All About Breast Lift: Ideal Candidates, Myths, Incisions, and How to Maintain | Ep 19

In this discussion, Dr. Kristy Hamilton and Dr. Roy Kim shed light on breast lift procedures, dispelling common myths and explaining the intricacies of the process. 

They emphasize the importance of patient selection, meticulous surgical techniques, and post-operative care for optimal results. Key topics include the impact on nipple sensation and lactation, different types of incisions used, the role of internal bra technology, and scar management strategies. 

The conversation provides valuable insights for anyone considering a breast lift, highlighting the procedure's safety, effectiveness, and potential benefits in enhancing breast aesthetics.

#breastlift #aesthetic  #candidates #lactation #breastaugmentation #incisions #internalbra #recovery #scars #plasticsurgery

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Transcript

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but that it was not gonna change their risk either way of getting breast cancer in the future we can do things to the breast tissue but technically breast lift will really not removing breast tissue that's not gonna change much to the shape of the breast itself but it will lift the nipple very very conservatively if you are really not able to lactate produce milk pretty well before surgery a breast lift may not help things Hi this is Doctor Roy Kim co host of The Beauty Scientists and I'm joined by Doctor Kristy Hamilton how are you? great so good to be here and I'm excited about our topic today so we'll be talking about breast lifting specifically aims more at aesthetic breast lift so of course things can change after gravity after time after pregnancy after breastfeeding so Doctor Hamilton what or who are the best candidates in terms of breast lift and what are you really looking for so the ideal candidate for a breast lift is someone who is seeking a rejuvenated higher tighter shape to the breast and we're restoring it back to how it originally was this is also not someone who's looking for more or less volume this is someone who wants essentially the same amount of breast that they have just placed higher and tighter on the chest so life happens changes happen many women experience pregnancy breastfeeding weight gain and weight loss and all those can lead to ballooning of the breast and then later their deflation and so it's essentially a restorative surgery it's turning back the clock and helping to reset back to the way the breast used to be and so one of the myths I think which we can talk about is okay you have an actual breast lift procedure in terms of the myths I think patients often ask me will something happen to the nipple so specifically nipple sensation ability to lactate to produce milk what do you say to patients when they ask those questions that's a great question especially because there are a number of patients that have the surgery before they are considering starting family so the vast majority of women after undergoing a breast lift are able to go ahead and breastfeed there's a certain percentage of women regardless of whether they have surgery that struggle to breastfeed when trying and so what I tell patients is just because you had surgery you could still be one of those patients but when you look at the percentages and we have studies to back this up we know that having a breast lift does not decrease your ability in most cases to breastfeed now sensation I think you can speak to this too I tell patients you can expect this sensation at first to be a little bit decreased the end shift impact are near normal but some patients will experience reduced sensation rarely absent sensation some patients will even have a little bit of hypersensitivity or more sensation afterwards but most patients can go on to breastfeed what's your experience I totally agree with you I think it really depends on the procedure but in general breast lift procedures you should be able to back to the produce milk long term as well as have normal nipple sensation my understanding of anatomy as well as physiology is if you are really not able to lactate produce milk pretty well before surgery a breast lift may not help things but that's simply the way that your anatomy is in terms of your own body and a breast lift really doesn't change much yes this causation versus correlation right so just just because those two things happen to come together didn't mean that one caused the other one right so you can hopefully get your breast lift if you wanna have kids in the future I think so and then also the nice thing is that in case an accident happens in case you wanna have more kids yes you should still be able to lactate to produce milk you should still be able to have nipple sensation long term in terms of let's see now this is the nerd talk because what is a breast lift as opposed to a breast augmentation great question and so one of the key factors we wanna decide when you're sitting down and discussing aesthetic breast surgery what are your goals if an increase in volume is one of them then you can still have the breast lift to restore the shape but you're gonna have to consider other additional surgeries at the same time other components of the surgery like adding an implant or fat transfer a lift alone is going to not not only is it not gonna add any volume but I tell patients that many of them will feel like they need to go about half a cup size down in their bras not because breast tissue was removed but just because everything is origami together so that it's higher tighter and more compact so if that doesn't sound appealing then you need to consider adding a small implant or fat and yes underneath the surface we can reposition breast tissue and I always tell patients it's important to realize where we can do things to the breast tissue but technically with breast lift we're really not removing breast tissue we are repositioning it and we're removing loose breast skin and tightening it up I think that's very important for patients out there to know in terms of pathology of the breast breast tissue breast cancer surveillance and all those good things what do you tell patients I tell patients that if they are over 35 35 or older I like them to get a pre operative mammogram for screening purposes but that it was not gonna change their risks either way of getting breast cancer in the future occasionally we catch some some early cancers with that pre operative mammogram so they have anything considering a left may actually catch something in advance but that's not the reason to have surgery of course and again I tell people to think about it is like an origami of their breasts right so we're working exactly with the tissues that they already have but we're rearranging them for a more aesthetic ultimate look and that's what's gonna change and specifically the position of the nipple on the breast so we make the areolas smaller often times after the breast getting larger and smaller the areolas have expanded to a size that's larger than they originally were so we make them shrink down to size I like to do about 38 millimeters or so across just depending on the proportions of the patient and then we position them exactly in the center of the breast and at first I tell patients afterwards you're gonna look like you've got small implants we make everything so high and tight that there's a lot of fullness at the top of the top of the breast and top of the chest but it will ultimately come down to a natural teardrop shape so that's the aesthetic that you're looking for a very natural look great if you like that more cleavage look then again we're probably looking at getting a lift as well as an implant to get that look so I think that's an important distinction that kind of convex upper pole of the breast versus that teardrop slightly concave look that's what you're gonna get with a breast lift I often tell my patients look if you feel in terms of volume your breasts are little too big breast lift is a great operation cause you're gonna lose some of that fullness you're gonna have a more aesthetically pleasing breast and you probably don't need an implant however the patients where they want a certain shape they don't like the slope at the upper pole of the breast if they already feel they're touch too small and they want to go even bigger in terms of volume then I mean you need you know some type of implant technology whether it's fat or implant to actually get you those long term results what do you counsel patients when you know they get a breast lift and they only get a breast lift what do you tell them in terms of like loss of volume or cup size after a pure breast lift only I tell them after a pure breast lift only to expect about going down about half a cup size in their bra again I make the distinction we're not removing breast tissue with this operation but it's just the way that the tissues are now sitting on your breast because we rearrange them to be more compact so everything's tighter and for that reason they may go down half a cup size in their bras and so that's a good distinction to know like are you okay feeling looking a little bit smaller than you currently are cause that's likely how you're gonna feel afterwards yeah that's what we always tell patients and as you know Doctor Hamilton there are four major different types of breast incisions to the outside world and then they're like sort of four major procedures Crescent incision Periareolar which is a fancy term for just an incision around the areola or also known as a Benelli Mastopexy Vertical Mastopexy / vertical breast lift and an inverted T incision or Anchor Incision where the incision sort of looks like an anchor or T I think the easiest one and not commonly done is the crescent I don't know how often you do that or the ideal candidate a crescent so that's taking a exactly what it sounds like it's like a little crescent of skin along the border of the Areola at the top and then just pinching the Areola that's not gonna change much to the shape of the breast itself but it will lift the nipple very very conservatively I this is not something I do for patients I think to me this is more of like a revisional if you're seeing a patient you see oh one nipple is a little bit lower than the other one maybe we can do like little crescent to help even that out but that's not gonna end up being a very powerful lift and I think in terms of the order that you were mentioning them the first two and the second one the Benelli that you're talking about where they go all the way around the nipple and shrink it that has the side effects of flattening a natural breast so unless you're putting an implant in there too to create that nice round shape that it's also called colloquially the donut breast lift I think that works reasonably well for patients having implants placed that needs one and a half cm of lift but otherwise you're looking at the vertical or that anchor pattern incision to really get a more powerful lift and whether you need the scar in the fold as well as the vertical ones depends on how much excess skin you have in the vertical as well as the horizontal dimensions and that's something that you and I walk patients through when they come in and we can demonstrate on the tissues why one might be the most appropriate but most commonly when I see patients that wanna seek surgery I'm doing the inverted tear the anchor pattern yeah same in my practice I think probably the same generally to in my hands the Benelli mastopexy the donut mastopexy in other words only an incision around the areola I can only lift it about an inch or a little less and most patients need a little more lift and you're totally correct about the overall shape it has to be the right patient otherwise it tends to be flattened the vertical masopexy of course I love calling it the lollipop incision and that's how a lot of patients know about it that is a great option and the inverted T is also a very good option if you need a lot of lift now that's on the outside internally yes we're tightening up breast tissue as you said sort of like an origami pattern but there's newer technology including the internal bra I don't know what preferences you have in terms of the tech as well as the ideal patient so the internal bra that's really become popularized on social media lately and I think it's the even calling it that internal broads it's a great concept right most women would love to not have to wear a bra but really appreciate the support that it provides especially if you have larger breasts so this concept of having something on the inside that's providing support I think is very appealing to patients and then as a surgeon I think it's a great innovation because the durability of the result obviously like you and I have to create an excellent surgery and do a technically great operation beautiful suturing excellent scar care afterwards on the patient's end follow all the instructions at the end of the day there are factors that we can't control and the namely the main thing is the quality of the breast tissue itself and one of the issues is that some people just especially as time goes on just their genetics if they were like smokers or what not at some point is they end up with or patients who have stretch marks on their breasts because of pregnancy and breastfeeding their tissues are just not as great as they used to be and that's one of the reasons why they found themselves wanting to have a lift in the first place and so for some of those patients you can do a beautiful operation they can do everything right and then a year later they find that things are already starting to go south again in terms of the position of the breast on the chest and the nipples are starting to go down and so if there's anything that we can do to I kind of like insurance policy for their surgical result anything that's gonna help give more support and prevent that droopiness from recurring as quickly I think that merits a conversation so I always bring it up with patients I don't think every patient needs to have one and not every patient wants to have one but a lot of patients are excited by that idea and if they find themselves being the ones that have more of that looseness to their tissues I think it's a great option how often what percentage of patients do you think you're using the internal bra for in your practice you know something where I'm using barbed sutures using internal tissue to create sort of patient tissue bra like every single case now in terms of using non autogenous tissue fancy medical term for man made material I would estimate probably about a third of my cases because cost is an issue as well as what the patient desires and there are couple other there are couple options of materials but I definitely strongly prefer something that is not a cellular dermal matrix for my breast cases I don't know what your preferences are yes because we found those were too stretchy and so that was an issue also incredibly expensive yes prohibitively expensive for most people so all of us have been using or the vast majority of us been using these materials that slowly degrade over 6 to 18 months and ultimately transform into a thin sheet of scar tissue or collagen and we place it along the lower pole of the bra so that's perfect that's exactly where like the cup of your bra would be then there's a new material that's just come out that people are starting to use I haven't used it yet but that's kind of a blend of some of the benefits of having the degrading one and they're using sheep's gut I believe of the biologic material and they're pricing it similar to the PDS and CH4B measures that we've been using so they're trying to break into the cosmetic market so we'll see how that goes just for rough cost analysis cause it's hard to say depending on your region and country the acellular dermal matrix is very expensive we're talking several thousand dollars additional on top of whatever surgical fee and obviously that's literally the wholesale cost of just using that material yeah and that's per side that's just for yeah for one for one piece that's correct and then that plus the stretching the newer ones don't stretch so once it's in set we know the exact position of your breast fold because it's not moving whereas the ones that are sort of stretchy the acellular dermal matrix unfortunately we're talking six or 12 or 18 months down the road the breast fold actual placement may be a little off because the internal bra unfortunately has stretched out so that's we like these other ones yes we like the stiffness of them and so even for the this hybrid one they were talking to me about they were like okay the benefit of the biologic of the tissue integration which we know so it kind of incorporates perhaps a little bit better although the synthetic ones incorporate really really well too but they still they recognize that we are liking the stiffness and the reliability of the synthetic materials and so they made sure they kind of incorporated that so I was like that's interesting yeah and so in terms of the patients what do you tell the patients to get ready for the actual operation and then the technique of closure and finally sort of the recovery think this is a fairly easy recovery I think it's one of the easier recoveries as far as like breast and body work bigger cases breast surgery it's not particularly painful patients are feeling pretty good right afterwards if you have a desk job I think you can get back to work just after the weekend you'll slow down your activity levels a little bit just because you got the incisions but once those have solidified you get back to your regular life pretty fast in terms of preparing again I think it's one of the surgeries that's easier to prepare for we just want healthy living of course absolutely no smoking just like usual run your supplements by your surgeon to make sure you're not taking anything that you need to stop but other than that I don't think there's so much preparation timing after having kids and pregnancy and breastfeeding is something to consider so I like patients to have not been breastfeeding for at least three months afterwards because it takes a while for all that residual milk and the milk production to shut down and we wanna make sure that we're not cutting into actively lactating tissue while we're doing your surgeries cause decrease the risk of infection yeah one of the things I always tell my patients is that the T incision or 3 areas of skin being brought together potentially is gonna have slower healing if you think about it most incisions are like literally just two sides you have a cut you fix both sides with the areola as well as vertical incision or the vertical incision with the horizontal incision now you're talking about three pieces of tissue and I don't know about you but the annoying t zone has always been an issue but I think that's true for all plastic surgeons and the reason is blood flow it is slower to heal and it's the tightest spot of the whole thing and so we know tension tension slows down healing as well and so I tell patients to that that's something that you can you may you may experience and there's a reasonably high chance that you'll experience that part of the scar slower to heal and so just to prepare for it and everything's gonna be great and look wonderful just may take a little bit more time than the rest of the breast yeah and and typically these procedures are done on an outpatient basis and usually I'm sure you do as well but most plastic surgeons now are using sort of the local numbing medicine given at the end of the operation patient still asleep we're giving you lots of numbing medicine and the stuff that we use today lasts for 72 hours so this really reduces the amount of pain you feel and you can definitely take fewer pills which can make you queasy nauseated out of it and this is where Doctor Hamilton said hey get this done right before the weekend and you can probably go back to an office job by Monday or Tuesday and that's been the experience of my patients as well and that's great and so cause that's always a major concern with patients is like okay I wanna have this I'm ready for the look like but I'm scared and so that's it's really important to make sure that patient comfort is a priority and that's cause we want it to be a good experience of aesthetic surgery something that you want to do something that you need to do and so we wanna make sure that you're getting back to your normal life as quickly as possible yeah now in terms of recovery of course most of healing will occur in the first month or two most of the swelling goes down in the first month or two to me one of the bigger things that patients always discuss is the potential vertical incision anatomically there's no vertical incision on the breast and they're very worried about it do you have any hints about how to really get that scar to look as nice as possible yeah so on our end we need meticulous technique perfect positioning of those tissue edges together and a great suturing technique so we'll handle that as the board certified plastic surgeons that we are and then on the patient's end you have to wear your post op bra we want it help take off the tension off the healing breast incisions and then I implement a after the steri strips come off in two weeks I implement a silicone tape protocol or gel for those who can't tolerate adhesives and we do that for as long as the patients can stand at least at least four months afterwards so that's been clinically proven to help with scar tissue formation and then we're watching them closely if we see signs of more scar tissue forming than we want we may do a series of injections so that is very important part of the healing process and we can do laser treatments down the line there's all sorts of different different options just depending on the patients like skin tone type and what type of scars that they're forming yeah ideally you know it's gonna heal up great we are plastic surgeons is typically looks great right after surgery but it has to heal up and as a new skin grows it will continue to be non red non wide non thick and will continue to fade over time but if it doesn't happen there are a lot of non surgical options within the first 6 12 months after your procedure I always you know tell my patients that if you tell me about it I'm not gonna see you every week but if I see you once in a while or you let me know there are non surgical ways to make this look better if you get the procedure and you disappear and I see you three years down the road not much I can do except cut out the edges of the scar and start all over again you definitely wanna attack if there's an issue that's forming you wanna attack it early so that you can you can get a handle on extra scar tissue formation and what not and then then I think one of the things that patients ask about a lot is just like the pigment or like the color of the scar and so we know that the pinkness or the purpley redness of a fresh incision that always fades so if that as long as the scar itself is thin and fine I tell patients like don't worry about the redness of the incision it just take the better part of a year for a scar to fully mature and so that part while the shape and the swelling and all that's been established earlier on you do have to wait longer to have the scars fade and that's just part of the process for any scar yes and of course a big question I patients always ask me as well is okay we do a breast lift how long is it gonna last and I always tell them depends on how you maintain it depends on your metabolism depends on how loose your skin was begin with it's not really measurable but the reason why you needed a breast lift in the first place is lack skin so any hints on how to maintain the results so continue wearing your bra all the time except on Saturday night if the dress calls for it but you wanna maintain as much support as you can maintain a healthy lifestyle and diet so that's really important um you know it's never too late to start that and you'll see improvements also in in the skin across your body on your face as well but you're right that there's there is a genetic component and there's also the reality of just like how your tissues are and if you are somebody who has stretch marks already so there's a certain amount of damage that's been done that can't be undone but you can always make improvements just by diet exercise taking good care of yourself and wearing your bra what do you tell patients? I tell them essentially the same thing cause so many patients don't really wanna wear a bra but I do tell them the more you support it we think that the better your long term result will be this is why it's so important to have an internal bra as well as an external one and that's what I always tell my patients I think more is more when it comes to support yes and so any final thoughts or questions Arthur Hamilton I think we cut about covered it this is probably worth mentioning that this this past year when the American Society Plastic Surgeons looked at the data this is the first year that breast lift popped onto the top 5 aesthetic procedures for the year so it's definitely it's a hot topic and it's a hot surgery something that people are definitely more and more interested in so I was happy to talk about it with you today I think it's gonna become even more more popular I do too yeah well on that note thanks as always for joining me Kristy and to all the listeners and viewers out there thanks for joining us if you have any topics you want us to discuss please fire away below or let us know and as always stay beautiful stay beautiful