Given a good health profile, it is possible to combine a breast lift with tummy tuck in the properly selected patient. At a 40DD breast size, it is likely that a breast lift without the placement of implants is feasible, and the expected cosmetic result could best be predicted at the time of examination of the breast tissues. In reducing and lifting the breasts, there will be some breast gland removed which may contain fibrocystic tissue and this could have a positive impact on how symptomatic you are. It is important to recognize, though, that there will be fibrocystic tissues that remain behind and consequently you cannot be assured of reduction in the discomfort. It is not possible to remove all of the individual lumps in the course of a routine breast lift. As far as using abdominal fat as a graft to the breasts, it is not recommended.

You raise an interesting scenario. I will assume that you don't want to incur the scars that are associated with a traditional breast lift. Liposuction of the breasts is a procedure used to reduce the breast size in a select group of patients, primarily those with very fatty breasts and the elderly, who may be too sick to undergo a full general anesthetic. It usually causes further sagging of the breasts, however. So, you would be worsening the sagging and then trying to correct it with placement of large implants. At any rate, you would have to go larger than D in order to tighten the skin enough to create a lift effect. I doubt that the scenario is feasible, but a consultation with a plastic surgeon board certified by the American Board of Plastic Surgery would better assess your situation to determine if it is.

There is no standard way of lifting and augmenting the breasts, which is the reason why you are getting different recommendations. It is much more complicated and therefore more risky to do both a breast lift (mastopexy) and an augmentation at the same time. That being said, there are a number of plastic surgeons like myself who do one stage mastopexy-breast augmentation procedures on acceptable candidates routinely. After a consultation to evaluate your goals and anatomy, it is therefore up to your individual surgeon's judgment and his/her experience as to whether it is advisable to do as a single stage or two stage procedure. Basically, there is no correct answer, just individual surgeon's expertise. Consult with board certified plastic surgeons that perform both one stage and two stage mastopexy-augmentation to get an unbiased opinion, and then trust your instincts. Obviously an informed opinion can only be provided after a comprehensive consultation.

In general, things don't change much after 3 or 4 months, so I would have to say that getting back into the type of garment that it sounds like you used right after surgery will probably not be worthwhile. It is always best to try to see your surgeon and get his/her opinion. You may need a revisional procedure which most surgeons will do for a minimal expense.

Thank you for your question. I always encourage patients to return to their original surgeon if they have any concerns or questions about their procedure, and I would recommend that you pose these same questions to your operating physician. This individual has all of your records and knows exactly what mastopexy technique and size of implants were utilized. If you are not able to follow-up with your original surgeon, then I would suggest that you seek a plastic surgeon who is board certified by the American Board of Plastic Surgery.



You may be a candidate to undergo removal of your current breast implants with replacement of smaller implants or with no replacement of implants. Either option would decrease the size of your breasts and make your breasts lighter and more proportional for your "small frame". You may need a revision of your mastopexy to help reshape your breasts to a smaller size if you either downsize or remove your implants. Your breasts are always subject to the force of gravity and the tissues will relax over time, so your breasts will eventually settle. If you decide to undergo additional breast surgery, you need to have a careful discussion with your surgeon about the risks of secondary surgery. The recovery following additional breast surgery should be similar to your original surgery with restricted physical activity for several weeks.

The situation you are describing is not unusual following a breast lift. Your surgeon is correct in what he is telling you. The swelling will "puff up" the breast, much as a balloon puffs up when filled with air. I would encourage you to be patient and to follow up with your doctor as he/she directs.

Whether or not a patient can have a combined procedure, i.e. breast augmentation with a breast lift or mastopexy, depends upon a variety of factors. If your nipple and areola need to be moved up quite a distance, it may potentially compromise the blood supply to the nipple if the procedures are combined. It also depends on the surgeon as well. Too much excess skin may also make it difficult. Some plastic surgeons are more comfortable performing the combined procedure than others. If you have developed a relationship with your board-certified plastic surgeon, you might consider visiting him again to review your options. You may also consider getting a second opinion of another board-certified plastic surgeon. It is not unreasonable to undergo a staged procedure if all factors point to it being the safest path for you.

It is impossible to tell you what is possible without seeing you in consultation so that I could better understand the elasticity of your skin, the shape of your breasts, the amount of sagging you have, your present breast size, your chest bone and muscle shape.



In general breast implants can in theory be used to "take up some of the loose breast skin." The problem is that any breast implant will add size - the smallest usually one cup size. The smaller implants are small in size but are also narrow. So if you have a narrow chest width, it may look proportional, but if you have a wide chest, it may look like a small bump on a wide breast.



So the answer is that small implant augmentation in select individuals may be a good way to address your situation but a consultation is the best way to truly understand your options.

Personally, I don’t believe that a capsulectomy (removal of the entire scar surrounding the implant) is safe to do at the same time as a lift. Too much of the blood supply can be affected, and I have seen complications of sloughing of tissue in these cases. So I believe that these should be staged for safety sake. That being said, and you can only tell once you have done an exam, you could do a capsulotomy if the breast isn't really hard (a grade 2 capsule). You can do a capsulotomy with a lift, as you are not involving the blood supply as much.
Insurance usually doesn’t help, as this was done for cosmetics in the past (if done for a reconstruction after mastectomy it is a different matter), but some times the insurance will help with the removal only. If you are putting another one back in, they will frequently deny it. Putting another implant back in is never covered (unless for reconstruction), and a lift will never be covered also unless it is a reconstruction.
I have seen some patients get a new credit card and place 0% interest for 6 months. That is the best financing I have seen. Other than that, a group called "Care Credit" has been recently introduced in many (and my) offices.

I would suggest a breast lift using the vertical incision. The scar will be around the nipple with a vertical scar coming from the underside of the breast mound. The vertical scar comes from the 6 o’clock position of the pigmented area of the breast (the areola) and ends at the natural breast fold. It does not matter whether it is a breast lift or a breast reduction. The difference is in the amount of tissue removed; however, both will lift the nipple and the areola complexes. You will look naturally proportional with a large B cup size.

There are several types of breast lifts or small reductions that would work well for you. During the consultation with your surgeon, a discussion of which technique would work best for you will take place. My personal preference is to use a new minimal scar lift that produces superb results in properly selected patients.

Even when patients have large breasts, the breast shape may be improved with the placement of a small breast implant either in front of or behind the muscle in the upper half of the breast. Depending on the patient’s size and desired shape, the best result is sometimes achieved by performing a small breast reduction at the same time as the placement of a larger implant. The implants selected are usually similar to the standard breast augmentation implant and while the companies do have some “partial” implants, these usually work best in breast reconstruction patients.

Stretch marks can occur following rapid growth, weight gain, pregnancy, steroid use or other health conditions which adversely affect the skin's health and elasticity. Skin characteristics such as color, tone, texture and elasticity are inherited traits but can also be affected by environmental factors. At this point, there is no "cure" for stretch marks. Areas of stria vascularis (stretch marks) that are located in zones of skin excess such as the lower abdomen can be removed at the time of abdominoplasty surgery. On the breast area, stretch marks can be removed during mastopexy (breast lift) or breast reduction surgery. These incisional surgeries require a surgical scar in order to remove the excess skin and tighten the "skin envelope," thus improving the shape or contour. A stretch mark represents a full thickness tear in the skin when the limit of elasticity has been reached. Direct removal of stretch marks in the thigh region would require a scar revision procedure, which could possibly make a very wide scar less noticeable; however, the scar would still be present. Therefore, until a new technology emerges, we do not have a perfect answer for most of these problems.

My recommendation is to lose as much weight as you can before going ahead with surgery. You can, of course, have your breasts lifted now, but there is a chance that you would need to repeat the procedure after you have attained your final weight loss goal.

Endoscopy is the method of performing surgery using an endoscope—a narrow, telescope-like device—to view the interior of an area of the body through a small incision. This minimally-invasive technique is not applicable to a breast lift. A breast lift, or mastopexy, is performed to correct drooping breasts due to stretching of the skin from pregnancy, or weight gain and loss. Since there is excess skin present in these circumstances, it needs to be removed to bring the breasts back to their normal position. Removal of this skin will cause scarring. Sometimes incisions can be made just around the areola (the pigmented area surrounding the nipple), where they will be less noticeable. Other times incisions will extend down to the breast fold. And sometimes there will be an incision underneath the breast as well. Consult with a board-certified plastic surgeon who has performed a number of these procedures. He or she will be able to advise you as to an appropriate technique in your specific case.

A breast lift, or mastopexy, is a very safe procedure. While any surgery carries the risk of poor healing, infection, bleeding, or dissatisfaction, these problems have been infrequent in my practice. However, the scars produced by a breast lift can be significant, and each person heals differently. Talk with an ASAPS-member plastic surgeon, look at photographs, and maybe speak with other patients. Most patients love the results of breast lift surgery, despite the scars.

Ideally, it is advisable to discontinue smoking at least two weeks prior to surgery. Smoking has deleterious effects on your lungs as well as your heart, and this could compromise your health during anesthesia. In addition, nicotine causes the small vessels in the skin to constrict and this could result in loss of skin or delayed healing. These problems might lead to the development of wide or raised scars. I would strongly advise you to quit smoking as long as possible before your mastopexy to help ensure the best possible result.