Your Questions

Q: Dr. Eppley, What is the cost of start to finish with Breast Augmentation. I am concerned that I may need a breast lift as well but I see you have a before and after photo on your website when you click on the breast tab and below its says large breast implants there is a female on the left that is very comparable to my breast structure and looks like she just had implants and looks amazing. That’s what I am looking for. I am 27 years old with one child now with extra skin. Thanks

A: The critical question is whether you need a breast lift with your implants or not. That, of course, would impact the results as well as the cost of the surgery.if you could send some pictures of your breasts I could make that determination. The other issue that can tip the balance for or against the need for a breast lift is the final size of the breasts one desires. In some cases, large breast implants can overcome mild to moderate amounts of breast sagging with the considerable volumetric expansion. But that depends on the position of the nipple to the inframammary fold. Large volumetric expansion (large breast implants) works to create a breast lift IF the nipple is at the level of the inframammary fold or higher.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting breast implants but am uncertain if I need a breast lift also. I saw a breast augmentation patient you had done who looked somewhat similar to me and she was able to have a good result with large implants alone. I was wondering if I might obtain a similar result. I have attached some pictures of my breasts for your opinion on this matter.

A: Thank you for sending your pictures. I think you just have too much ptosis (sagging) to avoid a breast lift with your implants. The key is the level of the nipple to the inframammary fold. If the nipple is at or just a hair below the fold level, implants can create a bit of a lift or at least not create the appearance of breast tissue sagging off the front of the implant. But when the nipple is really below the inframammary fold (and in your vase it is by several centimeters), the implant will merely drive the already hanging breast tissue off the front if it…making a not so good breast appearance even worse. While I do many breast lifts, I really don’t like them for women due to the scars and try to avoid them when there is a good chance that a women may get by without it. But unfortunately I just don’t see that being a good option for you. (implants with no breast lift)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a breast reduction but my situation is a bit unusual. I currently have breast implants but gained weight after surgery with my third child. That was over ten years ago. I would like a breast reduction with my implants removed. I do not want to be bigger than B cup… I am currently a D/DD cup.

A: With breast implant removal and some significant breast tissue on top of them, a full breast lift may be likely needed. Due to concerns about blood supply to the nipples, the amount of breast reduction/lift that can be done may be more limited than going all the way down to a B cup may permit. Conversely, based on the size of your existing indwelling implants and their location (submuscular vs. subglandular), such a breast size reduction may be very possible. Larger breast implants that are in a submuscular position will safely permit more of a breast reduction/lift. I would need to see pictures of your breasts to help make that determination.

Removal of breast implants by itself causes an obvious breast reduction effect. But the now excess and potentially sagging overlying breast tissue must be managed to create a smaller and tighter breast mound.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting some initial information about a tummy tuck and breast lifts. I also sustained an injury to one buttock, leaving a large dent of scar tissue that I would like to have repaired if possible.

A: There are numerous types of tummy tuck surgery (eight to be exact) and breast lifts (four to be exact) so it is impossible for me to say which type of tummy tuck and breast lifts would be best for you. I am also unsure what your buttock deformity looks like although I could imagine. The good thing is that that tissue from the tummy tuck (dermal-fat graft) or fat injections from any liposuction can be used for reconstruction of the buttock indentation. I could provide you with more specifics about these procedures if I knew what you looked like. You could do that by sending in some pictures of your abdomen and breasts. Otherwise I would have to see you in the office to know exactly what you need.

A tummy tuck, breast lifts and buttock fat grafting could all be done in a single operation which would allow for just one recovery. The tummy tuck is usually what requires the most recovery. The recovery from other procedures falls well within that of the tummy tuck recovery period.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I am interested in breast implant replacements with or without a breast lift. I have saline implants that are 18 years old. I was a small B and the implants brought me to a small D. I’ve had two children and breast fed without complications. I feel like the implants stayed in place and my breasts didn’t. I don’t really want them this large anymore anyways but I’m unsure if I should take them out and get a lift or get them smaller with a lift. It would partly depend  on cost but also on which one will look better. I just want a normal size and breasts that are perky.

A: It is not rare that pregnancy causes the existing breast tissue over implants to sag off of them after becoming enlarged and then deflated. This indicates that some form of a breast lift is absolutely needed, the only question is whether smaller implants are still needed to maintain persistent upper pole fullness of the breasts. A breast lift, while moving the nipple back up and tightening the breast mound around it will not maintain long-term upper pole breast mound fullness. This it is very likely that a small implant may still be needed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 32 years old with a full 34C cup breast size.. I went for a plastic surger consult last week and I figured I would need a breast lift because my breasts were very saggy. I also wanted a breast lift with implants as I want perky very round (ok to look fake) looking breasts. I wouldn’t mind being bigger even a DD cup. My plastic surgeron said he won’t do a lift and breast implants at the same time. I was shocked that he would not do them at the same time as this ultimately means more money, recovery and longer to finally get the breasts that I want. Why won’t he do them together? And do you think just a lift will give me the perky round look I want?

A: It is important to understand the combination of breast lift and breast implants is a ‘ying and yang’ type or procedure where want (how much) is done in one will usually adversely affect the other. If I needs a big breast lift (lifts and tightens the breast skin) it will be impossible to put in very big implants at the same time. Conversely if one wants big breast implants the amount of lift obtained will be small and you will likely end up with some residual sagging.

When one needs a lot of breast lifting and also wants larger breast implants, it is best that the procedures are staged. That way you can get the maximal breast lift and then secondarily (3 months later) you can put in implants of the size needed to obtained the amount of fullness that you want. Trying to both at the asme time dramatically increases the your risks of complications and has a very high incidence of the need for revisional surgery. If you are going to get two surgeries anyway it is far better to have the second surgery on your terms…not managing complications from the first procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a breast lift and tummy tuck. I’ve been thinking about the specifics of the breast lift and I’m hoping you can help with some questions. Attached are some images that will help guide our discussion. At the consultation we discussed the Wise pattern breast lifts with lateral extensions – Image1 is a quick sketch I did that represents my body type and my interpretation of what we discussed. What I’m unsure about is how much “pull” of excess lateral skin there will be with the breast lift and how much remaining fat will be left afterward. Also, would the lateral extension be an extension of deepithelialization from the breast lift or would there be skin and fat removal as is done in the tummy tuck?

If you take a look at attached images A and B you can see evidence of a pouch of fat lateral to the breasts post-surgery– this is what I’m hoping to avoid! Is this due to deepithelialization without fat removal? Images C, D, and E represent the flat appearance I’m hoping to achieve, all with different techniques. Image C is of a spiral flap procedure and this is the outcome I’m most fond of– though I’m not really interested in relocating the fat, just removing it from that lateral position! I’m wondering if this is the technique/outcome you had in mind or if this is something completely different.

A: Thank you for your questions about breast lift surgery. The issue at hand is how best to manage the excess tissue at the side of breast over the chest wall into the back. The Wise pattern breast lift procedure does provide some pull and tissue reduction to this area but will not produce a complete elimination of it. When the chest sidewall tissue excess is considerable, some direct management will be needed. Liposuction offers a ‘scarless’ method when fat is the main issue and one has good skin elasticity to allow for skin retraction. When there is a prominent skin roll extending the cut out from the breast lift into the sidewall and into the back is the most effective method for its reduction. But as your examples show it occurs with a price to be paid in terms of extended scars and scars that may not do as well as those of the breast lift or tummy tuck. But skin and fat needs to be removed from the side chest wall to be most effective.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in some form of breast reshaping surgery I am torn as to whether a breast lift or a breast reduction is the right option for me. I have attached some pictures so you can help me decide between the two options. 

A: Thank you for sending your pictures. In regards to your breasts it is important to remember that every breast reduction involves a breast lift and the associated breast lift is always a full anchor pattern lift. Thus the breast lift part does not change, the only variable in breast reduction surgery is in how much breast tissue should be removed (reduced) if at all.

Also every breast lift when done alone will reduce the size of the breast by almost one cup…and this is without taking out any breast tissue. (the removed skin is to lift and reshape the breast mound) In looking at your breasts I really see largely a breast lift with only enough breast tissue removed to ‘fit’ the remaining breast tissue into the lifted and reshaped overlying breast mound skin. Most likely you could get away with a full breast lift with no breast tissue removed at all.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a breast asymmetry problem. I am 26 years old and the mother of one. During the period of breastfeeding, my child developed a likeness to my left breast which cause it to fill faster with milk and now my breast has stretched to such an extent that my right breast is almost half the size of my left breast, I live in Guyana, but the expertise is not here in this area (plastic surgery) I would like to know which one of the surgeries for the breast would be right for me and also do you deal with clients who may come from another country for plastic surgery.

A: There are multiple approaches to treating breast asymmetries and the choice of procedures depends on the size and shape of each breast and their differences. The first and most important question is…is one of the breasts the size and shape that is desired? In your case that would mean is the right breast the goal to try and make the left one look like again? If so, then a breast lift and/or reduction on the larger left breast may be all that is needed. If neither breasts are ideal or even the  ‘better’ one needs improved, then bilateral breast reshaping procedures would be needed.

A unilateral breast lift is a relatively straightforward procedure that could be done as an outpatient under general anesthesia in about an hour of surgery. I will have my assistant Camille, who handles all of my far away patients, contact you later today.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a stomach stapling done in June  and have lost 56 pounds. I have had a tummy tuck, breast reduction and a brachioplasty ten years ago but have obviously ruined that. But now I’m on a healthy eating plan for life. I’m 64 years old and wondering what you would recommend for my body contouring. I have attached some pictures of how my disgusting body looks now.

A: Since you have all the scars from the prior procedures, you may as well take advantage of their existence and use them for skin and fat removal and overall tightening of the areas for your body contouring surgery. For your abdomen you need a fleur-de-lis extended tummy tuck to get rid of the loose skin in all dimensions. (horizontal and vertical) Thuis would need to extend around the flanks to chase the loose skin/dog ears. You would also benefit by a major breast lift, keeping all your existing breast tissue and lifting and tightening the breast mounds back up onto the chest wall. You can just use the breast scars that you already have. For the arms (which seem to have the least amount of excess and sagging skin) a repeat arm lift would be needed.

Most of these body contouring issues are fairly straightforward. The real question at age 64 is to not overdo any single operation and stress your body too much. While in younger patients I would do all three body contouring procedures together, that would be a lot for you to go through at your age. Thus I would recommend only the extended tummy tuck combined with at the breast lifts. These two procedures target the biggest problems that I see (and what most weight loss patients focus on the most) and would yield the single greatest body change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I hate my breasts! I am just 20 years of age and my breast looks like they are 85yrs. They sag and my nipples are huge. Due the weight I have lower back pains and my shoulders hurt. I can’t where certain clothes. For once I would to be able to a strapless bra or even not have a wear a bra at all with my clothes. I need a breast lift!

A: Large hanging breasts, even in young women, can be both aesthetically unattractive and cause symptoms of back, neck and shoulder pain. A breast lift with areolar reduction, and a little breast tissue removal, can create a dramatic improvement in their shape and reduction or elimination of their associated musculoskeletal symptoms. The trade-offs for these dramatic breast changes are scars in the classic anchor or inverted T shape. One has to decide whether these changes are worth it but most young women would say so. It is also important to understand that breast shape is variable over one’s lifetime particularly when one is still very young. Pregnancies and weight gain/loss will negatively affect the result of any breast lift/reduction procedure with the most common changes being further breast tissue loss (involution) and skin sagging. (pseudoptosis)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I first contacted you in March and have taken awhile to get a consultation scheduled. I am now down to Breastfeeding once a day, so even though my breasts don’t look exactly like they will once I’m completely done, I thought maybe I would still be able to get a good idea about what I need/want. As you’ll see in the pics, my right one is bigger. It is by far my dominant breast where Breastfeeding is concerned. I didn’t realize just HOW bad they look until I took these pictures!! Talk about being even more depressed. Lol. Anyway, I’ve been looking at doctors who offer the Rapid Recovery Breast Augmentation as I have a 1, 3 and 5 year old. I see now from the pictures that I may need a lift as well as implants. I’m very interested in the teardrop shaped moderate profile textured gummy bear implants. Ones with a warranty is preferred.  Also, will I be screened prior to the surgery to make sure there are no cancerous lumps or anything? Any info you can give would be great!  

A: In looking at your pictures, if you go large enough with the implants I am not sure that you absolutely needs a lift. But you has a lot of skin and it will take substantial volume to fill it out. If you go with a ‘small’ breast implant size, then some type of lift/skin reduction will be needed.

In regards to our breast asymmetry, while two different size breast implants can be used, you are going to have to accept that there will always be some asymmetry between your breasts. Implants alone will not completely solve most breast asymmetry issues.

Rapid Recovery Breast Augmentation uses a combination of early arm range of motion with intraoperative muscle injections to return the patient back to their normal life as soon as possible after surgery.

All breast implants have warranties that come from the manufacturer. These include lifelong implant replacement for device failure and a ten year from surgery contribution towards surgical cost ($3600) plus free implant replacement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been doing some research and I found some info on Refine Suture lift and mesh lift with fat grafting.  I was wondering about these procedures and if you would suggest this over the traditional lift with implant. I have read that these help with the lifts lasting longer and upper pole fullness, but wanted a professional opinion.

A: Your research and questions into these developing methods of breast reshaping are timely and insightful and merit a full explanation to put them into perspective  and how they may or may not apply to you and your breast reshaping goals.

While implants for volume increase and lifts for repositioning the breast mound and nipple upward are the traditional and time-proven methods of reshaping the deflated and sagging breast, they rely on a synthetic implant and scars to create their effects. So understandably alternatives have long been sought for either a more natural result (non-implant) and breast lifting methods that create less scars and more resistance to any lower pole breast relaxation.

Historically these searches for improved breast reshaping methods have been met with disappointment. But the three techniques you have mentioned (fat grafting, Refine anchors and internal mesh supports) have recently come into play and are promising…although they are still in various stages of development. Thus their use does not have a long track record so the initial enthusiasm must be viewed with guarded optimism.

Fat grafting can work in restoring volume to the deflated breast but what it can only achieve moderate volume increases. Fat grafting can not create large increases in breast size. This translates into an implant volume of about 200cc or less. If one has enough fat to harvest, then fat grafting can be a good substitute for this low volume increase which is usually perceived as ‘just adding a little extra upper pole breast fullness’. The only caveat about fat grafting is that its volume retention is not assured. As a genera statement, the volume of injected fat into a breast that survives and is maintained is around 50%…but some may have more or less volume retention.

Refine suture anchors for internal breast tissue suspension (internal breast lift) is based on placing a matrix of sutures with small plastic anchors that pull up the breast tissue upward and help anchor it to the upper pectoralis muscle fascia. As one of the few Refine-trained plastic surgeons in Indiana, I am very familiar with this device and its use. For small amounts of breast lifting, particularly in conjunction with fat grafting, it can have a useful role in breast lift surgery. But it will not provide a major lift when the transposition of the nipple-areolar complex must be moved significantly upward. In addition, its long-term effects are not well known as the device remains in clinical trials with long-term follow-up data yet to be reported.

The long-term stability of a breast lift is largely based on the skin tightening of the lower pole of the breast. This naturally relaxes to some degree in many breast lift patients, particularly when the breast mound is not supported by an underlying implant. The concept of adding a sling of support across the lower pole of the breast during a breast lift is both logical and has been tried in the past. But the use of non-resorbable synthetic meshes (hernia repair mesh) in the past has been met with wound healing and infectious complications. The concept has enjoyed re-emergence today because of a wide variety of cadaveric dermal slings and resorbable synthetic meshes. The two resorbable synthetic meshes currently available (GalaFlex and SIRI scaffold) offer a very adaptable thin mesh-like scaffold that be easily sutured across the bottom pole of the open breast lift patient. They are resorbable and are eventually replaced by new collagen tissue. Their use is gaining in popularity with good results and few complications and probably better long-term breast shape results. But they will not attain use in every breast lift patient as the cost of the mesh is around $2000 per breast. This adds substantially to the overall cost of the surgery which currently limits their use to the high-risk or revisional breast lift/implant placement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a consultation with a plastic surgeon last year who had all my personal information prior to the visit. Within two minutes they told me they don’t do any surgeries of any kind on cancer patients who had received radiation. I was upset, mad and disappointed because they knew all my history. Then I was charged $125.00 to be told that. Are plastic surgeons not doing surgeries on cancer patients? I do not need reconstructive work. I only had a lumpectomy but I would like smaller breasts and a lift. Any information would be greatly appreciated.

A: Reconstructive and cosmetic surgery can be done on the irradiated breast but it requires different considerations and surgical approaches. The irradiated breast, which may appear quite normal, is not. Its ability to heal is compromised by the negative effects of radiation on the blood vessels that supply the breast tissue, skin and nipple-areolar complex. A surgical procedure will likely unmask its limited healing ability resulting in incision separation, skin necrosis and partial or complete loss of the nipple.

In reconstruction of the irradiated breast, this well known compromised blood supply is managed by bringing in normal tissue that has a good blood supply through tissue flaps such as the LD, TRAM and DIEP. Such drastic’measures in cosmetic breast surgery, however, are obviously not warranted.

The choice in the irradiated breast patient that wants to undergo a cosmetic procedure like a breast lift is to either take the risk that no such complications will occur or to improve its healing capabilities. Improving the blood supply of the irradiated breast is done by initially doing first stage fat injection therapy. Through liposuction harvest, fat is concentrated and injected through the breasts implanting fat and stem cells. This approach has been well shown to obviate many of the negative effects on the tissues caused by radiation. Three months after the injection therapy, a breast lift/reduction can be more safely done. It may seem counterintuitive to initially make the breasts a little bigger by fat injections but this therapy completely changes the vascularity of the tissues which is essential to heal from any tissue injury.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in breast lift surgery. I have severe ptosis of my breasts. I had weight loss surgery in 2012 and my breasts turned into nothing but skin! I am let with extremely saggy breast.s I assume I need a reduction and then implants because my breast tissue is non existent at this point. I just know that I need new breasts. I want to know what my approximate cost would be to have the type of augmentation I need done. A breast lift with free nipple grafting may be the route to take. I just want nicer breasts. I don’t expect the nice set I once had but anything would be better than what I currently have! How can I achieve my goal?
I weigh 230lb, am 34 years old, and am a non smoker. I can be 180 to 200lbs in 30-45 days which is my target goal. I am ready to take the next step. I just need to know what procedure would work best to fix my horrible breast. Can I have decent looking breast with surgery? I want full breasts that aren’t saggy.

A: Many patients that have undergone extreme weight loss after bariatric surgery are left with saggy breasts  and little internal breast tissue. While there are a number of types of breast lifts, these patients always require a combination of breast implants with a full breast lift, also known as the classic anchor pattern lift/scar pattern. The issue in very extreme cases of breast sagging like yours is whether the implants and the lift should be done together or whether it should be staged. (breast lift first followed by implants later) To avoid complications and the risk of loss of the nipple, you are one of the rare cases of breast sagging in which I would probably stage it. Besides risking loss of the nipple as a single combined procedure, you are at a very high risk (probably 100%) of needing a revision surgery anyway. It is just too hard to get teh amount of lift you need, put in implants for volume and have them be very symmetric all in one surgery.

Dr. Eppley

Q: Dr. Eppley, I am interested in gummy bear breast augmentation.  I’m a mother of three and have breastfed each baby for about a year. (currently breastfeeding my six month old). Once I’m done, I’d like to have breast augmentation with gummy bear implants. After breastfeeding, I have been left with very small breasts (embarrassing!). Can you possibly just shoot me a ballpark figure so I know what I’m able/not able to do? I’ll be probably a small B and will want a natural looking D.  Thanks in advance!

A: Pregnancy and breastfeeding always cause some degree of breast involution or loss of one’s breast tissue. The breast skin is stretched out and then there is less volume inside to support the skin. This often, but not always, leads to some degree of breast sagging. How significant that is depends on what size breasts one had before the pregnancies. The bigger breasts one had to start with the greater the sagging will be afterwards.

When it comes to gummy bear breast augmentation using highly cohesive silicone implants, knowing whether any breast sagging has to be dealt with is critical in determining whether a breast lift is needed with the implants and that impact on cost. But for general numbers expect the total cost for gummy bear breast augmentation to be $5,500 and the addition of a lift can increase the to total costs to around $8,000.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to know if I just need breast implants or whether I need to get a breast lift. I don’t want an increase in size as I currently am a 36D cup size now, but I would like my breasts back up where they should be  and I don’t want the skin to stretch again as time goes on. I’m 5′ 4” and about 142 lbs. I have had three children, the last one being just over three months ago. I am planning to lose a little more weight (15 lbs) to shed the last of the baby fat. But with the breast sag that I now have, I am wondering if an implant will create enough of a lifting effect that I can avoid the need for a breast lift and its scars. I have attached pictures so you can see the shape of my breasts.

A: Your breast situation is very common and your desire to avoid a breast lift is also common and understandable. However, with breasts that sag to the point that the nipples are below the lower breast fold, the option of avoiding a breast lift no longer exists. This is particularly so when the amount of breast sagging will be aggravated by further weight loss. It is common misconception that breast implants have a lifting effect. While this is actually true when there is a slight breast sag and the nipple is close to but still above the lower breast fold, an implant will actually have a worsening effect on breast sag when there is the amount of drooping that your breasts have.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have severe breast sagging/ptosis I believe. I would like a breast reduction or lift without implants if possible. I have udnergone a 150lb weight loss which has ruined my breasts! I’m 33 years old with 90 year old bags for breasts. They are heavy,ugly sagging breasts. I currently weigh 220lbs with a weight goal of 180lbs. I have read that some surgeons will not preform the surgery on someone with a certain weight or BMI, so I’m working on dropping further weight. I obviously need other areas worked on but right now my breasts bother me the most. Do I qualify for the Lollipop procedure or the one that follows after that? Have you worked on breast this large or severe? Can you help me?

A: There is no question that you have extreme breast sagging and near total breast involution. (loss of breast tissue) Breast sagging or ptosis is classified by where the nipple sits relative to the lower breast fold. When the nipple and the breast mound hangs way below the lower breast fold that is known as a Type 4 breast sagging. (on a scale of 1 to 4) Given how your breast sags I would have to classify yours as a Type 5 sagging which is off the scale!

I have seen breasts just like yours and successfully operated on them. The question that relates to your breast surgery is what type of reduction/lift is needed and the timing of the surgery as it relates to your weight. Understand that every breast reduction incorporates a breast lift. (although not every breast lift is a breast reduction) Your breast lift is way beyond that of the lollipop lift, rather you will end up with a anchor scar pattern due to extreme amount of lifting needed and the amount of breast skin removal. Another consideration would be a partial breast amputation and free nipple grafting technique. This will get you the greatest amount of lift and reduction although your young age and the desire to maintain some volume probably precludes against this more simplest approach. If you were a smoker thisn would have to be the technique of choice. As it relates to your weight, you should be within 25 lbs or less of your weight loss goal to have the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am wanting to know if I can have a breast lift with implants in place. I had breast augmentation before I had children at 26 years old. Seven years later after two children my breasts have gotten so heavy and saggy. I saw one plastic surgeon who said he could just do a breast lift using my current implants. My concern is having a lift then having to go back in in a few years to have saline implants replaced when they eventually deflate. Would love to get good result with breasts that are lifted with more upper pole fullness using my current implants.

A: As long as the implants are in good position, one can always have a breast lift on top of them. No one can predict how long your current saline implants will function before they fail. It could be next month or ten years from now. To get the best value from your current implants, I would recommend having the breast lift and leaving the implants alone. They are not that old and you should get more than a few years of use out of them. You can always replace them with silicone implants when they fail as such a replacement surgery is very easy with next to no real recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am seeking information for breast augmentation and possible breast lifts. Here are my questions. I am a 45 year-old female who is 5’ 7” and weighs 125 lbs.

1) In order to achieve my desired look, will augmentation suffice OR would a lift also be necessary?

2. Would silicone be preferred over saline breast implants for the most realistic feel? (Prefer the round look over teardrop)

3. For inframammary incisions, what is the likelihood of decreased sensitivity in the breast? Is an armpit incision ever the best choice?

4. Is a caregiver necessary? I am from out of town, I would prefer to travel alone.

5. How soon after surgery can I return to work? How many days would I need to remain in the area?

6. How far out is surgery currently being booked?

Much thanks.

A: Thank you for sending your pictures. In answer to your breast lifts/breast augmentation questions:

1) You would need a vertical breast lift, the raising of the arms in the pictures proves that need.

2) Silicone implants do have more of a natural feel to them.

3) Very low risk of any nipple feeling loss with the inframammary approach. Since you need a breast lift, that would exclude the benefit of an armpit incision.

4) No caregiver needed.

5) Returning to work would depend on what type of work you do. Five to seven days for a sit down job, ten to fourteen days for a very physical labor job.

6) Surgery is booked based on your schedule. You are the one making the big effort so we accommodate your schedule.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in body contouring after weight loss. I have 2 very large, deep atrophy dents, one on each hip from kenalog injections. I have arthritis and fibromyalgia in my hips. The pain is unbearable, and has left me disfigured. I also have lost 100 pounds over the past 3 years and have bags of fat instead of breasts. And I have a giant stomach that is all skin and fat that hangs dramatically.

A: Body contouring after weight loss, also known as bariatric plastic surgery, is commonly done today. When one loses 100lbs or more, as often happens with successful bariatric surgery or great personal diet and exercise efforts, many expected body changes occur. The large stomach deflates and become an apron that hangs over the waist line, the breasts lose their volume and hand down onto the stomach like two empty bags of skin, and the once larger arms and thighs sag. These common extreme weight loss concerns are treated with extended tummy tucks or abdominal panniculectomies and sagging breasts are changed with full anchor scar pattern breast lifts with implants in most cases. By getting rid of these tissue overhangs, combined with the weight loss, back and hip pain is often lessened. At the same time the large hip dents, which have occurred as a result of subcutaneous tissue atrophy from the steroid injections, can be treated by fat injections or even dermal-fat grafts depending on its depth and degree of skin tethering.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am having a rhinoplasty by you later this fall. I was planning on a facelift and breast lift with fat transfer to face and breast. It’s the  beginning of a body makeover. I would prefer having you since the surgeons in my area aren’t capable of correcting the nose. Can we do all of the surgery mentioned above, I would  really like to do as much as possible.

A: Such combined face and body procedures are often done together and the economy of time, cost and recovery are the obvious reasons why many patients seek to maximize their operative experience. But each patient must be assessed individually to determine if it is the right concept for them. In making that determination the important factors are two-fold; is it safe and is the best result achievable in one combined surgery? From a safety standpoint, 62 years old is perfectly fine for these procedures as long as one is healthy with no major medical problems. (which you are) For your immediate recovery, however, such combination of procedures should only be done if you are observed overnite in the facility. That would be particularly paramount since you are from out of town.

From a procedure standpoint, combining a rhinoplasty and facelift (with or without fat transfers) is very common. The nose is a central facial procedure and the facelift is a lateral facial procedure so one does not affect the other. For a breast lift, however, volume augmentation by fat injections may or may not be affected by the lift. That would depend on what type of lift is being performed and what quadrant(s) of the breast fat may needed to be added. Depending upon your degree of ptosis (sagging) you may only need the Refine internal suspension lift with outward superior nipple lifts. That would allow the maximal volume of fat to be added at the same time. I would need to see some pictures of your breasts to better answer this procedural question.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a full breast reduction when I was a later teenager. I am now 36 years old) Now that I am older and with time my remaining breast tissue has fallen and is saggy. I would like to now have a breast lift to reshape them and give them more of a perky appearance. My original plastic surgeon has since retired and office records are no longer available. One plastic surgeon I consulted with said he said he would be worried about doing a second lift after the reduction. I have read from other plastic surgeons that a lift with a small implant is safe and will help. Is this a worrisome procedure after having a reduction? I would be open to a small implant but ideally would like to be the same size, just rounder. I’d love to be able to go bra less. Is this possible?

A: It is not rare to have a breast reduction done when someone is young that wants augmentation or a lift many years laters. It is perfectly safe to do a breast lift now using the same scars from the original breast reduction. The blood supply to the nipple through the central breast tissue pedicle will be undisturbed. It would be similarly safe to place an implant under the muscle which is beneath the overlying breast tissue mound. The role of the implant is to maintain upper pole fullness which a breast lift long-term will not do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a 38DD and my breasts sag slightly. I have been treated for back pain for several years. My question is…is it difficult to get this procedure covered by insurance? I’m very interested in getting a breast lift but could not pay the entire bill out of pocket. Should I even try to pursue this?

A: To answer your question, the first thing to determine is whether you are trying to achieve a breast lift (with no reduction) or trying to get an actual breast reduction done. (smaller breasts with the lift that comes with them) Breast lifts are never going to be covered by insurance as that is a cosmetic procedure. Conversely many breast reductions are covered by insurance as they improve back, shoulder and neck pain as the size of the breasts are reduced.  Thus they are often viewed as medically necessary and may be covered. But their potential coverage has to be determined before surgery by a predetermination letter which documents your breast size, the symptoms associated with them and how much breast tissue will be surgically removed. From this information, the insurance company bases their decision for coverage.

But when it comes to  breast lifts, there is no purpose in trying to see if insurance will pay for it as that can be determined right now…there is no medical need and thus no insurance coverage for the operation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have breast asymmetry and am interested in breast augmentation/lift surgery. I am 18 years old and have had two children. My breasts are significantly different by at least two cup sizes and have been so for six years. I have Tricare insurance. I am wondering if my being 18 years old is ok for breast surgery because I have already had two children so my body is done growing. I’ve spoken with my family doctor about wanting to have this done because its already done a lot of physiological damage to me.

A: Significant breast asymmetry is always a challenge in any form of cosmetic or reconstructive breast surgery. Having had two children and being two cup sizes different almost certainly speaks to the potential of needing some form of a breast lift on at least one the breasts (usually the larger one) and perhaps implants for both. Until I can see some pictures of your breasts I can not be any more helpful in recommending a specific plastic surgery treatment plan as there is great variability in many cases of breast asymmetry.

What is known now, however, is that insurance is not going to cover this type of breast surgery. Unless it is a case of reconstruction after breast cancer, breast reshaping surgery will be considered as a cosmetic procedure by any insurance provider today. The fact that you may have developed this through no fault of your own and it has a significant negative impact on your self-esteem is something that I have learned carries little weight with insurance companies.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have decided I am done having children and am considering a breast lift with implants. Two children and nursing have taken quite a toll of my breasts. They are just two sacks of hanging skin now. What type of implant or lift I need? I don’t want to look completely fake, but a more perky and fuller breasts would be a big improvement. Is this even achievable after having nursed two kids? How soon before surgery do I need to stop breastfeeding?

A: The ‘two sacks of skin’ breast look is very common after multiple pregnancies, particularly in women who have small to  moderately-sized breasts beforehand. When the breast tissue involutes (shrinks) after pregnancy, the stretched out skin collapses and falls over the inframammary crease. (lower breast fold) In each of these cases of breast sagging (with little to no breast volume), a combined breast implant and lift is needed. Usually either a vertical (lollipop) or combined vertical and horizontal (anchor) breast lift is needed and the resultant scar trade-off is unavoidable. A breast implant, regardless of size, adds volume but in and of itself will not lift the sagging nipple back up to a satisfactory position. You will need to stop breastfeeding three months before undergoing breast lift and implant surgery to give the engorged breasts time to fully ‘deflate’.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I am looking into getting a breast lift and possibly an implant. Does you do the breast lift with a vertical incision under  the nipple down?

A: There are four basic types of breast lifts which differ in the amount of lift and length of scars that are created. As a general statement, when breast lifts are done in conjunction with an implant, the most common type of lift performed is the vertical type. (lollipop) The breast implant also helps in creating somewhat of a lifting effect as well. When a breast lift is done without an implant, the most common lifting technique is the anchor or inverted T scar pattern where there is a combined vertical and horizontal scar. Without an implant more of a lifting effect is usually needed and that must come from the amount of skin removed and tightened.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I just want breast augmentation with implants and don’t want a lift. But based on my pictures do you think I need an uplift. My sternal notch to nipple distance measures 24 cms on each side. I had one plastic suregry consultation and was told I need a lift with breast implant. I would prefer them filled out and was hoping the use of an implant would lift them up. I have lost weight and breastfed so I have lost the fullness they once had.

A: Your pictures show an undeniable need for a combined breast lift and augmentation surgery. Implants only provide some degree of a lift if the nipples are initially at or above the lower breast crease. (inframammary fold) If not, the nipples will only be driven lower as the breast volume get bigger. Having a breast lift is really about accepting the scars as a trade-off for the improvement in breast shape. This is easier for some than others but is the defining decision about whether to do anything at all. There is another option, often called the ‘minimal’ or  ‘crescent breast lift. It is not really a breast lift at all but does lift the nipple a bit by removing a small crescent of skin at the upper nipple skin edge. For those women that have a minor amount of sagging, nipple lifts with implant placement must just be enough to get them an acceptable result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am wanting a breast lift and augmentation. I am 24 years old and my left breast is a cup size larger than my right. After having a baby a year ago and breast feeding for 6 months, the all around shape and liveliness has headed south. I want to get some information about a lift. I am interested I’m how much of a difference just a lift would make, is it better to do both augmentation and lift, and what is the likeliness of breast feeding if I were to have children in the future and would it bring the breast back down. Thank you

A: Breast asymmetry is always one of the most challenging of all breast reshaping surgeries to do. In interpreting your question, it sounds like you are just interested in doing something with the original larger left breast. That may be a reasonable approach if a lift can approximate the position or shape of the opposite right breast. In many cases of breast asymmetry, before or after pregnancies, it usually takes treating both breasts to get the best result. Whether this is done with implants, lifts or combinations depends on the size and shape of the initial breasts and their degree of asymmetry. Regardless of what is done, future pregnancies and breast feeding will negatively impact the surgical results that are obtained.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if when I got a breast lift plus augmentation if I can get the scar around only the areola. Who is the best candidate for it? I have doubleDD breast size and a lot if sagging since having my son who is almost a year. And I am 19. Thanks so much!!!

A: Having DD size breasts suggests that you definitely do not need an implant but a significant breast lift. A periareolar type breast lift only provides a very limited lifting effect and is almost used exclusively in the small sagging breast when the effect of the implants helps considerably in filling out the loose breast skin and providing a lifting effect of its own. As a stand alone procedure a periareolar breast lift, also known as a donut mastopexy, does not create a significant breast lift. By your description you are in need of a full breast lift that involves a horizontal and vertical tightening and creates the classic anchor scar pattern. While every woman would like a breast lift with limited scarring, that does not appear to be an option in your case.

Dr. Barry Eppley

Indianapolis,Indiana