Your Questions
Your Questions
Q: Dr. Eppley, I was looking into breast implants but I just want to know do I need a breast lift and an implant? I am 27 and have 4 kids, all of which I breast fed so they do hang low. I want fuller looking boobs. Also What is the best kind of breast implant to get?
A: Even if you had not stated that your breasts hang low, it would be highly unlikely in the vast majority of women that have had four children that they wouldn’t have significant breast sagging. Therefore, in seeking the goal of fuller looking breasts you are going to need a lift. What type of breast lift (and there are four types) I can not tell you by your description alone but I will assume it is a full version. Remember that breast implants do not lift sagging breasts, that is a common misconception. While the size and type of breast implant is important (silicone gummy breast implants are best), your more important consideration is the need for the breast lift and the resultant scars that will be needed to perform it. In addition, the combination breast lift with implants is the hardest aesthetic breast surgery to perform to get the best symmetric results with significant revision rates for aesthetic adjustments.
Dr. Barry Eppley
Indianapolis, Indiana
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
Q: I am the mother of 3 children and am soon to be age 35. After going through 3 pregnancies my breasts are definitely not what they used to be. They not only have gotten smaller but they seem to sag more now than before. With each pregnancy they have gotten progressively worse. I know that I need an augmentation but am uncertain if I need a lift also. How do you know if you need a breast lift when getting an implant?
A: An implant will do a great job of adding volume to a deflated breast but it will not lift up a sagging breast. This is contrary to what most women think an implant can do. When the position of the nipple is close to, at, or below the lower breast crease/fold, some type of breast lift will be needed. This is regardless of whether one is getting an implant at the same time. Without a breast lift, the implanted bigger breasts will merely drive down the position if the nipple and may even make it look worse. This can be predicted before surgery by carefully looking at the nipple position and the amount of loose breast skin. When lifts are done at the time of breast implants, the procedure is known as augmentation mastopexy.
Dr. Barry Eppley
Indianapolis, Indiana