Breast Lift FAQs

Speaker 1 (00:03):
Welcome to Kind of Beautiful with board certified plastic surgeon, Dr. Tracy Pfeifer. The podcast for women seeking the very best of modern beauty.

Dr. Pfeifer (00:16):
The first question that people ask me when they may need to lift is, can I just have an implant <laugh>? That's usually the first question because people are nervous about having a scar associated with the surgery. But as patients learn more, they understand that the scars really just fade away and they're not an issue. So oftentimes they're wondering, do I need just an implant? Do I need just a lift? How do I tell if I need an implant with the lift? These are the things that people are always wondering about. A really good test for a patient to decide to know ahead of time whether or not she needs an implant is how she feels about her breast size in her bra. So one of the first things that I'll ask the patient when she comes in for the consultation is in her bra, forget how you look outside the bra,

(01:16)
we know we don't care for that, but while you're wearing a bra, are you happy with the size? And some people will be happy with the size. In that case, they don't need an implant. And other people will say, well, I like the size, but the bra is gapping at the top. I don't have any volume in the cleavage area. So in that case, we're gonna need to have an implant. The reason why people benefit the most by having the smallest size implant to accomplish the goal, again, I like to call it the Goldilocks implant, is because the lift is working the opposite the way the implant will. So the lift is working against gravity. It's trying to pick up the weight of the breast tissue and lift it up and keep it up. So gravity is trying to pull it down and we're trying to keep it up.

(02:15)
And when we put an implant in, the implant is adding weight to the breast. So that is increasing the tendency of the breast to sag again. So these two things are in opposition. And so we want to really balance everything as much as we can. Doing a really good lift, lifting up the patient's own breast tissue, getting rid of the excess skin, raising the nipple so it's in the proper position on the breast, and then putting in as small and possible as possible implant to give that upper pole or cleavage fullness that people really want. And another misconception that people have is that if the implant is placed underneath the muscle, that somehow this is holding up the whole breast, it's holding up the implant and it's holding up the breast tissue. And that absolutely is not correct. And there are a lot of things that we consider when we're doing a mastopexy or breast lift with an implant that we wanna think about these factors so that we're getting the best long-term result.

(03:25)
Meaning seven years from now, we hope the patient doesn't need a revision because she's sagging again. And this has been the challenge with mastopexy/breast lift operations. The tendency is for the breast to sag again, whether it has an implant or it doesn't have an implant. And I always tell my patients, think about it, the only thing that's holding up the weight of the breast is the skin. There are these little threads of tissue which are named Cooper's ligaments, but they're not thick, heavy, substantial ligaments the way you would think of like that's in your wrist, for example. They're little thread like structures. And once the breast has sagged, those Cooper's ligaments have stretched out and they've lost their recoil. So it's as if you have a slinky and you overstretched it and it won't snap back. It's the same thing with the Cooper's ligaments.

(04:26)
And then we have the skin which could hold up the weight of the breast, but the skin has also stretched. And oftentimes when you look at a patient's breast skin, you'll see that there are stretch marks and that's an indication that the elastic recoil elements in the skin itself have been sprung. So that skin is damaged and is never going to easily hold up the weight of the breast for a long period of time. So as plastic surgeons, we're always looking for a way to support the weight of the breast and or the implant long term meaning three, four or five, seven years. And we've tried a lot of different techniques. And the one that I'm using now, which I think works the best, is to use a piece of uh, material that's like a mesh. It's called GalaFLEX. And the material breaks down into carbon dioxide and water in about two years.

(05:30)
But before it breaks down, it's around the breast tissue. So it's acting like an internal bra, if you wanna think of it that way. And while the breast is healing after the breast lift surgery, that mesh is supporting the weight of the breast, allowing the skin to heal and good scar tissue to form so that when the mesh dissolves, there's less of a tendency to have the breast tissue and or the implant sag. And that has been working very nicely. I've been using it for many, many years now and I've had very good results with that. So the number one challenge with a breast lift with or without an implant is how do we maintain the longevity of the results and prevent recurrent sagging and the GalaFLEX helps in that area. The type of thing that patients say when they come in asking about a breast lift is, I hate the way my breasts look.

(06:26)
They're deflated pancakes, sometimes they say that, they have no shape, they're ugly, they have a rock and a sock. Look, they're very sad. These are all the things that that they say. And a lot of times it's really not as bad as the patient thinks it is <laugh>. But obviously it's a big change for the patient because her breast, before she had children with weight fluctuations and or breastfeeding were one way and now they're very different. And so she wants to restore her breasts back to closer to the way that they were before. And it's perfectly reasonable to want that.

(07:15)
Most patients are who are candidates for breast lift surgery. There's no reason why they can't have it. It's just like all of our other patients. So if we said to ourselves, are there any patients who cannot have breast lift surgery? The answer really is no. Unless they have a medical problem which prohibits them from having general anesthesia. This is true of all our patients, 'cause all of our patients in aesthetic plastic surgery are having elective surgery. And so they need to be healthy. You can have a medical condition, you can have diabetes, you can have high blood pressure, you can have asthma. But as long as these conditions are managed, the blood pressure, you're taking blood pressure medication. And so your blood pressure's normal. You can have surgery. If somebody came in and had uncontrolled high blood pressure, they're either not taking medications or the medications they're taking aren't effective at the dosage that they're taking, that needs to be corrected before they can have surgery.

(08:18)
So if that's the situation, I just send the patient to their primary care doctor or their cardiologist and we get them fixed up and then they can have their surgery. So the only person I would say who really should think twice about having a breast lift with or within an implant is somebody who has plans in the near future to have a baby because that potentially is going to undo the work that we've done. And she might need to have a revision after she delivers the baby and has breastfed or even if she doesn't breastfeed. So if somebody has very firm or fairly firm plans to try to become pregnant, I always encourage them to wait until afterwards and they see the logic in that as well.

(09:06)
With respect to how often a breast lift needs to be redone, I usually tell my patients it's about eight to 10 years with the GalaFLEX. It may last longer than that. In fact, I have patients that have lasted longer than that. But before GalaFLEX, we would definitely say eight to 10 years. And certainly if there are in the intervening time, pregnancies, weight fluctuations, you know, weight gain, weight loss, all of these can affect the durability of the results. So maintaining a stable weight, wearing a bra pretty much 24/7 is very important in terms of increasing the longevity of the result. So breast health is really important and I, I really should get a clip of this because a plastic surgeon did a study where he was filming women jogging and then he slowed it down tremendously and was measuring the excursion of the breast even though they were wearing a sports bra and the breast was going, you know, up and down, up and down.

(10:13)
And that's a tremendous amount of stress and stretch on the breast skin. So wearing a properly fitted bra is really, really important in general, even if you just, if you have breast augmentation, but especially for somebody who's having a breast lift or, and or a reduction because stretch is already part of the underlying problem in those situations. And that's another reason why you don't use an overly large implant because that's gonna add to the problem. Choosing the implant in a breast lift is a really important part of the preoperative decision making. You really have to balance the tissue's, ability to resist, stretch with the desired size that the patient wants. And we have to explain to the patients that we are really trying to focus on the long term. So yes, maybe you would ultimately have been a little bit happier with a slightly larger implant, but we're trying to balance all these factors and give you a beautiful result that you're happy with that lasts for a long time and decreases the chance that you need a revision in the near future.

(11:33)
So the question about where the incisions need to be for a breast lift is really interesting because it depends on where the nipple is and how high the nipple needs to be elevated, number one. So if the nipple is too low on the breast, it's gonna look much prettier if it's more centered on the breast mound. And then the second thing is how much extra skin is there? How much of the breast skin envelope needs to be removed? So if there's a lot of excess skin, we're gonna need a lollipop pattern scar, maybe we need lollipop with a short horizontal incision. If the nipple is just a little low on the breast, the implant will rotate it up a little bit. But in some cases you still need to raise the nipple a little bit even after the implant is in place. So if the nipple needs to come up centimeter or centimeter and a half, you can usually do just a peri-areolar mastopexy where you just take out a little extra skin above the nipple areolar complex and the nipple areolar complex slides up into that opening and you close the circle around the circle.

(12:47)
In cases where you have the nipple very low, let's say it's below the crease underneath the breast and or there's extra skin there, you're gonna need to add a lollipop, a vertical component to the peri-areolar so you have an incision around the arreola and then vertical down, which is the stick part of the lollipop. And it's that vertical incision that makes people nervous because they can see it more, at least initially. They really wanna try to avoid it, but with careful handling of the tissues, good suturing technique. And now I'm using Brijjits, which is a device developed by Dr. Eaves who's a plastic surgeon. They're little plastic clips and you put them all along the vertical incision and it takes the tension off. The closure scars hate tension. So if there's minimal tension, it just fades away to a little delicate line. You can barely see it.

(13:44)
And the Brijjits are making a big difference in the results. So we, I use that for all the patients. And I always explain to people ahead of time that when you're first recovering, the first two months or so, we have paper tape on the incision. So you can't really see it, but when you take the tape off to change it, you're gonna see your little incisions, your eye, your brain is not really gonna see the per eular scar because it's a circle around a circle. So your brain kind of sees that as one. But the vertical line, the stick part of the lollipop is kind of in no man's land. So your brain is really gonna see that. But that will fade as the color fades and it just becomes really pretty much invisible. Your brain won't register that, that much anymore. And I have a series of pictures that I took on one of my first patients where I showed her like a three months, a year or two years.

(14:43)
And by the time she's at two years, you can't see it. And that's without the Brijjits. So with the Brijjits it's even better. I would say at three months people are looking pretty good with the Brijjits. There are certain patients who do a little better in terms of healing. One thing is that if somebody has a lot of stretch marks, they're gonna be more prone to sagging. So we have to be really careful with them, number one. Number two, people who in general are a little more prone to having thicker or heavier scars. Sometimes people with more pigment in their skin, it could be, in my experience, Asian people, Filipino people, black people, they have very healthy dermis part of their skin, but at the same time they're more prone to creating a thicker scar. Sometimes it's hyperpigmented. So with those patients what we do is we pretreat them with a bleaching cream.

(15:41)
It doesn't make your skin lighter. What it does is it suppresses the melanocytes, which are the cells that make melanin so that after the surgery, when all the cells are stimulated to be very active, we want the fibroblast which makes collagen, which is what scar tissue is made out of. We want the fibroblast to be active, but we don't want the melanocytes to be that active. So this cream will suppress their activity and that's very helpful. And then I keep a close eye on the incision. So at two weeks I'm really looking at the incisions to see, is the scar getting a little thick? Is it a little discolored? And there are injections that we can do and that can help a lot to suppress the activity of the scar tissue so that it doesn't get thick and it doesn't get hyperpigmented. And for people who really wanna do everything and they wanna be very proactive in terms of how their incisions look, we advise that they go on an anti-inflammatory diet.

(16:43)
So very low sugar diet. I have them take Juven, which has all the amino acids that are needed in the formation of collagen. And the scars heal beautifully with Juven. I highly recommend Juven for everybody. You can get it at Amazon or Walgreens, you take it twice a day. It's a little powder drink, you just put in a glass of water twice a day. And I'm a big fan of that. And then you could also have an appointment with a dermatologist before surgery and tell 'em, look, I'm having surgery and I wanna start doing some laser treatments about three weeks after my surgery. And that can help soften the appearance of the scars. It kind of speeds up the healing of the scars a little bit. So people who are more prone or are very concerned about the appearance of the incisions, um, they'll start seeing a dermatologist about three weeks after surgery and they'll start having laser treatments.

(17:29)
They usually do two types of treatments. They'll do one type of laser which will help speed up the color. So initially they're very pink, it'll help them get lighter faster and then they use one that kind of blurs the edges between the scar and the normal non-scar skin that's right next to it because that's what catches your eye. If when your brain is looking at a scar, it sees the texture and color of your skin. And then when there's an incision, there's an abrupt transition where you have the scar starting and it has a different texture, different light reflection, different color. So that's why your brain kind of sees it very clearly. So if you can create like a blurry fuzzy border between the non-scar and the scar skin, it kind of fools your brain and it's not really seeing the scar that much. And it works, works really great.

(18:20)
At the two week post-op appointment, we're taking off all the tape that's covering the incisions, uh, removing any sutures that are on the surface of the skin. Most of the sutures are underneath the skin and they'll dissolve on their own in about three months. We wanna make sure that the nipple has good blood supply, which it always does <laugh> and that all the areas are healing nicely. We don't need to do any injections to soften the scar. And that's pretty much it. And then we put tape back on and we have the patient keep wearing their bra night and day for at least the first six weeks after surgery and they can't do any strenuous activity for about four to five weeks. And certainly no bouncing, no activities that lead to bouncing. That's our worst enemy. When the patient comes in for their consultation, we talk a lot about what bra they should wear.

(19:13)
We have 'em get a sports bra. It's by a brand called Anita and it's a very snug bra. I would say 85% of the patients like the Anita style that we recommend. Occasionally that bra is uncomfortable for people. And so we'll switch to another sports bra. The Victoria's Secret bra within a bra is really good. It has a inner cup that closes with a clasp and then it has like sort of a second outer cup that closes with a zipper. And that really pushes the implants if they have implants towards the center. And some people need that because they might have a tendency for their implants to slide out to the side. So those two bras are usually my favorite ones. But there are other bras. If the patient doesn't like one of those two, they can wear their own sports bra that they like as long as it's supporting them.

(20:03)
We talk about how to find a properly fitted bra, number one that's for the future. And I measure them for their sports bra and we ask them to get a couple different sizes that should fit them, keep all the receipts. And then the morning of surgery they bring their bras with them, we try them on, we see which one fits the best and that's the one that we're gonna use. And at the end of the surgery I put them in their bra and the other bras get returned and everybody's happy. The post-op period after, um, breast lift, whether with or without an implant is pretty straightforward. We have the patient sleep upright for the first three days if they can, they wear their bra 24/7. They usually shower the second day as long as somebody's nearby. 'cause sometimes the heat from the shower can make you a little lightheaded.

(20:53)
No heavy lifting or vigorous exercise for at least three weeks. And that duration depends a little bit on what type of implant is used during the surgery. So it could be longer, it could be six weeks or eight weeks where their activities are limited. Usually around the fourth week I let them do lower body exercises and core exercises. But nothing that really involves the pectoralis major muscle, which is one of the muscles at the implant is either just on top of or just underneath. Usually people will take off a week from work and then the second week they'll start working, whether they go into the office or they work from home, it doesn't matter. They can drive in the second week. And then understanding that that second week after surgery when they return to work around four o'clock, they're gonna be pretty tired 'cause they're just outta gas, their body is still healing and healing takes a lot of energy. And plus they're doing some work and work takes energy. So around four o'clock they're just gonna be pooped and they need to just head home, have an early dinner and they'll feel better the next morning. In the third week people are pretty much okay in terms of their energy level, but they're still healing. So it takes a full three months to feel, you know, a hundred percent after any surgery.

(22:15)
If a patient decides that they don't want to follow advice and they start exercising a little too soon, they'll feel it <laugh>. Usually there's no harm done, but they will be very tired or the next day they might be sore and they'll say, oh, I thought I could do it. But the next day I realized that that was not a good idea. So fortunately there's no long-term harm that is done, but you know, we want our patients to feel comfortable and not have any discomfort. So we really encourage them to follow our advice and not necessarily listen to their friends or to Dr. Google who may be telling them something different. Breast lift in with or without implants is pretty much the same as other aesthetic plastic surgery procedures in terms of the timeline of when you're gonna see your results. It takes a, you'll see right away that you're lifted, but it takes about three months for the swelling to go down and for the implant to be in its final position.

(23:14)
So I would say three months you're gonna, you're gonna really see it, but it's always getting better. It looks better at seven days. It looks better at six weeks, it looks better at 12 weeks. It's always getting better. Patients are always wondering, you know, how much pain am I gonna be in after surgery? Which I totally get it 'cause I hate pain. Also, I don't even like to use the word pain. I like to talk about discomfort. So on a scale of one to 10 where a one is nothing and 10 is bad, you should be a two or a three. And we have a pretty detailed medication schedule, which involves using a muscle relaxer. And this is the key because whether the implant is under or over the muscle, the muscle relaxer will relax the muscle preventing any muscle spasm. And that spasm is what leads to discomfort.

(24:01)
It's really not the incisions. So let's say somebody is just having a lift with no implant, they're probably gonna be a two and they may only take Tylenol if they have an implant. They might be a three or four and they're gonna need to take the muscle relaxer plus some Tylenol, maybe a little narcotic to keep them at a two. But it's a pretty easy recovery. The only thing to do is wear the bra and restrict your activities. And really that's the whole game. When the patients see the results, they're so happy because remember this was a change for them. I mean, occasionally you'll have a patient who always had sagging breasts, but for the most part these are people that had nice breasts and they changed and they're really happy to have it restored. I mean, they say things like, this is the first time that I can go to the beach and feel comfortable.

(24:54)
I can wear these clothes that I couldn't wear before. A lot of people wanna wear outfits for a couple hours without wearing a bra. And so even though we don't advise not wearing a bra for a couple hours, it's okay. So it opens up a whole lot of clothes and outfits that they can wear. Uh, whereas before they couldn't, there's no way they could wear these clothes without a bra. So it is life changing for people. Even if people just have a lift without any implant, I mean, they're so happy because those patients can't go without a bra either. There are certain clothes and outfits that they just can't wear. And plus, you know, when you're by yourself or you're, you know, with your partner, you wanna feel confident in your figure and this is what the surgery does for them. The thing that's really important with breast lifts when you're considering having implants is the implant selection.

(25:49)
And I think it's very important that your surgeon understand the different types of implants that are available and what's best for you. In this situation, I find that I get the best results with an implant that's placed on top of the muscle. So it's under the muscle fascia, it's called subfascial, but it's basically on top of the muscle. This way the breast tissue and the implant are in the same place, so to speak. And it looks the best. It can also, if you're borderline for needing a lift, if you put the implant on top of the muscle, especially if you use a teardrop, a lot of times you can avoid doing a peral or lift. There are smooth implants and there are textured implants. And although a lot of US plastic surgeons don't use textured implants across the world, they do. And I do use textured implants.

(26:41)
And in some cases a textured implant is very helpful for a patient who needs a lift because your breast tissue kind of locks onto the surface of the implant with a smooth implant, the implant is rolling around in the pocket, your tissue doesn't lock onto it. So it's easy for that smooth implant to stretch out the breast pocket and the breast tissue leading to sagging over time. So a lot of times I use a textured implant and sometimes I use a teardrop implant. And unfortunately there's not a lot of plastic surgeons in the US that are using texture 'cause I don't think they truly understand the benefits of it. And they're worried about some safety issues with it. But overall it's a safe implant. And I will say that our peers in Europe and South America do use textured implants because they've had a slightly different experience than we've had in the US And I think it's very important for patients to understand that there are different implants available. And I would avoid using overly large implants or implants that have high projections because those are going to lead to tissue stretch over time. So any patient who's interested and has specific questions about themselves regarding a breast lift could contact us through our website, dr pfeifer.com or just call the office at (212) 860-0670. And a lot of times we have patients that'll send us pictures and we can jump on a Zoom call and talk about the options for you and what what you can expect from your result.

Speaker 1 (28:20):
To learn more, go to Kind of Beautiful podcast.com or follow Dr. Pfeifer on Instagram at Dr. Tracy Pfeifer, spelled P F E I F E R. Links to learn more about Dr. Pfeifer and anything else mentioned on today's show are available in the show notes. The Kind of Beautiful podcast is a production of The Axis, t h e a x i s .io.