Recent data released by the American Society of Aesthetic Plastic Surgeons has mirrored what we have seen in our practice over the last few years: i.e., more patients are requesting breast lifts as a stand-alone operation. It is now the fourth most common procedure requested by women and more than any facial aesthetic surgery. It has increased almost 600% over the last 15 years and this increase has been mostly over the last 5 years.
In the past women have been most concerned about breast volume. The breasts were too big or too small. These complaints were corrected by either a breast reduction or augmentation.
Women appear now more concerned with breast aesthetics. I often hear: “My breasts are a good enough size just ugly and drooping”. This may be just aging and skin laxity but may also be the result of pregnancy and breast feeding. Change after pregnancy is called “post-partum involution”: i.e., after pregnancy reduction in breast size. It does appear that the third pregnancy affects the breasts much more than the first two. The skin becomes stretched as the breasts fill with milk and the skin does not recoil once the breast is empty again. This skin laxity contributes to the droop. The nipple may be pointing down the floor and most of the breast tissue is below the lower breast fold. This is described as “passing the pencil test” when you can hold a pencil in position under your breast without it falling to the floor.
Breast aesthetics are such that you desire the nipple to be at or above the lower fold of the breast on the chest wall. One third of the breast tissue should be above the nipple and two thirds should be below the nipple. This is the aesthetics a breast lift recreates.
The biggest draw back with breast lifts is the scarring and the potential to lose nipple sensation (approximately 7%). We try to limit the scars as much as possible, but we still need an incision all the way around the nipple to elevate it. This gives us the opportunity to also make the dark areola smaller which is a more youthful appearance. Often an incision from the nipple to the breast fold is necessary to tighten the lower part of a breast gland and close the skin where the nipple was previously located. Nipple sensation can be variable, but losing sensation is uncommon.
Most women are extremely pleased after breast lifts. When wearing a strapless dress or sundress they can go without a bra, if they desire. Bras can now be purchased for beauty and not for lifting purposes. They also feel much more youthful especially out of clothing.
Thomas J. Francel, M.D.
