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