Achieving a pleasing breast shape after breast reduction surgery is possible with deep tissue work and the creation of “appropriate” cup size, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
In the past, breast reduction surgeries were primarily concerned with the removal of excess tissue and redraping the skin over the smaller breast. However, the approach has a fundamental weakness: The skin stretches over time and so the initial perkiness is lost invariably.
To prevent breast sag, or at least prolong the perky appearance of the breast, Dr. Smiley says he performs deep tissue work alongside his breast reduction surgery.
His deep tissue work is the same with the breast lift technique in which internal sutures and breast tissue “elevation” are used to create a pleasing shape—i.e., some fullness in the upper breast pole.
With the suturing techniques, the breast shape is not dependent on the overlying skin, which is known for its inherent weakness, but rather on the deeper structures. This approach promotes longer lasting perkiness and more favorable scarring and healing since the skin receives no or very little tension.
When there is little tension on the skin, the scar tends to fade and heal much better, says Dr. Smiley.
“Sufficient reduction” is another critical element to promote a pleasing breast shape that can last for many years. It should be noted that one of the most common causes for “bottomed-out” breasts after surgery is that they are not made small enough.
Patients with overlarge breasts who want a conservative size reduction should realize that they remain susceptible to bottoming out or sagging due to the excessive weight that is causing the skin below the nipple area to stretch out.
It should be noted that the surgery does not change the quality of skin, although making the breast smaller and lighter can diminish the effects of gravity.
The breasts appear perky in the first few weeks postop until they gradually settle (i.e., lose some of the fullness in the upper breast pole) within 6-12 months.