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Any woman unhappy with the "droop" of her breasts is a candidate for lift surgery. Although the surgery is relatively low risk, it may involve the use of an implant.

The medical term for breast droop is ptosis. Ptosis is defined by the position of your nipple in relation to the fold where your breast meets your chest wall, or inframammary fold. If your nipple is above this fold, you do not have ptosis. If your nipple over-lies the fold, you have Grade I ptosis. Grade II ptosis is when your nipple is below the fold, and Grade III ptosis is when your nipple points towards the floor (like Snoopy's nose).

Typically, surgery can be expected to correct ptosis by 1 grade (i.e. grade III becomes grade II, grade II becomes grade I ptosis. It is unusual to see a grade III ptosis convert to grade I ptosis following surgery.

There are two options for breast lifting: Restoring volume with implants, or removing excess breast skin. The benefit of implant surgery is simplicity, the main disadvantage is the implant. The main benefit of removing excess breast skin is the most "complete" lift, the main disadvantage are the scars that result from removing the excess skin.

If you desire a fuller figure, consider implant surgery. If your figure is already full, consider removing excess skin.

While this is the "simplest" choice, it does require placing a foreign object into your body. For women with limited droop (Grade I and some Grade II patients), this is the most common treatment choice.

Saline filled implants are the only implants currently approved for cosmetic surgery. Silicone gel filled implants are currently limited to use in reconstructive surgery patients enrolled in an FDA approved study.

Saline implants use a silicone bag filled with sterile IV fluids.

While there is no evidence that silicone gel implants are unsafe, if any increased risk is found, your theoretical risk from silicone will be the same with a saline implants as with the gel implants.

The manufacturer warrants implants against failure (leakage).

Before surgery, an implant of appropriate size & shape will be selected. You make this selection, with Dr Branson’s assistance. Factors considered include your desired breast fullness, your existing breast size & shape, as well as Dr. Branson’s assessment of your ability to tolerate implants of various sizes. Remember, your selected implant is unlikely to fully correct your breast droop.

Treatment is done as an outpatient. In all cases, the implant is centered under your breast tissue. The implant placed either below your breast tissue, or below both your breast tissue and chest wall muscle.

When the implant is placed beneath the breast tissue, the incision is usually placed in the fold where the breast meets the chest wall. If the implant is placed beneath both the breast tissue and chest wall muscle, I usually use an incision in your armpit, just at the front of the hair in your armpit.

When your implants are placed below your chest wall muscle, post-op pain is greater than when placed above the muscle. This occurs for the same reason that an athletic muscle injury takes several weeks to recover.

The most common complications related to implants are the risk of implant failure and capsular contracture.

Implant failure equals leakage. Failure is rarely related to trauma to your chest area. If your implant is leaking, you will begin to notice you no longer fill out your clothing (such as your brassiere or bathing suit) as you once did. While replacement of a failed is necessary, this is not urgent surgery.

Capsular contracture is the result of scar tissue tightening around your implant. Consider your implant to be a water balloon, and the healing (scar) tissue that forms around the implant to be a plastic bag. A water balloon in a plastic bag still feels like a water balloon. If you begin to twist the bag around the balloon, it will tighten around the balloon, making the balloon feel "hard." Neither the bag nor the water balloon changes, only the relationship between them changes. In simple terms, the same effect occurs when capsular contracture makes your breast feel hard. Just as the balloon feels "softer" by untwisting the bag, releasing the scar tissue around your implant treats capsular contracture.

Immune Disease: While there was dramatic press coverage of a possible link between silicone and immune disease, recently published data finds no link between silicone and any disease. Although there is no apparent link between silicone and immune disease, if you have a family history of immune-related disease (like rheumatoid arthritis or lupus), there a remote chance that implants could change your risks of immune disease. If your family history is positive, I suggest you see a rheumatologist to assess your personal risk for immune disease.

Less common complications include calcifications forming around the implant, shadows on your mammogram, and possible loss of some of your natural breast volume.

There are three ways to remove excess skin: 1) Removing a donut of skin around the nipple; 2) Removing a keyhole of skin around the nipple, with the leg of the key reaching from your nipple to your chest wall; or 3) Removing an "anchor" of skin around the nipple, with a wedge of skin from beneath the breast. Scars from surgery range from circling your nipple to circling your nipple, from beneath your nipple to your chest, and underneath you breast. Scars can range from as narrow as a pencil line to as thick as the pencil.

"Donut" Lift: The dark skinned area around your nipple is called the areola. Your areola marked, and a circle of skin is marked around the areola. After removing the skin, the incision is gathered around the areola, like a drawstring bag. Like the gathered drawstring, your skin is "lumpy" until healing is completed. Some changes in skin contour can be permanent. Because the skin of the areola is thinner, during healing, the areola can stretch, appearing larger than desired. Many candidates for this procedure choose implant surgery instead.

"Keyhole" Lift: Keyhole removal combines the donut excision with a wedge of skin from the nipple to the fold where the breast meets the chest wall. This technique is the most common breast lift (by skin excision) performed.

"Anchor" Lift: If your breast is extremely "droopy" (Grade III ptosis), you may require the anchor lift. The scars are the same as for patients undergoing breast reduction surgery. While this is the "classic" breast lift, it had the least attractive scars.

Like implant treatment, this surgery is performed as an outpatient, usually with general anesthesia. Required markings for surgery are made in the pre-op area while you are sitting up.

Surgical complications for implant surgery are the same as for any other operation. They include (but are not limited to) bleeding, infection, scarring, implant malposition, and the possible need for additional surgery.

For all treatment choices, you will use you old bra as part of your dressing. Absorbent gauze is placed over any incisions. Like all surgery, some oozing is expected, so older, comfortable clothing is recommended.

You can shower the day after surgery. Most patients can return to work within 1-2 weeks. While complete healing can take up to 1 year, most patients feel their breast have a "natural" feel in approximately 3 months.

Copyright © 2002 Denis F. Branson, M.D.  All rights reserved.
Revised: 10/28/02.