Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Breast Lift

Breast Lift at the Time of Breast Implant Removal : Is It Safe???

June 1st, 2020 — 9:30am

I saw a patient recently who would benefit a lot from having a breast lift at the time of implant removal and that was what I recommended.  She had read on Dr. Facebook that it was safer to delay the lift.  This launched me into a discussion about the blood supply to the breast, which to a layperson, is a pretty arcane topic.  I had to reveal myself for the lousy visual artist that I am and draw out a diagram of the blood supply to the breast with and without implants.  Later I was able to find a pretty good diagram of the breast with and without an implant and add some red squiggles of my own representing blood vessels.

Let’s walk though it:  The unoperated breast has a very rich blood supply with vessels traveling from the chest wall, through the pec and straight into the breast tissue and also blood vessels traveling more superficially, about 1 cm under the skin surface from the periphery of the breast.

A breast that has an implant or had and implant has a much altered blood supply.  The placement of the implant necessitates division of the centrally located vessels and thus results in a breast that is dependent on the peripheral vessels.  This is not to be regarded as a terrible thing; it’s just a trade off and many surgical procedures also disrupt blood vessels and change the pattern of blood supply (tummy tuck and face lift are two examples).

Trouble arises when a surgeon does not recognize the altered blood supply.  The most common procedure I do which requires deep appreciation of this altered anatomy is when I do a breast lift following removal of a breast implant.  I use a very different technique than I use when doing a lift on a breast that has never had an implant.  See this blog for a step by step explanation of a regular breast lift.  When an implant has been removed, the peripheral vessels must be preserved or the breast tissue, including the nipple, will lose its blood supply and necrose which is a nice way of saying it will die.  When I have just removed an implant, I am on HIGH ALERT in regards to blood supply and also in a position to select the layer of breast tissue that is safe to undermine in order to shape the breast.  This sounds creepy but I can place one hand in the implant pocket and the other on the surface of the breast and judge the thickness of the breast tissue and location of the blood vessels.  In a delayed case where I wait several months for the breast to heal, I cannot do this because the pocket where the implant had been has disappeared and thus there is no way for me to do the one hand in and one hand on trick.  In delayed cases, there will also likely be some scarring and tethering of the tissues that can make safe dissection difficult as well.   The very worse case scenario is if a patient who has had implant removed has a lift by surgeon who is not really mindful of this altered anatomy.  Using a normal breast lift technique would have a very high risk of tissue necrosis.

so, IMHO, doing a lift at the same time of implant removal has some real advantages.  I hope this blog and my fabulous illustration add some clarity. Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift

Breast lift: Fear not the scars!

January 23rd, 2018 — 9:57am

I see many, many women for implant removal after years of being unhappy with their breast implants.  Many of these ladies consulted a plastic surgeon for sagging of the breasts and instead of ending up with a breast lift, ended up with breast implants.  Often the explanation for this is that the patient did not want the “scars of a breast lift”.

So here’s the deal on breast lift scars.  Yes, they are more extensive than the scars from an augmentation but,……………………… the vast majority of patients, the scars fade to near no-big-deal status in about a year.  Check out the example shown.  The top photo is before a lift, the middle photo about 6 months post op and the bottom photo is one year post op.  See the scar?  Well you hardly can see the scars in the bottom photo.  This is not an exceptional case.  This is usually how it goes.  Now there are some rare individuals who scar badly because of their particular biology but they are the exception.

So………….if you are saggy, you should get a lift.  If you are really small you should get an augmentation with either an implant or fat transfer.  As with everything, the correct diagnosis should lead to the correct treatment.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift, Scar

Nipple reduction and a breast lift can make the breasts look fuller.

September 27th, 2017 — 11:55am

Check out this case.

This lady initially came in for breast augmentation.  She wanted to look a little fuller but was a worried about the impact of larger breasts on her competitive tennis game.  After chatting with her and examining her, I came up with the plan of a lift and a nipple reduction.  These procedures would give the illusion of fuller breasts without actually increasing the volume.

A small and saggy breast with a long stretched-out nipple looks – I’m gonna say it – a little pathetic.  Once the breast skin is tightened up and the nipple shortened, the breast looks almost the way it did before babies, breast feeding, gravity, general aging, etc.  And a procedure like this is maintenance free.  It should last a lifetime.  But remember to wear a bra most of the time when upright.  Gravity never sleeps.

Thanks for reading!  Dr. Lisa Lynn Sowder

Follow me on Instagram @sowdermd and @breastimplantsanity.

Breast Contouring, Breast Lift, Mommy Makeover, Nipples


May 14th, 2017 — 7:00pm

motherhoodSeattle Plastic Surgeon Discusses Mommy Makeover on Mother’s Day

Ah, the joys of motherhood! I can wax eloquently about fat little feet, apple cheeks, wet baby kisses and so on but one of the joys I did not expect was a boost in my Plastic Surgery practice, especially my “mommy makeover” patients. Since becoming a mother myself, I speak “mommy” really well. I know first hand the glorious details of feeding, bathing, changing, and schlepping the baby. I can recite the stages of the toddler, the preschooler, the gradeschooler, the tween, the teenager and currently I am becoming an expert on the joys of being the mother of young adults.  

Being familiar with all that being a mother requires makes me much better at counseling patients about the process and timing of a “mommy makeover”.

“Mommy makeovers” usually combine breast surgery (augmentation and/or lift or reduction) with body surgery (usually abdominoplasty and/or liposuction). Most women are healthy enough to have a combination of procedures during one operative session. It is, however, the first couple of post operative weeks that are the most challenging for the patient.

Mommy is used to taking care of everyone but herself. After surgery the Mommy needs to take of only herself. She needs to be “Queen for a Week or Two” and resist the urge to cook, clean, change, wipe, mop, vacuum, load, unload, fold, etc. And if her youngest weighs over 20 pounds, she may not pick him/her up for at least two weeks if breast surgery was done and for at least six weeks if an abdominoplasty was done. The little one can crawl into Mommy’s lap for a cuddle but NO HEAVY LIFTING for Mommy. This also applies to the dog.

It’s very important to for patients to discuss these issues with their families. I’ve had a few ladies who have underestimated their recovery time, have done too much too soon and have turned what should be a relatively comfortable and relaxing recovery into a very sore and frustrating one.

So, calling all mothers interested in a “mommy makeover”: Plan ahead and get your husband and your children and your friends on board. Make a sign for your bedroom door. “DO NOT DISTURB – MOMMY RECOVERING”.

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery

The Ideal Breast

November 6th, 2014 — 10:08am
blog ideal breast

The ideal breast has a little more fullness below the nipple and above the nipple.

The Ideal Breast

I just read an interesting review of an article published in the Journal of Plastic and Reconstructive Surgery about the ideal breast.   Here’s the link.

If you don’t want to read the review, I will summarize.  A bajillion individuals which included men and women of various ages and nationalities were asked to rate a series of breasts on their attractiveness.  The findings were interesting in that size was not as much of a factor as was the shape and proportion of the breast.  And – surprise!- the majority of judges preferred a breast that looked natural which translates into a breast that does not have a bulging upper pole.

I am just glowing after reading this article.   I have made it my life’s work to make breasts look like they could have occurred in nature on a really, really, really good day!

Thanks for reading!  Dr. Lisa Lynn Sowder


Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift

The magic of mastopexy a.k.a. breast lift

September 19th, 2014 — 5:34pm

Seattle Plastic Surgeon blabbers on and on (again) about her favorite operation.

brest lift 1One reason that breast lift a.k.a mastopexy is my very favorite operation is the variety of breast lift techniques that can treat many different issues with breast shape.  Breast lift can do many things to improve the appearance of the breast.  Obviously, breast lift can lift the breast but it can also improve the position and/or size of the nipples and areolas and can even lower the actual breast mound in relation to the nipples.

As usual (especially in plastic surgery), a picture is worth a bajillion words.

Let’s take a look at this patient.  The top photo illustrates a few issues with her chest.  Her nipples and areolas are a little too large and too low. The fold under her breast is too high.  She has fullness of the upper lateral area near her arm pits and an indentation in the middle lateral area of her breasts.

breast liftA breast lift can address all of those issues.  The nipple and areola diameter is decreased and they are raised just a bit.  The actual breast mound is pulled down and the breast fold is lowered.  This gives the breasts a nicer shape.  And, as icing on the cake, the indentation is filled in to make a smoother transition from her arm pit area to her breast mound.

All of this is done without disrupting the blood supply or nerve supply to the nipple and areola.  This patient can expect normal nipple sensation.  She should not, however, expect to be able to breast feed.  The breast tissue has undergone a lot of rearrangement which will likely interfere with the production of milk.

The scars around the areolas and the vertical scars will fade with time.  These scars are a trade off for her nicer shape and will not interfere with normal lingerie or swimwear or even a bustier!

Thanks for reading!  Dr. Lisa Lynn Sowder


Breast Contouring, Breast Lift, Stuff I love

The Non-surgical Breast Lift – All You Need Is Tape

August 19th, 2014 — 2:46pm

Seattle Plastic Surgeon performs a non-surgical breast lift in the exam room in 72 seconds!

blog breast lift

Non-surgical breast lift on the left. Nice, huh?

Recently I had a lady come in who really, really wanted to know what HER breasts would look like after a breast lift.  Showing her photos of ladies with similar breasts wasn’t quite enough.  She wanted to look in the mirror and see what a perky breast would like on HER chest.  So………………………………..I got out the tape.  Using the tape, I did what I do in surgery.  I raised the nipple, I tightened the breast and in her case I flattened the fatty area near her armpit.  Since the tape covered the nipple, I drew one on with a purple surgical marker.  She looked in the mirror and, except for the purple nipple, really liked what she saw.

Feel free to try this at home if you are thinking about a breast lift but just be aware that sooner or later you will need to remove that tape!  A surgical breast lift will last a whole lot longer!

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift, Non-invasive, Now That's Cool

What breast shape do you like?

June 5th, 2014 — 2:38pm

Seattle Plastic Surgeon explains how different breast implants influence breast shape.

Take a look at these different breast shapes.  It is important to know what type of shape a patient prefers when doing a breast augmentation consultation.  The size and shape and projection of breast implants influences the final shape of the breast.  Other factors include the original size and shape of the breast and whether or not a lift will be done.

The French Breast.  If a woman likes this shape, she may do really well with just some fat transfer to boost her maybe a cup size and fill in the upper part of the breast just a little bit.  The French Breast can impersonate a Could Have Occurred In Nature breast with a well fitted and lightly padded bra.  Oo, la, la.

Let’s Stop Traffic!  This shape will likely require either a medium or high profile round  implant.  These implants give a big boost to the upper pole of the breast.  Some women like this look.  Most men like this look although not all men will admit to it.

Could Have Occurred in Nature.  This shape is likely to be achieved with a medium profile implant.  This provides a nice full slope to the upper breast but not a bulge.  Ladies with this shape of breast can get Let’s Stop Traffic! with a push up bra.

Tennis Anyone?  This sporty shape is most likely achieved with either fat transfer or a low profile implant.  This breast has some medial fullness to get a little cleavage and some lateral fullness to balance the hip but does not have a lot of projection.  This shape may also be achieved with a breast lift or a breast reduction.   This breast shape is preferred by many mature ladies because big, projected breasts make most mature ladies look (gasp) fat.


breast shapes

The French Breast——–Let’s Stop Traffic!———Could Have Occurred In Nature——–Tennis Anyone?

So there you have it, Breast Enhancement 101 on a single blog entry!  When I see patients in consultation, I try to show them lots of examples of my work to get an idea of what they like and to give them an idea of what I can do.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Fat Transfer to the Breast

Beware the Benelli a.k.a.donut a.k.a periareolar breast lift.

October 8th, 2013 — 12:18pm

Seattle Plastic surgeon blogs about one of her pet peeves – Big breast implants and a Benelli (circumareolar or donut)  lift done to avoid a full breast lift.

Big implants and a Benelli lift.  IMO it's must not a good look.

Big implants and a Benelli lift. IMO it’s just not a good look.  A full lift and smaller implants would have served this patient better.

I do alot of breast revision surgery and I see at least one patient a month who had the operation shown on the left who is unhappy with their result.  And it is almost always the case that the patient did not want the scar from a full breast lift to treat significant sagging.  So she and her surgeon agreed on a large implant to take up some of the slack breast skin and a Benelli (a.k.a. circumareolar a.k.a. donut) lift to lift and reduce the diameter of the nipple and remove some excess breast skin.

The Benelli lift always flattens the area around the nipple as is seen in this case.  Occasionally flattening is indicated if a patient has a tuberous deformity.  And if the Benelli is expected to lift just a little and tighten just a little, the results can be very pleasing.  Problems occur when surgeons and their patients ask too much of this technique.

With breast and body surgery, shape and contour is more important that length of scars.  A long scar almost always will fade and smooth out but a weird contour will not change over time.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift

The Breast Implant Double Bubble Explained

September 5th, 2013 — 12:23pm

Seattle Plastic Surgeon explains what causes a double bubble deformity in the implanted breast. 

The implant rides high and the breast falls over the lower edge of the implant creating the weird shape of the "double bubble".

The implant rides high and the breast falls over the lower edge of the implant creating the weird shape of the “double bubble”.

I saw two patients this week with the so-called double bubble.  Both of these ladies had implants that were over 10 years old and both had experienced some sagging in their natural breasts.

The double bubble occurs when time and gravity result in the natural breast drooping and falling below the bottom border of the breast implant.  Breast implants tend to stay put over time because they are held in place by the implant pocket and the resultant scar capsule that forms around them.   Or, in some cases, the scar capsule starts to thicken causing a so-called capsular contracture and the implant can be displaced up which can result in an early or really bad double bubble.

Treatment depends on how much the double bubble bothers the patient, how bad the double bubble is, the age and condition of the implants and the condition of the patient’s breasts.  Usually treatment will consist of doing a breast lift to get the breast back up into a better position relative to the implant.  If the implant has developed a tight capsular contracture, removal of the old implant and capsule and replacement with a new implant may be necessary.

Sometimes ladies in middle age develop the double bubble and don’t really want to do anything surgical.  It can be “fixed” with a good bra.  And sometimes ladies in middle age decide that their implant days have come to an end and opt to have the implants out and a breast lift.  These ladies are often relieved to be implant free and often just love their smaller and perky breasts.

So, with the double bubble and many other things related to plastic surgery, the main culprit of  is time and gravity, which keeps me in business.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift

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