Mommy Makeover: Season 1 Episode 5

Breast Lift

So far we have focused on the nipple and its Postpartum changes. The same changes that affect the nipple may affect the entire breast.  Sometimes, breast size will increase 2 or 3 cup sizes during pregnancy.  Most of the time this excess volume, and even some of the original breast tissue will disappear after breastfeeding.  This is called “involutional hypomastia.  Often the remaining skin and nipple drops below its original position. The following is an example:

One of the most common questions that I get in regards to Mommy Makeovers is, “Will I look good with implants alone or do I need a lift”

A good rule of thumb is that if the nipple has descended beneath the inframammary crease, then a lift will be necessary.  Sometimes, subtle differences between people’s breasts can make it so that one person may be able to look good with implants alone and another may need a lift.

Am I a Good Candidate?

One of the big considerations when deciding whether or not to do a mastopexy (which is just another name for a Breast Lift) is the age of the patient and their history of scarring. Younger patients with a history of hypertrophic or keloid scars are not good candidates for breast lifts.  Older patients typically heal more slowly with scars that are thinner and less noticeable, due to their immune systems not being quite as vigorous as a younger person. 

Also, when somebody is greater than 40 years of age, the aesthetic quality and shape of the breasts may have deteriorated to the point where the improvement in shape is worth the scars. Whereas, a younger person may have experienced some negative changes to the shape of appearance of their breast from the pregnancy but it’s not bad enough to justify the scars.

I believe that in order for a mastopexy to be worth it, the end result has to be better, not just different.  In other words if we get the shape perfect and the scars are excessive, then the surgery may not be worth it.  A slightly imperfect breast with implants alone may still look better than the scars of a Mastopexy. 

Next time we will discuss the different types of Mastopexy. 


Mommy Makeover: Season 1 Episode 4

Changing the Position of the Areola

Last time we discussed making the areola smaller and more round. Today I will discuss 2 major techniques for moving the nipples. After pregnancy, if the breast becomes deflated and sags then the nipple can be repositioned higher with a technique that is similar to the one previously described. An oval is drawn around the inner circle that is marked. As these patterns are brought together the nipple will move up to 3 cm in the direction that the oval is oriented. The following is the markings of the pattern described and a one week result in a patient that I performed it on.

   

Free Nipple Graft

If during pregnancy the breast increases massively in size and never returns to normal the nipple may need to move so far that it can’t be done without detaching it. This is called a free nipple graft. The nipple areola are marked with the cookie cutter and the nipple is removed with a scalpel. Next the nipple is thinned to the perfect thickness and it is sewn back on in a spot that has been deepithelialized in a shape that matches. The following is an example of nipples that have been removed and thinned.

Patients are warned that sensation will be lost after this technique. However, some patients have told me that it eventually did come back for them.