By: Dr. Haideh Hirmand
What is it about women and breasts? They spark jealousy, anger, embarrassment, pride … A rainbow of emotions are associated with how we view our breasts as part of our womanhood and how we accept our chests and those chests around us. In my last wOw article, I addressed the psychological, physical and social relationship women have with their breasts. For some of you, you spoke openly about your breast size, how you felt about it and how you feel about women who speak about it. Others expressed disappointment in women who would even spend any time worrying about their breasts. To conclude, you've been living in your body since the day you were born, and it's no surprise that your bosom buddies, the girls you took with you to college, may not be what they once were. But you - your sexuality, femininity and energy - may be the same, more vibrant, or at least still there. For some women, there is an acceptance of the change and the impact as positive and inevitable. For some other women, a significant change in size or shape or feel of their breasts affects the very essence of their feminine self in profound ways. They want their breasts back so they can match with how they feel as women. For this latter group, here are the latest and greatest in options for breast enhancement.
The idea of a breast lift is just that: to lift the breasts.
Breast Lifts Fix: Sagging Breasts
In addition to gravity, what causes the sagging? Typically, women who've undergone pregnancies experience a change in the size of their breast and the skin quality. During pregnancy, breasts enlarge, causing them to go from big to small again. That can lead to sagging due to the loss of volume and the occurrence of loose skin that was stretched. Similarly, we see this in women who experience massive weight loss (which we're seeing more of with the advent of medical procedures that help ward off obesity, including gastric bypass surgery and stomach stapling).
Another cause of sagging breasts is aging. When we age, our skin loses elasticity, and allows gravity to take its course. Sagging breasts can also run in the family - it can be genetic. Lifts also may help women with asymmetrical breasts. (I'm talking about completely different cup sizes - as opposed to the usual unevenness that we all have.) During a lift, a size adjustment can be done at the same time as changing the shape of the breasts by removing some breast tissue on the larger breast to make it closer in size to the smaller one. Women with tubular-shaped breast - where the bosoms are narrow, begin high and literally hang from the chest, and are often underdeveloped on one or both sides - would most likely need a lift together with implants to correct this developmentally altered shape. I have met many women with this genetic breast shape deformity who, for a long time, were not aware that it could be corrected and went through a significant portion of their lives self-conscious about their breasts with grave impact on their intimate relationships.
The Procedure: Traditionally, plastic surgeons just cut the extra skin off and used the skin envelope to suspend the breast higher. This would tighten the skin and hence decrease the weighed-down breast. The procedure has evolved over the years. Today, surgeons still tighten the skin but they also reorganize the breast internally to lift it, which gives longer-lasting results and shorter scars.
For women with very droopy breasts, the scarring from lifts used to be quite obvious. Many may have seen the anchor scar - which goes around the nipple, down the breast and along the creases on both sides. The scars could be visible in low-cut shirts or from the sides. With the latest techniques, scarring is much shorter, and in fact, most people only get a lollipop scar - which is just around the nipple and down from there.
We are also working with sutures and suspension sutures to slightly lift breasts - without scars or surgery.
Recovery: Recovery depends on the extent of the procedure and age; however, in general a week of rest - no exercising or running - is a good ballpark period of time. Contrary to common belief, it is not a very painful recovery but the first few days can be sore and pain medications do help. General anesthesia is typically needed. Scars will heal in about two to three weeks. Avoid sun exposure while the scars heal.
Risks and Aftermath: The modern lift is always an exchange of improved shape for some scarring. The scar-less lift that can deal with very saggy breasts is still elusive. With any surgery, there is a risk of infection and bleeding. Some patients experience a change in the sensation on and around the nipple.
Words of Caution:
- Just because you had a lift doesn't mean the shape of the breast will never change as you age. Weight gain and loss after the lift can affect your breasts. It's best to do a lift when you get all the pregnancies out of the way or when you're at your ideal weight.
- A lift can boost the breast, and newer techniques replenish some volume in the middle of the breasts. However, if drooping is not the only issue and you are looking to get volume back, a lift alone may not be the solution. When the breasts have become flat, the only way to increase volume is to put back volume. And today, the ways to give volume back are through implants, fat and fillers.
Add volume to the breasts
For those whose breasts are not too droopy but the skin pocket is emptied out and the breast tissue has thinned out, implants offer a choice for volume augmentation and are sufficient to replenish the shape and lift the breast slightly. Implants are made with the following:
- Saline - composed of saltwater, FDA-approved and widely used in the United States.
- Silicone - composed silicone gel and FDA approved after extensive studies found that there were no causal relationships between auto-immune diseases and silicone implants. The science behind this was so overwhelming that eventually it prevailed over the fear factor. Silicone feels more like native breast tissue and gives a realer feel and shape.
I. Breast Augmentation with implants: Simply put, through a small incision under the nipple, under the breast or in the armpit, an implant in placed under the breast tissue. Implants are usually in the pectoral muscle, which is just under the breast, for a more natural cleavage, better mammography and softer feel.
Recovery: Average recovery is a week but the significant part of the discomfort subsides after the first three days. It is a good idea to avoid strenuous or impact-type exercises for the first two weeks.
Risks and Aftermath: The usual risks of surgery including infection and bleeding are very rare. The side effect to take note of is capsular contracture. That's when the scar tissue on the inside around the implant thickens; the breasts will feel firmer as a result. This is a relatively infrequent side effect that occurs less than ten percent of the time. However, if it happens and is significant, the scar tissue needs to be cleaned out surgically. It also doesn't happen to the same extent in every case. Many times it is very mild and self-limited and nothing needs to be done.
Price: For silicone and saline, $4,000 to $6,000, depending on size and the location of the surgery.
II. Fat Injections into the breast: This is the new buzz procedure for adding fullness to the breast. It involves taking fat from another part of the body (if there is enough of an excess since quite a bit is needed) and transferring it to the breasts. It is being done abroad, as is the usual case for all new and untested procedures. The techniques are rapidly evolving to get reproducible and good results. I have seen it being promoted and advertised online by all sorts of unqualified physicians. Here is the big word of caution on this procedure: the SAFETY and long-term results of fat transfers to the breast itself have not been conclusively shown yet and are under investigation. Fat is a living tissue with hormone receptors (specifically estrogen) and there are other biologic activity that is associated with fat cells. It is wise to allow studies to be conducted and announced before embarking on this type of breast enhancement no matter how "natural" and easy it may seem. For those interested, I recommend that you only partake in fat transfers into the breast under an approved research study protocol. Moreover, do not fall prey to online or other advertisements by unqualified physicians or non-physicians. Remember to look for board-certified plastic surgeons (American Board of Plastic Surgery).
III. Filler Injections into the breast: You may have heard about this from friends abroad. Internationally there are fillers, namely hyaluronic acid fillers much like those injected into the face, that are being injected into the breast for volume. At present time, these fillers are NOT approved by the FDA for use in the US and presently not recommended…
In future columns, I will be sure to expand on our exploration of breast enhancement with breast reductions - yes there are actually those of us who look forward to reducing the size - and cutting-edge breast reconstruction options for women with breast cancer. Be sure to look for them and as always I welcome your comments and conversations on this very debated topic.
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