When patients ask about the long term effects of breast lift, oftentimes they refer to the longevity of the shape. While many surgeons would say that it would probably last between 10-15 years, the truth is there is no definite answer due to the large number of variables.
The quality of skin, weight, sun exposure, diet, exercise, pregnancy, use of bra, and smoking and other lifestyle factors will have an influence on how long the breast contour and “perkiness” would hold. And while no surgery can stop aging, patients who have had breast lift in general will experience progressive sag that is significantly slower than someone who did not get the procedure done.
While aging and pregnancy contribute to breast ptosis (sag), leading Beverly Hills plastic surgeon Dr. Tarick Smiley says lifestyle factors also play a critical role in its appearance.
Dr. Smiley says that controlling lifestyle factors that have a detrimental effect on skin elasticity remains important after surgery.
Cigarette smoking reduces dermal collagen and skin tone, leading to breast ptosis. One previous study involving pairs of twins has clearly established its deleterious effects on skin elasticity.
Large weight fluctuations lead to breast volume deflation or involution, which can accelerate breast sag. Hence, the ideal candidate for any body contouring surgery should be committed to a healthy lifestyle, which they can adhere to long term. Diet pills and diet fads, meanwhile, are nothing but a palliative or temporary solution.
- Exercise and healthy diet
Combined with superb diet, exercise is the key to healthy weight and ultimately perkier and more youthful breasts. Of course, this only applies to women who make sure that they always wear a good fitting supportive bra.
Aside from smoking, UV rays also destroy the dermal collagen that gives the skin its youthful tone and elasticity. A good rule of thumb is to minimize sun exposure and use sunscreen regularly.
Breast augmentation and lift accomplishes two important things in one surgery: Increase the “cup size” and correct the sagging appearance. But sometimes, they are done separately to minimize risk of complications, which can be an issue if the patient wants bigger implants.
Breast augmentation, which is accomplished with the use of saline- or silicone-filled implants, increases the volume, while breast lift tightens the skin and deeper tissue. While combining these two procedures is known to enhance the overall contour, it is important to note that they have conflicting effects—tighten and expand the skin simultaneously.
The first step to achieve high satisfaction rate is to identify the ideal candidates for the combo procedure, and whether the surgeries can be performed simultaneously or in stages, says leading Inland Empire plastic surgery expert Dr. Tarick Smiley.
The placement of the nipple is one of the key elements that determines if a concomitant breast lift is warranted. One established aesthetic guideline suggests that the ideal distance between the nipple and the sternal notch (dip between the collarbone and neck) is 17-21 cm. Of course, women with longer torso and larger breasts can have a “larger gap” without their breasts looking saggy.
Furthermore, the nipple area should lie a few centimeters above the submammary fold, but then again the exact distance will depend on the breast size. Nonetheless, one study has suggested that the nipple position should “support” the 45:55 breast volume “distribution” ratio, which leads to the teardrop shape.
If there is too much distance between the sternal notch and the nipple, or the nipple falls at the same level as the submammary fold or beyond, a simultaneous breast lift is warranted lest an implant-alone approach can exacerbate the sagging appearance.
The standard or anchor breast lift suits women whose “breast bottom” has sagged more than 6 cm below the submammary fold. This entails a donut-shaped incision around the areola’s border, a vertical one between the nipple area and the crease, and another one that goes across the base of the breasts.
Meanwhile, patients whose nipple area remains above the submammary fold but can still benefit from a conservative elevation of their areolar complex will only need a donut-shaped incision technique.
After elevating the breast tissue and repositioning the nipple higher, implants are then propelled into their pocket, which should lie centrally behind the nipple area. The use of overlarge implants (or more than 600 cc) is generally discouraged unless breast augmentation is performed at a later date, ideally 3-4 months after breast lift.
If overlarge implants are simultaneously used during breast lift, they tend to ride higher on the chest wall leading to unnatural fullness in the upper pole/cleavage. In addition, they increase the risk of poor wound healing and less than optimal results.
Breast lift and implants is a “combination” surgery to reshape the pendulous breasts and provide additional volume especially in the upper breast pole, which tends to deflate with aging or following weight loss and pregnancy.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted breast lift and implants before and after photos on Snapchat to illustrate its “contouring and volumizing effects.”
During breast lift with implants, Dr. Smiley always completes one breast before proceeding to the other side. The idea is to create a template for the other breast, leading to more symmetric results.
Prior to surgery, the patient shown in the photos had significantly drooping breasts whose areolar complex, which is the ring of pigmented skin around the nipple, settled below the level of the breast crease and were hugely disproportionate.
With the severity of her breast ptosis, or sagging, Dr. Smiley performed the anchor breast lift, which involved a donut-shaped incision around the areola that extended down the midline to the breast crease. Another incision shaped like a crescent was also created along the base.
The anchor breast lift is also referred to as inverted T lift due to the shape of the incision or scar pattern.
The donut-shaped incision around the areola allowed Dr. Smiley to drastically reduce its size. To achieve good symmetry between the two sides, he used a cookie-cutter device to delineate the new smaller areolar complex.
When making the areolar incision, Dr. Smiley says “it is important not to go too deep in order to preserve the blood supply,” and ultimately “minimize the risk of healing problems and delayed recovery.”
Before and after photos of breast lift with implants
During breast lift, Dr. Smiley elevated the tissue of the lower breast pole with the use of internal sutures, and repositioned the areolar complex higher, ensuring that it would lie approximately at the center of the breast mound. Meanwhile, studies have suggested that the ideal nipple position should be above the breast crease, and there must be a 18-21 cm distance between the nipple and the sternal notch, which is the small dip at the base of the throat.
Afterwards, he positioned the implants beneath the pec muscle, instead of placing them above this anatomical layer. This technique, referred to as submuscular implant placement, reduces palpability and risk of rippling and bottoming out due to the additional padding from the muscle.
Lollipop breast lift with implants delivers two goals in one surgical setting: Correct the pendulous shape and add more volume with the use of breast implants, which are either filled with saline or silicone.
To demonstrate the results of lollipop breast lift with implants, leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat involving a patient who has had the procedure.
The patient had drooping, tubular shaped breasts prior to surgery.
The patient had severely drooping breasts in which the areolar complex, or the ring of pigmented skin around the nipple, settled beyond the breast crease, or the inframammary fold. Furthermore, her areola was disproportionately big relative to the breast mound.
“The patient needs the base of her breasts reconstructed. The base looks tubular and so we need to reshape it in order to deliver a fuller cleavage,” Dr. Smiley said in the video.
To reshape the breast and elevate its sagging tissue, Dr. Smiley performed lollipop breast lift technique in which a circular incision around the areola and a vertical line down the midline to the inframammary fold were used; hence, the resulting scar would resemble a lollipop.
The lollipop breast lift suits patients who need their areola lifted more than 2 cm, which the donut lift (i.e., only incisions around the areola’s border are used) cannot accomplish.
Meanwhile, several factors determine the ideal position of the areola, although the most critical one is the breast size. In general, its placement should promote a teardrop shape, or at least a 45:55 ratio, in which most of the volume is found in the lower breast pole.
Compared to the standard breast lift that also uses a crescent-shaped incision along the base of the breast, the lollipop lift generally results in shorter recovery and lower risk of wound dehiscence.
In standard breast lift, which is also referred to as anchor lift, the junction where the vertical and horizontal incisions meet is prone to wound dehiscence or delayed healing due to tension on the skin.
With lollipop lift, Dr. Smiley elevated the sagging tissue of the lower breast pole and reduced the areola by one-third of its previous size.
Afterwards, Dr. Smiley positioned implants beneath the muscle, which provides additional tissue coverage and support; these are particularly important in patients with a history of breast ptosis (sagging) and women with decreased skin thickness to prevent drooping recurrence, palpability, and rippling.
Breast reconstruction with internal lift aims to correct the sagging appearance without the extensive use of incisions. Some doctors refer to it as scarless breast lift, although the term might be confusing because it still uses a short incision right at the border of the areola.
Anytime the skin is injured the body creates a scar—its natural way of repairing tissue. Nonetheless, the scar from breast reconstruction with internal lift is made precisely at the areola’s border (light-dark skin junction) so it blends well into background.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos and images on Snapchat to demonstrate the results of breast reconstruction with internal lift.
But to enjoy the full benefits of breast reconstruction with internal lift, Dr. Smiley says meticulous patient selection is critical.
“A lot of people are asking who are good candidates for it. Usually, patients with no severe sagging will be able to do this,” he said in one of the videos.
The patient shown in the video had minimal sag. While her areola was positioned lower than ideal, it was still above the inframammary fold or breast crease.
Dr. Smiley positioned a small curved incision precisely at the lower border of the areola for optimal scar concealment. Then, he used a surgical mesh that would serve as an “internal bra” to support the new contour without the appearance of long scars, which is an issue with the traditional breast lift.
In traditional breast lift, the appearance of scar down at the midline (between the areola and the breast crease) is one of the main concerns of patients due to its more conspicuous placement. The peri-areolar and horizontal breast crease scars, meanwhile, are more concealed and so many patients would find them “acceptable.”
Aside from the use of surgical mesh, the success of breast reconstruction with internal lift also boils down to meticulous suturing technique. Dr. Smiley says all efforts are made to eliminate tension on the skin to promote healing and fading of scar.
He says that he uses buried tension suturing technique in which several rows of stitches are used to close the incision. The skin, meanwhile, is not “picked up” by any suture, with its edges simply allowed to “kiss” each other. This method promotes the best scar possible because it eliminates most if not all of the tension.
Mommy makeover surgery is any combination of body contouring surgeries performed simultaneously to improve the post-pregnancy body of patients. Common combination procedures include tummy tuck with liposuction of flanks, tummy tuck with some type of breast enhancement, and breast lift with implants.
The results of body contouring surgeries are near permanent, provided that the patient manages her weight through regular exercise and superb diet. It is important to note that fad diets and pills almost always don’t work long term and so weight management should be a lifelong commitment, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
After muscle repair, precise skin removal, and liposuction along the flanks, this patient is ecstatic with the results.
To shed light on the issue, Dr. Smiley has recently posted several mommy makeover surgery pictures on his Snapchat.
One patient received tummy tuck to remove the redundant skin between her mid and lower abdomen. To further achieve a flatter contour, the underlying muscle between the sternum and below the navel was tightened with the use of internal permanent sutures known for their additional strength (compared with absorbable sutures).
To further achieve a more feminine silhouette—i.e., cinching effect on her waistline—she also received liposuction along her flanks. Dr. Smiley started off the surgery with this procedure so he could tighten and pull more skin during tummy tuck.
When looked closely, the “after” photo (taken six months postop) reveals some muscle definition, which contributes to the more athletic but still feminine appearance of the abdomen. Furthermore, the new navel looks smaller and more proportionate compared with the “before” photos.
Tummy tuck and breast lift give this patient a more feminine and more youthful physique.
The second sample of mommy makeover surgery pictures shows a patient who had tummy tuck and breast lift performed simultaneously. Due to her underlying anatomy—there is a great distance between the lowest rib and hip—Dr. Smiley was able to significantly “reshape the sides” or flanks, leading to the hourglass appearance of her body.
And as seen from the “after” photos, tummy tuck has given her a flatter tummy, a significant improvement from her previous barrel-shaped torso.
To further complement the cinching effect of tummy tuck, she also had a breast lift in which her actual breast tissue, not just the skin alone, was elevated and reshaped with the use of internal sutures. Aside from the perkier appearance, Dr. Smiley has also created better cleavage and additional upper pole fullness of the breast.