What is a breast lift?

A breast augmentation means only one thing: enlargement of the breast. But "breast lift" is a general term that applies to a number of very different procedures, all of which have in common some removal of breast skin, which thereby tightens and reshapes the breast. It can be just a reduction of the areola size; a slight upward repositioning of the nipple and areola; tightening a slightly loose breast that has just collapsed but not actually gone south; reshaping a misshapen breast; projecting a "pancaked" breast; and lifting a breast that has fallen low.

Who is a candidate for a breast Lift?

A breast lift is appropriate for patients who need tightening or reshaping of their breasts and who are in good health for an elective procedure.

What are the most important factors to consider when deciding whether or not to get a breast lift?

Scars, scars, and scars. It is a trade-off of scars. v. shape. Would you rather be higher, perkier or better shaped with scars, or as you are now without scars? Two women with the identical breasts may feel that different options are most appropriate for them. There are of course the usual risks of surgery such as infection, but the scar issue is the one that women considering a lift most struggle with.

Why are there different types of breast lift procedures?

Since there is nearly an infinite number of ways in which a breast can need tightening, lifting, or reshaping, there needs to be many types of breast lifts. Breast lifts have also been devised for the purpose of reducing the total length of scars, though some of these procedures fail to be able to lift or reshape as much, and though the scar will be shorter, each inch of the scar may be thicker.

What is a Full Pattern, Inverted T, Wise Pattern or Anchor breast lift?

This is the classic, time-tested way to do a breast lift. The scar is around the nipple, straight down from the bottom of the areola to the crease under the breast, and across the crease under the breast. This allows the greatest degree of skin reshaping because it is separately adjustable in both the vertical and horizontal direction. It can remove the most skin in the loosest breasts, and raise the lowest of nipples. Though it has the greatest length of scar, the scar quality is usually the best of all the methods of breast lift. It has been and remains the most commonly done breast lift technique.

What is a "lollipop" or "vertical" lift?

In a vertical lift, there is a scar around the nipple and straight down from the bottom of the breast to the crease under the breast. It differs from the anchor lift by not having the horizontal scar under the breast. It is really a misnomer to call this a vertical lift. Though the scar is vertical, by definition it narrows the breast horizontally. Only a horizontal scar shortens and lifts in the vertical direction. Just think of a dart on a dress. Tucking it will narrow the dress horizontally, but only removing fabric at the hem will shorten the dress vertically. This method has become increasingly popular due to patient requests for shorter scars. But it often creates an overly pointy breast; sometimes it leaves the distance between the nipple and the bottom of the breast too long; the scar often needs revision, sometimes including the horizontal scar meant to be avoided; and though the total scar length is less than with an anchor lift, inch by inch the scar is often worse because the vertical breast lift requires bunching of skin on each side in order to only have a vertical scar.

What is a Benelli or Donut Lift?

A donut lift is a scar only around the areola. It works for reduction of the size of the areola, slight vertical repositioning of the areola, and reducing a slightly lax breast that is not also very droopy. It is very limited in what it can do. By its nature this procedure reduces an overly projecting or pointy breast. In fact, we often use this technique in "tuberous" or other types of overly projecting breasts in an effort to flatten them out a bit. But it will also flatten the front of breasts that do not need flattening, which can be an unattractive appearance. Many patients ask for this lift because they want shorter scars, but it is important to understand that this technique is limited in what it can accomplish in larger or heavier breasts.

What is a Crescent Lift?

A crescent lift is a largely abandoned lift in which there is a scar from about 9 O’clock up and around to about 3 O’clock. At its best it only raises the nipple a small amount, perhaps tilting up just a bit a nipple that is tending to point down. However it invariably results in some enlargement of the upper half of the areola, and some degree of elongation and ovalization of the areola, which most women find disagreeable. When a patient only needs a slight upward tilt of their areola, usually today a donut lift is done because there are few women in this situation who wouldn’t prefer the scar to go all the way around the areola in order to create a smaller and rounder areola.

Other than location and length, is the scar quality the same for all lifts?

The quality of the scars varies widely with all of these lifts. When skin is carefully tailored and sewn together, with equal lengths of skin on each side and no bunching, the skin heals very nicely. But the vertical lift and the donut lift by their nature absolutely require some degree of bunching. This pleating results in a bit wider or thicker of a scar. Sometimes a slight starburst kind of appearance can be seen with the donut lift emanating from the scar as little radial lines. This does not mean that these methods are bad; it just means that one must consider not just the length of the scar but the quality of the scar. Oftentimes – but not always – a breast lift with a longer scar that is of a better quality is less conspicuous than a breast lift with a shorter scar of lesser quality.

How do you decide which breast lift to do?

I make the decision together with the patient. Sometimes there is one lift that is clearly the best or clearly inappropriate. In other situations a patient will have a choice. If the need is for just a bit of tightening of the breast envelope, a slight vertical elevation of the nipple, a reduction in the size of the areola, a desire to make an oval areola round, or improve the shape of a pointy breast, I will suggest the donut lift. If the nipple needs to be elevated some but not a lot, if the breast is lax in the horizontal dimension but not long from the nipple to the bottom vertically, then I will suggest a vertical lift. For all other situations – and indeed most commonly – I suggest the anchor lift. Sometimes a patient will have a choice, and I will discuss the pros and cons of each options and show photographs of similar patients who have had each type of lift so that they can decide which would be better for them.

Can I breast feed after a breast lift?

All breast lift procedures Dr. Teitelbaum performs do not cut the milk ducts, so theoretically there should be no loss of the ability to nurse. Yet this must be acknowledged as a risk of surgery.

Will I lose sensitivity in my breasts after a breast lift?

While a lift usually does not decrease sensation, that is a well-recognized risk of the procedure. Patients must accept that as a potential side effect. But on the other hand, since sexual sensation is very psychological, a woman that feels more comfortable with her breasts, or a sexual partner who acts more interested, can result in women reporting an increase in breast sensation after a breast lift. However there is no anatomic basis that would suggest that this should occur.

Will a breast lift help with any neck or shoulder pain?

Traditionally we say that pain can only be alleviated by a reduction of breast weight by removing breast tissue. But studies have shown that merely elevating the breast by tightening the skin envelope results in a reduced need for pulling up on a bra strap to elevate the breasts. In some situations this can reduce neck and shoulder pain.

Will my nipple be removed when the breast lift is performed?

Never! Everyone asks that question, and a nipple is not removed with a breast lift.

Will my breast be much smaller after the lift?

Only skin is removed. The skin is of an inconsequential volume. Your breasts will be of the same size but located higher on the chest. Because there is less droopiness, sometimes it is perceived to be smaller. And because the breasts are higher with more upper fill, sometimes the breasts are perceived to be bigger. But the volume of the breasts is simply not changed with a breast lift.

Are the results of a breast lift permanent?

The elevation of the nipple is usually permanent and they rarely need to be lifted again. But gravity can cause the weight of the breast to stretch of the lower part of the breast.

For how many years does a breast lift last?

There is no time that a revision is required. The breast will always look better than if it did not have a lift. But gravity will act and the breast will descend with time. The heavier the breast and the thinner the skin the more this will happen. Some people have revisions to retighten the breast, but most do not. Weight gains, losses, and pregnancy can cause breasts to drop depending on how much larger and emptier the breasts become.

Should I be afraid that my breasts could look round and fake after a breast lift?

Depending upon your perspective, it is either a good or a bad thing that breast lifts will almost never create a high, round, or fake looking breast. The breasts will be higher and rounder, but they never look fake or round as can be seen after a breast augmentation.

If I gain weight after a breast lift will my breasts get big and or sag again?

A weight gain can cause the breasts to sag or droop over time due to the increase in breast weight. But weight loss has a greater tendency to make a breast look loose and empty.

Don’t I need to get implants to get a good shape from a breast lift?

Many patients come to Dr. Teitelbaum with advice from other doctors that they need to have a breast implant to get a good shape with a breast lift. While an implant will often create a rounder and perkier breast, it invariably makes a breast larger. That is only something to do if you specifically know that you want to be larger. In any case, a properly done lift will give a great shape in most circumstances; an implant is rarely required to create a good shape.

Can I get breast implants at the same time as my breast lift?

If you have decided that you want implants, it is a big decision whether to do it at the time of the lift or at a second stage. This is a controversial subject and it requires one-on-one discussion. In general, there is only one possible reason to do it in one stage: convenience. But a host of other reasons suggest better results if done in two stages: it is safer; a more complete lift can be done; people needing lifts often have asymmetries of volume and droopiness, and this can be more accurately fixed in two stages. Despite that, many patients accept those trade-offs and decide to do it in one stage.

How do I decide if I should get breast implants with my breast lift?

The only reason to get breast implants is to be bigger. It should not be done because you perceive your result will be rounder or perkier. In fact, though an implant can make a breast rounder and perkier in the short term, the additional weight will only make the breast droop more in the future.

How will you decide if I should get breast implants at the time of my breast lift?

Dr. Teitelbaum will suggest it be done in one stage only if there is relatively good symmetry to start out, your tissue is not very thin, and you are not very droopy. But better results are achieved if the breast tissue has really dropped low, there is a lot of asymmetry, or if the breast tissue is very thin.

Can I get regular mammograms after a breast lift?

A breast lift affects neither the ability nor the need for a mammogram. You should consider with breast self-exam and mammograms the same after a breast lift as if you never had one.

Does insurance cover breast lifts?

A breast lift is a cosmetic procedure. Insurance only covers "medically necessary" procedures and therefore insurance will not pay for a breast lift. The only exceptions are cases in which there is a congenital or developmental asymmetry, or to treat the non-cancer breast after a mastectomy in order to create symmetry.

What form of anesthesia will be used for my procedure?

A light general anesthesia is the most common form of anesthesia for a breast lift, though local or IV sedation is a viable alternative in many situations.

What should I bring with me the day of surgery?

You will be given complete instructions for this prior to your surgery. Just wear comfortable and loose fitting clothing that buttons or zips in the front. Bring any medications that you take.

Do I need to go to an aftercare facility after my surgery?

After a breast lift a patient is always able to go home so long as there is a responsible adult to take care of her.

How painful is the recovery?

A breast lift is not a very painful procedure. There is some tightness and soreness, but it builds gradually and is easily managed with medications. Of all the procedures we do in plastic surgery, the pain and recovery from a breast lift is among the easiest.

Will I get a phone call from the doctor the night of my surgery?

Dr. Teitelbaum will phone you the night of surgery. You will also be given his cell phone to make it easy for you to reach him if you have a question.

How soon can I go to work?

When you will feel ready to do your job is highly individualized. So long as your work doesn’t involve straining and heavy lifting, you can expect to be back to work after three or four days. Some people go back even sooner, and many work from home the next day.

When can I drive?

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. That is ultimately a decision that I cannot make for you.

When can I travel by airplane?

There is nothing about being in an airplane that poses a risk for breast lift patients. It is just important to give yourself a few days to heal. Moreover, it is important that you be somewhere where you can see a doctor if you need to have your incision looked at. But in general, patients will start travelling after five days or so, so long as they are going somewhere where there will be a plastic surgeon.

When can I resume exercise?

I suggest you wait 3 weeks. I want to be sure that everything is healed. There is always a chance of causing bleeding if you start much before that time. When you start, listen to your body. You will be a little out of condition and a bit sore. But you will get back to where you were before surgery very quickly.

What is considered to be exercise?

Elevating your heart rate or blood pressure, bleeding hard, or straining or sweating. But light walking is beneficial starting the day of surgery.

Does not being able to exercise then exclude sex?

Sex can be resumed as you feel comfortable. Most often patients hit their level of comfort in 3-7 days. Again, respect the fact that you have undergone surgery and try to avoid the manipulation of the incisions.

When can I lift my child?

You can lift a cooperative child that is up to 35 pounds right away. But don’t try to pick up your child if he or she is upset.

When can I drink alcohol?

A small amount of wine is always okay unless they are specifically forbidden by the antibiotic that you are taking.

When can I smoke cigarettes?

Cigarettes reduce blood flow and consequently healing. This is of particular concern in breast lifts, face lifts, and tummy tucks. A breast lift patient should abstain from smoking for about three weeks before surgery and two weeks after surgery. This really is not a joke: serious healing problems can result from smoking. Dr. Teitelbaum will often test patients’ urine the morning of surgery and if there is evidence of nicotine he will cancel surgery at your expense in order to preserve your well-being.

When can I sunbathe?

We would like to say never, since nothing ages us as much as the sun, and the damage it does to the skin. This is particularly true in the decolletage area, where sun damage makes women look very aged. But it is okay to go out in the sun within days after surgery, provided that the incision is protected by something that will totally block the sun, and it is a good idea to keep the incision totally blocked form sun for a year or so.

When can I shower/take a bath?

You can take a shower the day after surgery. You should wait about two weeks before taking a bath so that your incisions are somewhat healed.

What will my post-operative appointment schedule be like?

There are no drains or stitches to be removed after a breast lift, so there are really no compulsory visits or times at which something in particular must be done. Dr. Teitelbaum wants to see everyone the day after surgery to be assured that everything is okay. He offers patients frequent visits thereafter, usually at one week, one month, six months, one year, and yearly therafter. But some patients will come more frequently, some less frequently. He does not charge for these visits. Some people have little questions they want answered, and other people feel fine on their own. But I am always available for a patient who wants to come in. So the visits are more on an "on or if-needed" basis than anything specific.

Is there swelling and if so, how long does it last?

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Is there bruising and if so, how long does it last?

Bruising can occur, but it usually resolves after about ten days from the time of surgery.

Will I have a special bra or garment to wear after surgery? How long will I have to wear it?

Usually a soft and supportive bra is given to you by Dr. Teitelbaum after surgery. During the first few days, it is normal to have a little bit of blood-tinged drainage through the incision. Instead of soiling your own bras, use the one provided to you. But you can switch to any other bra you want when you feel like it. It is best to wear a bra and sleep in one for the first month after surgery. After that you can return to your usual habits.

When can I wear an underwire bra?

You can wear an underwire bra right away so long as the wire is not irritating you. In fact, that goes for any bra: don’t wear one that is irritating.

Can’t I go without a bra after after I have a breast lift?

Breasts droop because gravity pulls them down. The more you wear a bra the more they will stay up. People who have drooped once have proven that they have this tendency, so it makes sense to wear a bra most of the time after having a lift.

Can you make me perky enough so that I won’t have to wear a bra again?

It is still generally wise to wear a bra in order to prevent gravity from dragging them down. Smaller breasts with good skin can often be made perky enough to look great without a bra. But larger, looser breasts with thin skin often will stretch a bit with time and may need a bra to make them look perky.

What do I have to do to care for the incision?

Your incision will be covered with little tapes called steri-strips. You can get them wet and blot the breast dry. They will start to peel off at about a week. See below for advice on scar management.

When do the stitches need to be removed?

Most of the time dissolvable sutures are used for a breast lift, so you do not need to have sutures removed.

What should I do to prevent scarring?

The bottom line is that the fate of your scar is mostly determined by your own genetics and by the surgery itself. It is not clear the extent to which putting things on scars will influence their final appearance. However, most patients want to do something. There has never been a direct comparison between the various products. Patient feedback has been the most positive from three sorts of things: Scar Guard, which is a liquid containing steroid, Vitamin E, and silicone that you brush on like nail polish; Silicone gel strips (such as Neosporin scar strips); and silicone ointment (such as Scar Fade.) You can get these from the office or the pharmacy, and you can start putting them on once the glue or the steri strip is off, following the instructions on the packaging.

What do I need to watch out for?

A sudden increase in pain, firmness, or swelling after surgery can mean that there is bleeding. This requires immediately contacting the office. A dark blue or very pale areola and nipple could be a sign of poor circulation and the office should also be immediately contacted. Redness or drainage may be a sign of infection. But this operation has a relatively low complication rate and patients typically enjoy an easy recovery.

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