What Plastic Surgery Procedures Do I Need To Improve My Breasts And Stomach After Having Had 4 Children?
Q: Dear Dr. Eppley, I am not sure if I need a lift or lipo on the love handles. That decision I would leave up to the expert. But I would love to have breasts that look like actual breasts and not deflated socks. I have never had breasts. Growing up there was just a small protrusion of breast itself but was mostly at the nipple.(hard to explain) My stomach has stretched out due to 4 pregnancies, 3 in quick sucession. I run sprints, lift weights, and eat very healthy, I have attached pictures for you to see what I am left with.
A: Thank you for sending your pictures. In reviewing them you can see many of the typical changes that have occured with multiple pregnancies and having very small breasts to start with. The little breast tissue you have has stretched out and the nipple now hangs down over your existing high lower breast fold. You will need both breast implants and a small vertical breast lift to get a much improved breast size and shape. The vertical breast lift is a key component of the procedure as an implant alone will provide volume but will not get the nipple up and centered on the newly enlarged breast mound. This results in fine line scars around the nipples and then down vertically towards the lower breast fold. Whether one wants saline or silicone gel implants is a matter for further discussion of their benefits and liabilities. From abdominal stand point, I would recommend a mini-abdominoplasty with flank liposuction. While there are stretch mark across a lot of your trunk areas, there does not appear to be enough of loose abdominal skin to justify a full abdominoplasty procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I want to get implants for my saggy breasts. I want them to be at least a full C, maybe a D cup. My breasts also sag but I think implants will take care of the problem. What do you think? I have attached some photos for you to see what they look like.
A: Thank you for sending your photos for review. While it is clear that you have had near complete breast involution (breast tissue shrinking) and would benefit by the substantial addition of volume (implants), you also have a significant breast sagging issue. You can not achieve your desired results unless a vertical breast lift is done at the same time as implant placement. Contrary to the perception of many patients, breast implants will not cause any significant lifting effect. Rather they will take the breast tissue the way it lies and make the breast much bigger but have the nipple and the existing breast tissue hanging off of the bottom of the implant. This is not likely the look you are after.
The key to knowing whether a breast lift is needed at the time of augmentation is the determination of where the nipple and any breast tissue hang relative to the level of the lower breast crease. (inframammary fold) If the nipple and any breast tissue is at or below the lower breast crease, some type of breast lift will be needed. Your photos show that, not only the nipple, but at least half of your breast tissue and skin is at or below the breast crease.
There are different types of breast lifts but I think you would do well with one in which the scar goes around the nipple and down to the lower breast crease. (hence the name, vertical breast lift) Your nipple needs to move up several inches so that it can be centered around a substantially enlarged breast mound.
Q:I had a combined breast augmentation with a lift about 3 weeks ago. It seems like my implant on the left side is below my breast. It has been like that from the beginning so I should have asked the doctor aboutthat when I last saw him. I was just wondering if it is like that because of swelling still or is it going to stay like that. I know it has only been 3 weeks and my doctor said you really can’t critique it for 3 months, so I’m not overly concerned just wondering about it. Maybe my left one required more work, it’s still a little bruised. I didn’t know if I should try to do something to push it up? I guess I was wondering if this is normal. I probably wouldn’t think as much about it if both of my breasts did the same thing. I have attached some pictures for you to see.
A: Based on the pictures, the left breast implant is below your original inframmary fold of which some of that crease still exists. It is often necessary to lower an inframammary crease, particularly in cases where there is breast asymmetry. I would suspect that your original left breast was smaller with a higher imframammary fold prior to surgery. This made it necessary to achieve better symmetry during surgery by lowering the crease on that side so the implant will match better with the original larger right breast. This is an issue in which more time is going to be needed to see how the whole breast shapes out over time. Combined breast augmentation with lifts are always more complicated than when implants are placed alone, particularly when there is significant prior differences between the the breast mounds and the level of the inframammary folds. I think it would be alright now to begin wearing an underwire to give that left breast better support as healing progresses.
Dr. Barry Eppley