Q: Dr. Eppley, After breast feeding two babies my breasts have gone deflated. I know that I need a breast lift. My breast size now is a small 36C. Since the upper part of my breast (that part I see the most!) is flat, do you think I need an implant as well? I am not looking to be huge but think that it would help make my breast look fuller. If I get an implant with my lift, what type should I get? I’ve read that a silicone implant is more natural looking.

A: You have very astutely pointed out one of the most overlooked deficiences in breast lifts for some women. The fullness that it creates in the upper pole of the breast will likely only be temporary and often an implant is needed as well. When using implants in a breast lift, there are two general size considerations. A smaller implant can be used in which the goal is persistent upper pole fullness but not a significant change in breast size. A larger implant is used for both upper pole fullness and an overall breast size change. That is a decision that requires patient input. Whether the to go with a  saline  or silicone implant is matter of personal choice, the most significant factor is a cost difference (saline less costly) and the risk of eventual implant deflation (saline) versus silent implant rupture. (silicone)

Q: Dr. Eppley, I had breast augmentation last year and was advised before surgery that I needed a breast lift also to get the look that I wanted. I have had two children and had a bit of breast sagging. But I didn’t want the scars or the extra expense at that time. Now I have come to realize that the doctor was right and feel now that the scars would be better than the way the breasts look now. The implants have actually made my breasts look worse even though they are bigger. Can I still get a breast lift now even though I already have implants in place?

A: For those women who have some minor amounts of breast sagging that present for breast augmentation, the idea that they need a lift as well is often a bit much. Due to concerns about scarring and the extra expense from a simultaneous lift, they may defer and let the results ‘prove’ that a lift is beneficial or not. While in hindsight you may have regretted this decision, the possibility of avoiding scars and saving some money was not an unreasonable one. Now that you have the implants in place you can certainly go on to a have lift as a ‘two-stage’ approach to your breast enhancement. The good news is also that you might get a better breast lift result because of working with an established breast mound underneath from the previously placed implant. 

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I recently had a breast augmentation with a lift six weeks ago. My lift was the vertical type and my implants were silicone gel above the muscle. While I know it is still sort of early and the breasts are still settling into place, I am concerned that I am experiencing that they already sit lower than I would like and they have some rippling on the sides. This rippling is most apparent when I bend over and goes away when I push the implants upward.  I am concerned that I will need another lift in the near future if they sit this low already. Should the implants have been positioned higher in the first place?

A:  The combination implant-lift breast reshaping procedure (augmentation mastopexy) is a tough one to get just right. It is an artistic balance during surgery of implant size and positioning and how much lift and tissue tightening needs to be done. On top of these difficulties is the unknown variable of how the whole breast settles and what support the breast tissue and skin provides. While six weeks is not the final result, more settling may or may not occur. It would be best to wait a full six months before considering any revision. The rippling you have is a result of the implant being above the muscle and the lack of a substantial breast tissue thickness between the implant and the skin. This might be improved by a higher implant position or a change to an under the muscle position…but there is no guarantee that even with these changes that it will be completely gone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I have a problem with sores on my breasts. My breasts are very small and extremely saggy having lost most of my breast tissue after breastfeeding four  children. I kid you not that they are literally two sacks of skin just hanging there. When I wear a bra they get all bunched up inside it and are folded unto themselves. This causes the skin and particularly my nipples to rub and get weepy,oozing painful areas. Due to these sores, is it possible that I would qualify through my insurance to have a breast lift with implants covered? It would seem that insurance should cover it since it is causing a medical problem. What do you think?

A: Medical insurance will never cover any breast procedure that involves a lift or implant, unless it is part of a breast reconstruction due to breast cancer. While it would seem logical that your skin problems would provide the reason for a surgical solution, that will not happen. Insurance will cover the medical treatments for your breast skin problems but not for breast lifts whether implants are used or not. This will be viewed as a cosmetic procedure, not a reconstructive one.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to know how much of a cup size is lost after having a breast lift. I am currently a 42 DDD and my breasts really hang down after a 75 lb weight loss. I want them lifted but I definitely don’t want to be any smaller than a D or DD cup. I wonder if having implants would make up for any loss of size after a lift. I really don’t want to get implants but I don’t want to be any smaller either. What are your recommendations?

A: In a breast lift procedure, only skin is removed to create the lift and breast reshaping effect. So a loss of cup size should not really occur since no breast tissue is removed. But there is often a perception that the breast can seem smaller because the conical reshaping of the breast results in less overall surface area. What most women expect from a breast lift is to have not only an uplifted breast but one with more upper pole fullness as well. While this most certainly occurs early after a breast lift, the settling of the breast after surgery will cause some loss of upper pole fullness. That is the role that a breast implant plays in many breast lift surgeries, to get and maintain upper pole fullness. Given the size of your existing breasts and the amount of lifting that will be required, it is understandable why you would be on the fence about the need for implants in your lift. When in doubt, do the breast lift without the implants first. Let the six month results determine whether implants would really be beneficial.

Dr. Barry Eppley

Indianapolis, Indiana