Upper pole fullness after breast augmentation can be achieved with precise physical examination of the breasts. The idea is to identify the “challenges” and anatomical variables that must be overcome to achieve the best shape and projection possible.
Of course, the patient must be able to describe in details her cosmetic goals and expectations. Hence, patient-doctor communication plays a crucial role in the satisfaction rate, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted a series of Snapchat videos showing one patient whose primary goal was to achieve increased upper pole fullness after breast augmentation.
While the patient’s pre-operative breasts had adequate soft tissue, they were remarkably pendulous that her areola sagged a few centimeters from its breast fold (or submammary crease). Further aggravating the sagging appearance was the deflated or “empty” upper breast pole.
Due to the extent of her breast sag, Dr. Smiley performed the standard breast lift technique in which an incision goes around the areola’s perimeter, down the midline, and then across the breast fold. The resulting scar from this method resembles an anchor, and so it is also aptly named as anchor lift.
before and after photos
Despite the growing popularity of modified breast lift techniques, the patient remained suited for the standard incision pattern because her areola required more than 5 cm of elevation, something that cannot be achieved with shorter incisions.
The anchor lift has allowed Dr. Smiley to remove some tissue and skin at the bottom of the breasts before lifting and reshaping the remaining tissue with the use of internal sutures. But as a stand-alone procedure, breast lift cannot give ample fullness on the upper poles of the breast—this is where implants become helpful.
Because the patient was more concerned about the final breast shape and fullness of the upper pole, a smaller or conservative-sized implant would suit her.
While showing the patient’s before and after photos, Dr. Smiley said “there is no significant change in her breast volume even with the use of implants, although the upper pole has received significant improvement in terms of looking full and youthful.”
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).
Out of town breast augmentation requires advance planning to avoid complications and to achieve optimal results from the surgery. In general, patients are required to stay within the vicinity 3-4 days postop for follow-up visits to ensure that they are healing nicely.
Patient safety always starts with pre-op testing to rule out medical conditions or any other factors that can lead to increased risk of complications. For out of town patients, their local primary care doctor may order lab work whose results are faxed to the plastic surgeon who will conduct the surgery. With this “arrangement,” they can arrive as early as 2-3 days prior to the operation for an in-person consultation.
Photo Credit: nitinut at FreeDigitalPhotos.net
Ideally, the lab tests are performed not later than 10 days before surgery.
Aside from lab tests, out of town patients might also be required to fax results from breast MRI and possibly mammogram as well.
Even before the actual meet-up, there should be good rapport between the patient and the surgeon performing the out of town breast augmentation. Skype or video online chat is particularly helpful to allow both parties understand each other’s goal.
Meanwhile, it is important to avoid tobacco products, aspirin, ibuprofen, and medications and supplements known to increase bleeding for at least three weeks. The goal is to achieve one’s optimal health and thus minimize risk of healing problems and other complications.
Complete smoking cessation is particularly critical because it is closely tied to increased risk of capsular contracture in which the normally thin scar capsule around an implant inadvertently thickens, leading to painful, deformed breasts that require a revision surgery.
Factors linked to increased bleeding and hematoma (i.e., clotted blood beneath the skin or within the implant pocket) such as use of aspirin and aspirin-like products and hypertension must also be avoided and “controlled” well in advance of the surgery to reduce the capsular contracture rate.
After surgery, most patients are instructed to stay within the vicinity for at least three days (or sometimes even longer) for follow-up visits. After this period, most can travel by plane or car provided that a friend or family member will accompany them.
During the initial healing stage, patients should avoid heavy lifting (that’s why someone else should carry their luggage) and rigorous activities to prevent healing problems. Furthermore, they should never drive themselves when taking narcotic painkillers because these can cause poor coordination and lethargy.
In Beverly Hills plastic surgery, many doctors continue to monitor their patients up to one year, with some even permitting online video chat should their patients find it inconvenient to travel long distances just for a follow-up visit (provided there is no major concern).
Cosmetic breast surgery that combines two or more procedures has become a common routine nowadays. In some situations, this is even a more preferable approach than having two separate surgeries in order to produce more natural results.
Today, the most common “combo” procedures are breast augmentation with lift, and breast reduction with lift, according to the California Surgical Institute website.
Breast augmentation with lift prevents a specific deformity called Snoopy due to its close resemblance to the profile of the classic cartoon dog.
When implants are used in sagging breasts without a simultaneous breast lift, their bottom edge might become visible beneath the lax skin, and thus there will be an appearance of two pairs of submammary fold.
But with a simultaneous breast lift, the implants will not “herniate” as the internal support and the actual breast tissues are reinforced with sutures. In addition, the south-pointing or low-lying nipple area is positioned higher to further achieve a proportionate result.
Breast lift is also commonly incorporated with breast reduction, a procedure that produces a smaller “cup size,” which in turn can provide instant relief from back pain, rounded shoulders, postural problems, and other ill effects of overlarge, heavy breasts.
Large breasts are susceptible to the effects of gravity (i.e., causing their skin to lose their elasticity), thus it always makes sense to incorporate some type of breast lift during the surgery.
Meanwhile, breast lift does not always entail a simultaneous breast reduction unless the patient specifically requests for a smaller cup size as well.
Cosmetic breast surgery involving combination procedures aim to produce a more natural-looking and youthful appearance—i.e., conical shaped, 45:55 breast ratio (i.e., most of the volume should be in the lower pole), proportionate nipple diameter relative to the breast size, and “ample” distance between the areola and the submammary fold.
A slight lateral bulge is also deemed ideal, although all efforts are made to prevent it from becoming excessive and thus giving an illusion that the breasts are too wide apart.
Also, it is ideal to produce a ski-slope appearance in the upper pole. In fact, one study has suggested that the ideal breast profile should have a 45:55 ratio, with the areolar complex serving as the delineating mark between the lower and upper breast poles.
Of course, good symmetry between the left and right breasts must be achieved during cosmetic breast surgery. For this reason, some patients may need different sized implants, or require more tissue removal or additional elevation on one side.
Mastopexy for tuberous breasts is designed to correct the herniated appearance of the nipple area. Oftentimes, it also incorporate the use of breast implants to further improve the overall projection and shape, as suggested by leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Mastopexy, or breast lift in layman’s term, is typically performed to reshape the sagging breasts. However, women with tuberous breast deformity can also benefit from this procedure.
While the exact origin of tuberous breasts remains unclear, its physical manifestations have been widely studied: They are caused by constriction of the connective tissue around and behind the areola, and the weak and thin tissue support that leads to the puffiness and herniation of the nipple area.
Aside from areola puffiness, mastopexy for tuberous breasts also deals with asymmetry in variable degrees (i.e., some are very mild while others are highly obvious) due to differences in shape, nipple size, breast volume, and projection.
Other physical manifestations of tuberous breasts include little soft tissue, enlarged or wide areola complex, and drooping appearance.
Mastopexy for tuberous breasts not just corrects the drooping appearance. Oftentimes, the surgeon must also remove some tissue behind the areola complex to reduce its puffiness. This is achieved by creating incisions around the areola’s edges, which typically fade into imperceptible scars.
The round incisions along the areola’s edges can also allow the surgeon to reduce its size.
While the tuberous breasts could be improved with mastopexy alone (without breast implants), it is important to note that it has its own limits.
With a simultaneous breast implant surgery, the surgeon is able to reduce the wide spacing between the breasts and improve their overall shape and volume.
During mastopexy for tuberous breasts that includes implants, it becomes more important than ever to release the constricting bands of connective tissue. The goal is to allow the prosthetics to settle centrally behind the areola complex, leading to a natural-looking shape.
Mastopexy for tuberous breasts is technically more demanding than a breast lift involving an “average” patient (no significant deformity; only soft tissue laxity due to aging or pregnancy). For this reason, one should be extra strict when choosing a surgeon.
Aside from having appropriate board certifications, the “right” surgeon should also be performing mastopexy, breast augmentation, reduction, and reconstructive breast surgeries on a regular basis. Ideally, he must be able to present hundreds if not thousands of before-and-after photos of his actual patients, which can serve as a proof that he has extensive experience.