the breast changes with time.

A breast lift by itself won't do that. And we'll talk about that more in a minute. For What a breast lift also won't do is eliminate the stretch marks or improve the stretch marks that some women can get after the significant changes in size that happen with pregnancy and breastfeeding. It also won't eliminate side boob or extra skin, at the outer part of your breast under your armpits.

But the most. Common misconception is that a breast lift improves hollowness at the top part of the breast. This is where we have to add volume. And we can do that with some of your own breast tissue. If there's enough tissue on the lower part of the breast underneath the nipple, we can move that up on the inside, kind of do some internal breast origami, and help fill that upper part of the breast with your own tissue.

Another way we can use your own tissue is to do fat grafting. So, liposuction, taking that fat, you know, liposuctioning another area of the body, taking that fat, processing it down, and then injecting it into those areas to help with contour. Now, fat grafting isn't a great tool for augmentation, primarily because it's unpredictable, and There is a limited amount of size that we can get with fat grafting.

You can really only get about a cup size at the most with fat grafting, but it is good to fill in contours. The third way that we can add volume, which is probably the most common way to add volume, at least in my practice, Now in 2024 is to use an implant and there are limits to what we can do in a single stage lift an implant together, but using an implant will help fill in that upper part of the breast that tends to hollow out.

What are some special considerations with breast lift surgery, whether you're having an implant and adding volume or whether we're not? One of the most important things to understand is that both the final result and the durability, how long that final result is going to last, really depends a lot on the quality of the skin and the breast tissue and the elasticity of the skin and the breast tissue that we're working with.

Both skin quality and elasticity are damaged with natural course of time, pregnancy, and breastfeeding. And those are not things that we can change surgically. These are out of our hands. It's out of my hand as a surgeon. It's out of your hands as a patient. We can still get a nice result, but as soon as surgery is over, The aging process resumes and the worse the quality of the skin, the worse the quality of the breast tissue is, the quicker that aging process can occur.

Now, does that mean you're going to end up back where you started six months later? No, you're still going to get a nice result, but it means that we have to have a conversation during a consultation where we're looking at different before and after pictures and matching women with the same quality of skin and breast tissue to where you're starting so that you can see how things change over time.

The second thing to really consider is that an augmentation, breast augmentation with a breast lift, Traditionally has been done in two parts. It's been done in two stages, three to six months apart. Usually the breast lift is done first and then the augmentation is done. And the reason that it has been taught that way and done that way for a long time is that a lift and an implant are essentially two procedures that have 180 degree opposite goals.

With a lift, like we said, we're lifting the nipple, reshaping the breast. We do not want tension on those incisions, because tension is the enemy of good scar healing. We want pretty scars. We don't want problems with healing, and so we want as little tension on those incisions as possible. An implant, on the other hand, is The goal is to stretch the skin out and have the breast take the shape of that implant.

We, and that's essentially done. The implants placed and the skin is trying to essentially fight that impulse, trying to contract down around that implant. And that's what gives the shape that we're looking for at the end. And you can imagine if we're lifting and then adding, um, We were kind of walking a balance beam.

They're doing this in one stage and we have to use a conservatively sized implant. We can't go with a giant implant if we're doing a lift and an implant together. And understanding that If your breast kind of ages, if you get a little bit droopy, if we, we kind of err on the side of caution with our lift and there's a little bit of sagginess left over at six months, we can go back and we can tighten that up with a relatively small revision or that if we do our lift and our implant, everything looks great, but the implants not as large as you want, we can then safely go back and upsize between six months and a year if we need to.

The other option is doing things where you're guaranteed 100 percent to have two surgeries, three to six months apart, doing that lift first, and then the implant. Scars are another big consideration with breast lifts, and there are really three versions of scars that we talk about. There's the small one, which is a Essentially the donut lift, so right around the areola or nipple.

There's the medium where the donut lift adds a incision from the bottom of the areola down to the breast crease. We call it kind of a lollipop incision. And then there's the large or the teddy bear or ship's anchor incision, which is the lollipop plus an incision in the breast crease. The vast majority of women who have all three of these have scars that are beautiful.

But you have to understand what the scars are going to be when we go into surgery. And you can see pictures of, of women with all three on my website. And we'll link to some videos here where we can, you can see what those scars look like because you have to be okay with the scars if we're going to undergo surgery like this.

Next thing we want to talk about is really what does that procedure look like? This is obviously all done in the operating room, general anesthesia. In surgery, the implant is typically put in first and then the lift is kind of performed around that implant so that we get the right shape and size.

And this is where we can kind of correct some minor asymmetries. I don't use drains. I don't use any. sutures that we have to take out. All of the incisions are covered with surgical tape and you can get up and shower and actually have to shower the next day. I typically buy about a week. We take that tape off.

We start routine scar management in terms of recovery. I typically will tell people, if you have a physical job, take a week to 10 days off. If you're, have a desk job, Within a week, you're back at work. If you can work remotely, usually about 72 hours and you're back on the computer, all you can do is be sober.

And usually by 72 hours, most women are able to switch over to Motrin and Tylenol and not need narcotic pain medication workouts. On the other hand, I like to tell patients you want to pause your workouts for about six weeks. You can walk, you can use a, a, elliptical without the arm motions. You can use a stationary bike after about two weeks, but anything where you're using your chest, I like you to give me six weeks.

You really want to recover, especially if we're using an implant, let that implant settle where it is so that we're not putting pressure and moving that implant around during that first, crucial six week recovery period along with. A breast lift with or without an implant. We can do tummy tucks.

We can do liposuction. The tummy tuck plus the breast surgery is kind of the mommy makeover that is a popular procedure in my practice these days. Thanks. Okay, so we've talked about goals, we've talked about what to expect, what not to expect, procedure itself. What are some warnings? What are some things you need to know about before you decide to have a breast lift? With or without an implant? I think the biggest thing is because of multiple variables, which include skin, which include breast tissue, which include just your, your natural healing, there are cases that will need to be revised.

Revision might have to happen. In my practice, revision mastopexy is less than 10%. I can't give you an exact number, but it's fairly rare, but it is something that happens. Secondly, is to understand that your breasts don't start out perfectly symmetric, they won't end perfectly symmetric. Even if we're correcting asymmetries, because you've had surgery.

You are going to be very in tuned to little minor things that are different and you will always see minor asymmetries in breast size and nipple position. The key is that we don't want them to be glaring. Those are things that need revision that we just talked about in warning number one.

Third, is that, your final cup size may be a bit different than what we anticipate. Now, that's a little different. That's not going from, a B, a droopy B or a droopy C to a big C or D. Not like that.

It, that's, you know, if you want an E cup, well, if you want an E cup, we need to talk about whether this is the right operation for you to begin with, because there's a lot of safety issues that go along with that. But if you've got your heart set on being a large B, you may end up a small C. And there, it's very difficult to kind of control small differences like that.

And I will say that bra sizes are very different manufacturer to manufacturer. You know this better than I do. And so, don't be married to a specific bra size or cup size When we're done, it will probably be different. What are some things that can go wrong? So complications, this is surgery.

Complications happen. Um, and this is another area that if you can't envision having a complication, then you shouldn't have unnecessary cosmetic surgery. , the absolute worst complicate, well, the worst complication is somebody dying in the operating table. Fortunately, knock wood. That is very, very, very, very, very uncommon.

So uncommon that it makes the news. If it happens in the case of a breast lift with implants, the incisions coming apart, us seeing your implant and causing it to be essentially infected, which means we have to take the implant out, let you heal and start over. which is in this situation is a disastrous complication is exceedingly rare.

Less than 1 percent of patients have that happen. Another exceedingly rare complication is a hematoma. So blood collecting around that implant requiring a repeat trip to the operating room to clean that out. That is also very, very rare. Less than 1%. Seromas. So little bits of fluid that collect around the implant, which is.

You know, early on is not a problem, but is kind of a pain in the butt, is also a rare problem. , numbness, specifically numbness around the lower pole of the breast and around the nipple are very common. The temporary numbness is common. Almost everybody is going to have some degree of numbness after surgery.

Permanent numbness, especially permanent numbness, Permanent nipple and areolar numbness is exceedingly rare and is usually really relegated to patients who have had a significant lift. And in those patients, a lot of times we won't recommend an implant just because the lift is so involved. We want to let that heal.

We don't want to compromise blood supply. And so, you know, permanent numbness in a lot of cases is, is fairly rare. We'll see you next time. Lastly is scarring. Um, and like we kind of, I was saying before, scarring is one of those things that is associated with skin quality. There's not a lot we can do if we start seeing poor scarring other than being really careful, catching it before it becomes a problem, and then treating it.

to prevent the poor scarring from actually happening. Once it's happened, we have to kind of get into treating bad scars, which can be very, very difficult. But if we're vigilant through the healing process, we can minimize a poor scar in the outcome. I hope that you have learned something about a breast lift with implants.

Like I said, it's a very, very common procedure, very, very common procedure in my practice from number one or number two, depending on what year it is. And also has a very high satisfaction rate. But you have to understand what you're getting into, you know, what can go wrong, what it does and doesn't do.

If you understand those things and they make sense, then it's a great operation for you. So thank you for listening. As always, if you'd enjoyed this show, please leave a review on Apple podcasts that helps other people find the show and helps to spread , the education that I'm trying to share here.

If you have an idea that you'd like to see made into a show or have a question that you want answered, send me an email media@drjasonhall.com drop me a DM on Instagram or X @drjasonhall. You can also leave a voicemail and be anonymously featured on the show by going to the link in my Linktree bio and leaving a voicemail there.

Thanks, and we look forward to seeing you guys on the next show.


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