Breast reduction and lift scars are placed within the natural folds of skin and will usually heal into a fine white line about one year postop. Nevertheless, modalities known to improve scar appearance remain important especially prior to its full maturity, as suggested by experts from the California Surgical Institute.
Breast reduction and lift surgery performed as a combo procedure is ideal for women with overlarge, pendulous breasts. Both techniques use the same scar pattern, so there is additional scarring.
Almost all breast reductions utilize the techniques used in breast lift—i.e., reposition the nipple-areolar complex and/or tighten the deeper tissue with internal sutures—to achieve natural contour and good projection.
On the other hand, patients who need a breast lift to correct the drooping appearance may not require a reduction surgery, particularly if they are already satisfied with their current cup size.
Most patients will need an anchor-shaped scar in which the incisions go around the areola’s border, vertically down the lower pole, and within the breast crease.
The vertical scar between the areola and the crease is the most visible, although over time it will fade significantly and blend in with the skin for most patients.
While time remains the best scar treatment, a simple scar massage remains helpful especially in the first 3-6 months. The idea is to break up the scar tissue with the use of manual manipulation, leading to the appearance of finest scar possible.
Scar creams and lotions that contain silicone and other hydrating agents are also known to help improve the scar appearance.
Raised scars are believed to respond well with silicone sheets or tapes and embrace dressing; both modalities work by reducing the tension on the skin and applying constant pressure to the scar to prevent it from becoming thick and raised.
Breast reduction and lift scars that appear red, meanwhile, are often treated with lasers to help them blend in with the surrounding skin tissue.
To further achieve the finest scar possible, it is crucial to avoid sun exposure for at least six months because they are known to trigger the “injured” skin to produce more melanin, leading to darker, more conspicuous scars. And since some UV rays can pass through fabrics, it still makes sense to apply sunscreen under clothes.
Despite the resulting scars, surveys have suggested that breast reduction and/or lift surgeries provide a high patient satisfaction rate, especially in women seeking relief from symptoms caused by overlarge breasts.
Breast augmentation results should appear natural in terms of shape and size (relative to the patient’s body frame), thus it is of paramount importance to take into account the underlying anatomies.
The general rule of thumb is to use breast implants whose size/volume, profile or forward projection, and width will reflect the chest/breast measurement and the soft tissue coverage.
To further achieve natural-looking breast augmentation results, any pre-existing asymmetry must be identified prior to surgery, as suggested by experts at the reputable California Surgical Institute.
While all patients have some form of asymmetry, in most cases it is barely noticeable or at least can be easily ignored. However, women with visible lopsidedness will need additional procedures to achieve the best possible result from breast augmentation via implants.
If there is a visible difference in breast size, it is possible to use implants of different volume to achieve a more balanced look. However, asymmetry is often associated with disparity in shape, projection, and nipple position as well, further complicating the surgery.
If one breast sags more than the other, breast lift may be necessary to create a more balanced result. In this adjunct procedure, the skin is tightened, the deeper tissue is reshaped with internal sutures, and the nipple-areolar complex is repositioned higher.
Aside from breast size and shape disparity, Snoopy deformity must be also addressed to achieve natural-looking results from breast augmentation. Women with this condition have their nipple area and the tissue around it looking herniated and “puffy,” so the silhouette of the breasts resembles the famous cartoon character.
In patients whose Snoopy breast deformity is severe, a modified form of breast lift with implants is needed to create a more natural appearance. But in mild cases, implants are usually enough to deliver a good amount of improvement.
Over the Muscle Implant Placement Vs. Dual Plane Technique
Some doctors suggest that using dual plane technique—in which the upper half of implants is positioned behind the chest muscle, while their lower half is only covered by a strong tissue called fascia—is ideal for women with Snoopy deformity.
Meanwhile, patients with Snoopy breast deformity and ptotic (sagging) breasts may want to avoid the subglandular technique in which the implants lie above the chest muscle, with only the breast tissue covering and supporting them.
Occasionally, reducing the size of an overlarge areola—or the pigmented part of skin—is needed to achieve a more balanced and youthful result from breast implant surgery. However, this is only attempted when the patient specifically asks for the procedure.
The primary goal of breast reduction surgery is to eliminate or reduce symptoms associated with overlarge, heavy breasts such as chronic neck and back pain, rashes or non-healing irritation within the inframammary fold, rounded shoulder, postural problems, and shoulder bra strap grooves.
Oftentimes, breast reduction insurance is possible because the goal is to improve body functions.
Breast lift, meanwhile, aims to correct the saggy breast by tightening the deeper tissue and skin. For this reason, it is always labeled as a cosmetic surgery by health insurance issuers.
While both procedures seem to have different goals, it is important to note that they share the same incision techniques and patterns.
Also, overlarge breasts are highly prone to sagging due to the extra weight their ligaments need to “carry.” Fortunately, breast reduction surgery is a major lift as well because aside from “downsizing,” it also reshapes the nipple area and “mound” to achieve a more youthful appearance or at least near normal contour.
Both procedures require the use of incision around the nipple then downward on the breast, leading to a lollipop-shaped scar. But for patients who need more correction—i.e., larger breasts and/or significant droop—their surgeons may have to make a cut within the inframammary fold, resulting in an inverted T scar.
Also, both surgeries involve reshaping and tightening the deeper breast tissue because relying on skin tightening alone could lead to wide scars and less than optimal contour. In fact, it has become a common practice among Orange County plastic surgery experts to use some type of internal sutures to maintain the lifting effect.
To further achieve impressive results, it is also crucial to reduce the areola that appears too wide or too large. And since both procedures involve an incision around the border of nipple area, this is always attainable.
While breast reduction surgery is a major lift as well, take note that breast lift does not always entail downsizing particularly if the patient is content with her current “bra size.”
However, some patients with large, saggy breast may have to reduce its size as well if they want the lifting effect to last longer. The idea is to make the breast mound lighter and less susceptible to the effects of gravity.
Patients with small, saggy breasts, meanwhile, may not have to worry about early recurrence of drooping although they have the option to use small implants, which can also correct the deflated or “empty” upper poles of their breasts.
As someone considering plastic surgery, the worst thing you can do is lie to your doctor, especially when it comes to smoking. Take note that the use of tobacco products can lead to a wide array of risks, which can be prevented or at least minimized by avoiding them well in advanced of your operation.
Dr. Tarick Smaili, one of the leading experts in Los Angeles plastic surgery, says the “general rule of thumb” is to avoid tobacco and smoking cessation products like nicotine gum and patch at least three weeks before and after surgery. The idea, he further explains, is to flush out the nicotine and other chemical toxins known to impede healing.
Dr. Smaili says any prudent plastic surgeon will not operation on heavy smokers because of the low oxygen content in their body due to the effects of nicotine known to constrict blood vessels. This detrimental effect makes them at risk of developing skin necrosis in which the wound and tissue around it turns black and literally dies.
One of the subsequent complications of skin necrosis, he warns, is “unnecessary” scarring especially if the surgery involves extensive skin incisions or excisions such as facelift, breast lift, breast reduction, tummy tuck, and body lift after weight loss.
The poor healing effects of smoking have been well documented, with studies suggesting that smokers are 12 times more likely to suffer from skin necrosis after facelift and tummy tuck than non-smokers. Cigarette smoke exposure, including “second-hand” smoking, has also been linked to more than 70 percent of skin slough, or the process of shedding dead surface cells.
According to a study involving about 400 patients considering plastic surgery or elective procedure, 9 percent admitted being an active smoker, while around 33 percent said that they had quit smoking, although a urine nicotine analysis showed that many of them were lying.
Remember that even smoking just one “stick” may be enough to jeopardize your healing and postop results. For this reason, today’s plastic surgeons typically require blood and urine test to determine any presence of nicotine even if their patients have claimed that they are not a smoker or they have already quit.
Aside from smoking, other factors that could lead to poor scarring and healing problems include blood-thinners such as aspirin and ibuprofen, medical conditions such as hypertension and heart disorder, and alcohol abuse, the leading Los Angeles plastic surgery warns.
Skin tightening in plastic surgery is a common procedure performed on seniors (facelift), massive weight loss patients (body lift), and women who want to reverse the effects of pregnancy (tummy tuck and breast lift).
Any type of elective plastic surgery is only reserved for healthy patients with the right motives and expectations. Meanwhile, individuals with medical condition that could predispose them to higher risk of healing problems and poor cosmetic results are almost always considered as poor candidates.
Blood clot formation or deep vein thrombosis (DVT) that commonly affects the legs is one of the risks associated with skin tightening surgery. Nevertheless, the possibility is greatly reduced if the operation is performed on healthy patients who avoid the “known” risk factors and perform the necessary preparations.
Dr. Tarick Smaili, one of the leading Orange County plastic surgery experts, says the first step to minimize blood clot risk is to avoid tobacco, second-hand smoke, and smoking cessation products such as nicotine gum and patch at least one month before and after skin tightening in plastic surgery.
The association between smoking and blood clot has been well documented, making smokers poor candidates for any type of plastic surgery. Studies have already shown that compared with non-smokers, smokers have a higher incidence of poor healing and “unnecessary” scarring after breast surgery and facelift, explains Dr. Smaili.
Aside from nicotine and other toxic constituents of smoking, the use of contraceptives and hormone replacements is also linked to higher risk of DVT. For this reason, they must be discontinued for at least three weeks prior to surgery.
Another risk factor for DVT is a sedentary lifestyle, so the renowned Orange County plastic surgery expert recommends light exercise or walking after surgery. The idea, he explains, is to pump blood through the leg veins, preventing not just blood clotting but also persistent swelling and bruising.
Prolonged immobility, meanwhile, could significantly increase the risk of DVT, thereby immediate long travel and bed rest are an absolute contraindication after an elective plastic surgery.
With any type of elective plastic surgery, especially if it involves skin tightening, overweight and obese individuals are poor candidates because of the increased risk of healing problem, wound dehiscence, and DVT because of the pressure in the veins of their legs and pelvis.
Aside from obese patients, skin tightening plastic surgery is also not for individuals with blood-clotting disorder, cardiovascular disease, cancer, and inflamammatory bowel disease because of the increased risk of DVT and other types of complications.