The exact instructions as regards to breast lift wound care may differ from surgeon to surgeon; nonetheless, there are generally agreed upon guidelines such as preventing or treating infection immediately, avoiding over-exertion while healing is not yet complete, just to name a few.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that aside from the quality of breast lift wound care, the suturing technique will also play a critical role in the prevention of wound separations and healing problems.
The goal is to eliminate most of the tension on the skin surface by placing it on the deeper tissue, says Dr. Smiley.
Aside from meticulous wound closure technique, risk factors such as obesity, smoking, serious medical conditions, and use of aspirin and other drugs with blood thinning properties must be eliminated or at least controlled well ahead of the surgery.
In standard breast lift (i.e., anchor or T-shaped incision technique) wound separation is not uncommon in the T junction (or the area where the vertical incision meets the horizontal incision along the submamammary fold) because of the opposing tension. Hence, patients who only need mild to moderate tissue elevation is encouraged to choose the modified form in which the inframammary crease incision is eliminated, a technique referred to as lollipop lift.
Meanwhile, Dr. Smiley explains the postop care that can prevent or at least reduce risk of wound separations.
- Prevent or treat immediately signs of infection
Persistent swelling, pus or foul discharge, fever, and increasing pain are common signs of infection. To prevent this complication, a good rule of thumb is to achieve one’s optimal health well ahead of the surgery.
The use of antibiotics and good hygiene (washing one’s hands before and after changing the dressing) can also reduce risk of infection and its subsequent problems such as wound separation and poor healing.
The truth is, patient cooperation will also play a crucial role in the prevention of complications. It is important to avoid heavy lifting and strenuous exercise for a minimum of three weeks postop to avoid wound separations, persistent swelling, and other things that could compromise one’s recovery.
- Avoid premature removal of sutures
Non-dissolvable stitches, which are usually used to “hold” the superficial layer of the wound, should not be removed prematurely lest wound breakdown may occur.
Furthermore, certain suturing techniques such as monofilament are believed to be less prone to “spitting.”
The general rule of thumb is to avoid smoking three weeks before and after surgery to give the body ample time to flush out the effects of nicotine, which is a strong vasoconstrictor (it shrinks the blood vessels that the nutrient supply going to the wound is greatly diminished).
Breast lift for large sagging breasts faces unique challenges, which must be recognized and assessed well in advance of the surgery to achieve impressive results, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
One major caveat of breast lift for large sagging breast is the susceptibility to drooping recurrence because of the sheer weight of the breasts. Nonetheless, this perceived challenge could be offset by several techniques, which have been explained below by Dr. Smiley:
- Achieve one’s optimal health
Dr. Smiley only performs breast lift on patients who are near their ideal weight, which they are able to maintain for at least of six months. Not only it ensures more precise tissue resection and thus more predictable long-term results, women of normal weight are also less likely to experience healing problems, infection, and unacceptable scarring compared to obese patients.
Obesity—along with diabetes, blood disorder, and other serious medical conditions—is closely linked to increased risk of complications after any type of surgery.
- Simultaneous breast reduction
If the saggy breasts are hugely disproportionate in relation to the patient’s [thinner] frame, she may ask for a simultaneous breast reduction, which not just improves “body proportions” but also makes the breast less susceptible to the effects of gravity and aging.
It is important to note that breast reduction and breast lift share the same incision sites; hence, additional scarring is not an issue.
Modified breast lift techniques—i.e., they result in fewer scars and possibly shorter recovery—give patients more options. Nonetheless, women with large sagging breasts can achieve no or very little improvement from them.
The anchor breast lift remains the best option for women with large sagging breasts; this is particularly true for someone needing a simultaneous breast reduction.
During an anchor breast lift, doctors create keyhole-shaped incision above the nipple area and then an anchor incision pattern that goes from the right to the left side of the lower breast pole. The goal is to remove some of the excess skin and elevate the breast tissue with the use of internal sutures.
The resulting scars go around the areola’s perimeter (perfectly blends at the dark-light skin junction), vertically between the areola and the submammary fold, and parallel to the fold.
The wise pattern breast lift, which is also called as anchor lift due to the shape of its resulting scar, is reserved for women with significantly droopy breasts—i.e., the nipple falls way below the submammary fold.
This “standard” breast lift technique uses donut shaped incisions around the areola’s perimeter, with the scar expected to lie precisely at the dark-light skin junction so it blends nicely to the “background.” Furthermore, vertical incisions between the nipple area and the submammary fold, and another one placed horizontally along the crease are created for additional lifting effect.
As a stand-alone procedure, the wise pattern breast lift is a powerful tool to reshape the saggy breasts, although it has no or very little effect on the fullness of the upper pole. Hence, some patients choose to have implants at the same time as their surgery.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated breast lift surgery combined with implants on his Snapchat account, a combo procedure that further ensures a good breast shape.
The female patient shown in the video also had her areola reduced in size to achieve more proportionate results, before it was elevated about 5 cm from its previous saggy appearance.
Dr. Smiley also tightened and elevated the breast tissue with internal sutures, instead of relying solely on tightening the skin, which over time could relax and sag due to the effects of continuous aging and gravity.
Meanwhile, the patient has asked for a “double D” cup henceforth she required larger implants, which her body can accommodate because of her wide chest wall. Dr. Smiley says it is important to measure the pertinent anatomical features such as the chest and breast dimension during the implant selection process.
By using implants that the chest and breast dimension can accommodate, most known implant-related risks can be avoided, says Dr. Smiley.
The scars around the areola’s perimeter and along the submammary fold are well concealed; however, the vertical scar in the lower pole is in a more obvious location and thus concerns most women. For this reason, the celebrity plastic surgeon highlights the importance of meticulous wound closure.
In all his patients, he closes the dermis [deeper layer of the skin] and just allows the skin wound edges to kiss each other to ensure the best scar possible. To further reduce the amount of superficial tension and thus help the scars fade and blend nicely, he also uses tapes or steri-strips.
The appearance of breast lift cleavage is one of the most pressing concerns of patients. While the surgery to some extent can provide additional upper pole fullness, the real issue is how long the “effect” can last.
It is important to note that breast lift primarily reshapes the lower pole of the breast, which is the area between the nipple and the submammary fold. Basically, it repositions the low-lying, downward pointing areola and tightens the breast tissue of the lower pole with the use of internal sutures.
In standard technique, the resulting scars go around the areola’s border, vertically between the nipple area and the submammary fold, and parallel to the breast crease; hence, it resembles an inverted T or anchor, according to the California Surgical Institute website.
As a stand-alone procedure, the improvement in breast lift cleavage appearance is very minimal—i.e., the upper pole has a concave appearance while the lower pole has most of the volume. Simply put, the overall breast shape resembles a teardrop.
But a good number of breast lift patients want more fullness in the upper pole, which can be accomplished with a simultaneous breast augmentation via round implants, which in essence are like a flattened sphere. High profile implants are particularly ideal for women seeking fuller-looking upper cleavage because they “stick out” more from the chest wall.
It is important to use implants that reflect the underlying anatomies, particularly the breast and chest dimension, to prevent inadvertent implant displacement (going “south”), rippling, and palpability.
Meanwhile, implants that are too big for the anatomical dimension can spell disaster because patients seeking breast lift surgery have poor skin quality to begin with. For this reason, surgeons not just reshape the skin, which cannot support the new contour over time, but also the actual tissue by using internal sutures.
However, some women do not like the idea of using synthetic implants. For these patients, fat grafting or injection to their upper breast pole can be a good alternative. (Note: About 100 cc of purified fats are often enough to achieve fuller looking upper cleavage.)
Another possible alternative to implants is auto-augmentation technique in which some of the tissue in the lower breast pole is rotated and lifted higher with internal sutures to create additional fullness in the upper pole. This method only works for women with ample amount of breast tissue.
While repositioning the lower pole tissue, it remains attached to its blood supply (stalk) to prevent healing problems.
The breast augmentation internal lift might be a good alternative to the standard breast lift technique in which the extent of scarring is often perceived as a major concern.
In standard breast lift (which is often combined with breast augmentation via implants), the scar goes around the areola’s border and within the submammary fold; hence it is well concealed. However, the main concern is the vertical scar that goes from the nipple down to the breast crease because it is placed in a more obvious location.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate how breast augmentation internal lift is accomplished.
The patient shown in the video had pseudo ptosis, which means that the breasts were sagging and the upper pole appeared deflated, but the nipple area had not drooped below the submammary fold.
Dr. Smiley created a U-shaped scar at the lower border of the areola to create an implant pocket. He also used internal sutures (they were vertically oriented) in the superficial fascia of the breast, particularly above the nipple area to elevate the tissue along with the areolar complex.
The vertical internal sutures that hold the nipple area and its surrounding tissue also give some fullness and tightness in the upper poles.
Precise pocket dissection is also a critical part of breast augmentation internal lift technique. Dr. Smiley says the goal is to prevent inadvertent implant displacement that may lead to sagging or bottomed-out appearance and excessive lateral bulge.
Despite the benefits of breast augmentation internal lift, Dr. Smiley says the technique is only suitable for patients with very minimal sag—i.e., their nipple does not require more than 3 cm elevation.
Meanwhile, patients with significant sagging—i.e., their nipple has drooped way below the submammary fold—will need the standard breast lift technique (with or without implants) to achieve the most desired results, says the celebrity plastic surgeon.
Regardless of the type of breast lift utilized at the same time as breast augmentation, Dr. Smiley highlights the importance of “respecting the skin to promote the best possible scar.”
While closing the U-shaped incision, Dr. Smiley is seen closing the wound in which the dermis beneath the skin was sutured while the actual skin edges were just allowed to kiss each other.
Breast lift with augmentation scars will depend on the extent of ptosis (sagging appearance). Nonetheless, a good plastic surgeon will make every effort to place the incisions in the most inconspicuous areas such as the areola’s border and within the breast crease/submammary fold.
The standard or full breast lift requires a scar around the areola and from the nipple area down to the breast crease; another incision is created parallel to the submammary fold. Simply put, the scar pattern resembles an inverted T.
However, incorporating breast implants could mean additional internal lifting effect and so the patient may avoid the submammary fold incision, which is quite prone to small wound separations. This breast lift technique is referred to as lollipop lift due to the final shape of the scars.
The lollipop lift is also called vertical lift because only the vertical scar is visible from the anterior view. Over time, it is expected to fade into color that resembles the patient’s skin.
It is important to note that every time the skin is cut or injured, scar will inevitably form and so it is critical to place it in the most concealed areas. Furthermore, the quality of wound closure can have a large effect on the final results.
While breast lift with augmentation scars generally fade significantly over time, no surgeon can 100 percent guarantee favorable scarring since one’s predisposition to aggressive scars is largely determined by genetics. Studies have suggested that ethnic patients (dark skin) are more susceptible to keloids compared to Caucasians.
Despite the genetic factors, leading Beverly Hills plastic surgeon Dr. Tarick Smiley suggests that wound closure will still play a critical role in the final scar appearance. In his recent educational video posted on his Snapchat account, he is seen closing the incisions in which there was no tension on the skin surface.
“We just suture the dermis beneath the skin, while the actual skin edges are just allowed to kiss each other. This ensures favorable scarring,” says Dr. Smiley.
To further minimize superficial tension, the celebrity plastic surgeon places tapes or steri-strips to hold the skin edges together, and requires a proactive scar treatment approach once the wound is clinically healed—i.e., the scabs have fallen off by themselves.
Dr. Tarick Smiley often instructs his patients to use silicone sheets for several weeks postop to reduce the risk of aggressive scarring (keloids and hypertrophic scars).