Large breast reduction surgery, which entails removing at least 1 pound (or 454 gram) of tissue, typically involves patients whose disproportionately huge breasts are causing physical problems such as poor posture, chronic back and neck pain, rounded shoulders, and migraine headaches.
In extreme cases, some patients even experience shortness of breath and numbness in their fingers, a symptom stemming from the excessive weight pulling on the nerves around their shoulder and collarbone.
Recently, leading Los Angeles plastic surgeon Dr. Tarick Smiley performed a surgery involving drastic “downsizing” to eliminate physical discomfort experienced by a patient.
The said patient requested for a smaller breast size not just for physical relief but also for improved body proportions. (She has a medium frame body.)
During surgery, which was recently posted on Dr. Smiley’s Snapchat, he created an anchor shaped incision—i.e., the incision went around the areola, down the midline, and across the base of the breast.
The resulting scar around the areola’s border and the one across the base of the breast will be inconspicuous due to their strategic placement. Even the vertical scar, despite its more visible position, is expected to fade into the background within 6-18 months.
One of the most notable benefits of anchor breast reduction technique is the pleasing contour because it allows surgeons to remove excess tissue, fat, and skin quite uniformly. Modified incision patterns, meanwhile, tend to provide less natural shape (i.e., boxy) particularly when the incision across the base of the breast is eliminated.
After reducing the breast size, Dr. Smiley incorporated some breast lift techniques to create a more pleasing contour and to provide additional fullness to the upper cleavage. After all, these two surgeries share the same incision pattern.
Breast lift in general involves suturing the tissue and transposing some of the lower breast pole tissue to the upper cleavage to create a more youthful result.
To further ensure cosmetically pleasing results, Dr. Smiley raised the drooping nipple about 8 cm. The goal was to create at least a 3 cm distance between the areolar complex and the breast crease. In addition, its size was reduced to complement the smaller breast size.
Some patients require areola reduction and breast augmentation to achieve the most aesthetically pleasing results possible. It should be noted that large areolas make the breasts appear matronly even though these are not droopy.
Leading Orange County plastic surgeon Dr. Tarick Smiley has recently demonstrated on Snapchat the areola reduction and breast augmentation surgery performed in a patient who had “double bubble deformity” in which her breast tissue looked like it was hanging from the implant.
The patient requires areola reduction as part of her reconstructive-revision breast surgery.
To correct the double bubble deformity and allowed the new implants to settle into their most natural position, Dr. Smiley also performed a simultaneous breast lift.
The patient’s breast lift involved donut-shaped incisions to reduce the size of her areola. Supplementary incisions from the bottom of the areola and the inframammary fold that were extended across the base of the breast were also used to improve the overall shape and projection of the “breast mound.”
Dr. Smiley reduced the size of the areola by creating a circular incision around the desired diameter, which is about 38-42 mm, and another one at the dark-light skin junction. This donut-shaped incision pattern allowed him to shave off the skin (epidermis) in between, a technique medically referred to as de-epithelization.
Dr. Smiley said all efforts are made to reduce tension during the closure of areolar incisions to prevent healing problems and re-expansion or “spreading” of the areola, which may happen over time. Hence, he used several deep rows of sutures in which the tissue, not the skin, would receive most of the “tautness.”
Reducing tension on the skin would also allow the scar to fade nicely into the background, said the celebrity plastic surgeon.
Because the circumference of the outer incision was larger than the inner incision, the skin of the areola’s margin was “gathered” during the closure. This resulted in the pleated appearance of the new areola’s border, although within a few months this will flatten out.
To further achieve a nice breast shape and size, Dr. Smiley created “more distance” between the areola and the inframammary fold. In most cases, the ideal areola position is about 3 cm above the breast crease, he explained.
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.
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.”
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.