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,………………………..in 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
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.
Seattle 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”.
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 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.
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”.
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.
Seattle Plastic Surgeon will present “Breast Implant Removal and Breast Lift in the Middle Aged Patient” at the annual meeting of the Northwest Society of Plastic Surgeons.
Implants? I am so over implants!
Tomorrow I am heading off to my favorite meeting to give a talk on the surgical treatment of women who have either physically or mentally “outgrown” their breast implants. I see a lot of these ladies in my practice and I have been very happy with the results I obtain with doing a breast lift at the same time as implant removal. This leaves, of course, a smaller breast but the shape is usually very nice and almost all of my patients are pleasantly surprised at the results.
Seattle Plastic Surgeon shares a great patient story about sagging breasts.
One thing I just love about being a plastic surgeon is all of the great stories I hear from my patients. Some of the stuff they tell me is better than anything I could make up. Here’s one:
Last week I had a patient come in who was interested in breast surgery. As we were chatting, she told me that she had passed the rolling pin test. I had certainly heard of the pencil test but not the rolling pin test. Just to refresh your memory, the pencil test is done by placing a pencil under your breast. It the pencil stays put when you let go, you just may need the services of a plastic surgeon.
Will your breasts hold up this rolling pin?
Well, my patient passed the rolling pin test. Yes, it is true; her breasts were so saggy and heavy that they could hold up a rolling pin.
But not for long. She has signed up for a breast reduction which always includes a breast lift. I am certain that she will be thrilled with her result but what about her rolling pin? It probably appreciated the attention.
Fat transfer to the breast is looking like a great operation to this Seattle Pastic Surgeon.
Before (left) and after (right) fat transfer to the breast in a 60 year old jazz vocalist.
Here is yet another satisfied fat transfer to the breast patient. I slimmed down her muffin top and added some fat to her breasts. She went up one cup size and also got a bit of a lift, not only in her bustline but also in her spirit!
Her recovery was quick. She was back to all her normal activities in about 3 weeks.
It has been sooooo rewarding doing this new procedure for the past year and a half and seeing what a difference it can make in selected patients.
Seattle plastic surgeon’s patient shares her BREST BRA EVER.
I hope she is wearing a good sports bra.
Yesterday I saw one of my patients who had undergone a breast augmentation and was now training for the Seattle Marathon which (what were they thinking?) is held the Saturday after Thanksgiving. She was in the process of ramping up her mileage but was being careful not to ramp down her chest.
She had gone from not needing a bra to needing a really good sports bra. She discovered a great bra at Lululemon. It’s called the Ta Ta Tamer II and it looks like it would do the trick on the bounciest of bossoms and it’s even nice looking. No Brunhilda styling with this bra.
I tell all of my breast surgery patients to wear a really good bra when exercising. It’s all about protecting that investment against the ravages of gravity. So unless you live in the International Space Station, make sure you’ve got some great support.
Seattle Plastic Surgeon blogs about the highly variable “ideal” breast size.
Yesterday was a great day in the office seeing patients. It was one of those days where all my post op patients were pleased and all the new patients were good candidates for surgery. I had two patients, one a post op and one a new patient, that drove home the fact that there is no single ideal breast size. What is ideal for one woman may not be for another.
Patient A was a year out from a breast augmentation. She was thrilled with her result and was happy with her 34DD bra size. The breasts looked good with her shoulders, tummy and hip line. She was all curves.
Patient B also wore a 34 DD bra and was horrified at the size of her breasts. She wanted a reduction. Patient B’s breasts looked almost identical to Patient A’s augmented breasts but they did not fit her narrow chest or narrow hips and clearly they made her the recipient of a lot of unwanted attention. She wanted to go down to a C cup which is where Patient A started. Too bad they couldn’t have just swapped, huh?
Breast surgery is so individualized. The entire body must be taken into account as well as the woman’s age, child bearing plans, athletic endeavors, career goals, etc. This is what keeps my job interesting.