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.
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.
Breast lift and shape: These are the two main concerns of women with breast ptosis or sagging who want to undergo plastic surgery to correct the condition, according to Upland Plastic Surgery Institute.
First and foremost, the postop shape is primarily determined by the incision pattern and the patient’s underlying anatomies. The goal is to create a soft rounded lower pole, a nipple area positioned a few inches above the submammary fold, and possibly a “curved” upper cleavage, as opposed to a flat sloping upper breast.
Patients who need the most amount of lift and/or adjunct breast reduction will need the standard technique to achieve the most ideal postop shape. However, the patient must accept the appearance of an inverted T scar resulting from “donut” incisions around the areola’s border, within the submammary fold, and vertically in the lower pole.
Standard breast lift technique.
While the modified forms of breast lift result in shorter or fewer scars, due to the natural diffusion of loose skin they could lead to less than optimal shape especially in patients with large, droopy breasts.
But for the right patients, the vertical lift technique—which eliminates the horizontal scar within the submammary fold—can provide a good shape. The consensus is that it is suitable for women who only need their areola complex raised about 3 inches or less.
For the right patients, the vertical lift can provide a nice perky shape that has a “soft” rounded bottom or “moundish” look, as opposed to a boxy appearance.
“Boxier” breasts may occur after an over-aggressive surgical maneuver, which left the skin overly tight. However, some doctors have also noticed that this appearance also affects a good number of “heavier” patients with a lot of fatty tissue lateral to their breast.
Contrary to popular belief, breast lift is not just a skin operation. To hold the planned shape, the vast majority of doctors use internal sutures that reshape and support the tissue.
To further achieve a more natural shape, the stretched, large areola must be reduced as well. This adjunct procedure is particularly important if the patient will receive breast reduction at the same time.
Despite best efforts, any form of breast lift will have no or very little effect on the upper breast pole. For this reason, it is sometimes combined with round breast implants, which in essence are shaped like a flattened sphere, although once placed vertically in their pockets their contour will resemble a teardrop due to the effects of gravity.
Regardless of the surgical maneuvers used, a skilled surgeon will make every effort to create a breast mound that has upper and lower pole ratio of 45:55.
Breast lift and reduction are typically performed under one surgical setting instead of “staging” them since it is more convenient to experience just one recovery. Also, patients will only have to pay for one anesthesia and surgical facility fee.
And because breast lift and reduction share the same incision pattern, there is no additional scar, says leading Beverly Hills plastic surgeon Dr. Tarick Smaili.
According to a recent survey, this combo procedure typically costs between $5,000 and $10,000; this great price variation is due to factors like location, amount of correction needed, breast size and shape, surgeon’s fee, adjunct procedure if there is any, etc.
Dr. Smaili explains how these factors affect the cost of breast lift and reduction surgeries.
- Breast size. Larger, droopier breasts require longer operative time than smaller, less pendulous breasts. Nevertheless, it remains ideal to keep the surgery under six hours to minimize the risk of excessive bleeding and control the amount of surgical trauma.
In standard breast reduction and/or breast lift, which favors patients who need the most correction, surgeons create incisions around the areola’s perimeter, between the nipple and the submammary, and within the inframammary crease.
But for smaller breasts, the submammary scar can be eliminated, leading to less scarring and possibly shorter downtime.
- Living in elite districts and metropolitan areas where the demand for cosmetic plastic surgery is high often means more expensive breast procedures.
Because of money “issue,” some patients travel long distances to receive plastic surgery. However, this poses some challenges in terms of follow-up visits and communications.
Traveling long distances for plastic surgery is reasonable as long as the patient feels that she will get the best aftercare from a reputable, board-certified plastic surgeon who has an impressive track record in providing natural results.
- Surgical technique. The complexity of the combo procedure is largely determined by the size and shape of the breasts. In general, patients who need drastic downsizing and lifting will have to pay more.
Additional procedures such as nipple reduction and liposuction will also mean higher fees.
- Surgeon’s fee. Reputable and seasoned plastic surgeons charge higher than “neophyte” doctors who have just started their career. Most experts agree that experience plays a crucial role in their ability to deliver natural-looking results since cosmetic surgery is more of an art than a science.
However, a high “price tag” does not always equate skills and “exclusivity.” Sometimes, unscrupulous non-specialists charge higher fees than bona fide [board certified] plastic surgeons so they might appear like an expert despite their lack of training and experience.
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.