Q: “I would very much like to enhance my breasts before the bikini season is over! A few doctors I’ve seen have recommended an uplift along with implants, but I was not happy with the pictures of the scars that they showed me. What should I do?” — Sara P., Coto de Caza, CA

A:  Breast enhancement surgery is as elective as it comes and each procedure should be designed to meet the patient’s expectations. The first question you should answer is: what are your expectations?

Many options must be considered when planning breast enhancement. But the planning has to take into consideration each patient’s anatomy and expectations! Breast enhancement can be accomplished via a breast reduction or a breast augmentation (with or without an uplift) or with an isolated uplift. It all depends on the desires of the patient.

An enlarged breast almost always has some drooping of the nipple, and the nipple is raised in most breast reduction procedures. Breast reduction is a separate subject. This article will focus on breast enlargement, with or without an uplift, and isolated breast uplifts without the use of an implant.

Breast Augmentation vs. Uplift

A breast augmentation by itself rarely leaves visible scars. The tiny incisions can be placed in the fold under the breast, around the areolus or in the armpit area.

Breast uplifts, on the other hand, can never be done without leaving a scar that will be visible forever. The surgeon must make sure that the degree of improvement warrants the resultant scaring. If an uplift is attempted for a very minor degree of breast ptosis (drooping), it is unlikely that the patient will be thrilled with the trade off. On the other hand, if the nipples are hanging halfway down to the navel, the minor scaring visible with uplifts will not be much concern to the patient. The trick is to make the right decision for the patient who falls in the grey zone in between these two extremes.

You are correct in thinking that the traditional uplift procedures do leave visible (when naked) inverted “T” scars. But newer techniques today allow a surgeon to obtain similar results with minimal incisions, sometimes limited to a circle around the areolus. Incision patterns chosen by the surgeon will be dictated by the surgeon’s experience, the patient’s anatomy and each patient’s expectations. Basically, the droopier a patient is to begin with, the more skin will be resected and the more scaring can be expected.

When a Breast Uplift Is Recommend

A key anatomical factor in deciding whether or not an uplift is recommended is based on the position of the nipple in relation to the inframammary fold (the fold that runs under the breast). With the patient standing, if the nipple sits above the level of the inframammary fold, a breast uplift is not indicated. If the nipple is an inch or more below the fold, an uplift will be necessary to achieve normal breast shape.

The difficult decisions come when the nipple is within an inch or so of the fold, the so-called grey area. In these situations, the patient (note that I said “patient”, not surgeon) will have to decide if a breast uplift is desirable. In such borderline cases, we help the patient make an informed decision by showing examples of various breast configurations, with or without uplifts, and showing each patient examples of expected scars. Each patient then has to decide whether the improvement in breast shape is desirable enough to warrant the scars associated with a breast uplift.

Breast Lift vs Lift Plus Implant

To help a patient decide between a lift alone versus a lift plus a breast implant, I explain that an implant makes the breast volume increase but does not significantly change breast shape. Conversely, a bra will lift a droopy breast in a manner similar to a breast uplift but, by itself, does not change breast volume. So if a patient is happy with their volume and only wants to be uplifted, an uplift by itself should be recommended. Whereas, if a patient puts on her bra and still feels that a fuller breast would be desirable, she would be better off having an uplift with implants.

Here are a few examples of enhancements to illustrate the difference:

(Actual patient of Dr. Bunkis) A 25-year-old desirous of breast enlargement before and after implant placement. Note that her nipples are well above the fold, so an uplift is not indicted.

(Actual patient of Dr. Bunkis) A 25-year-old mother of two with droopy breasts, nipples just below the level of her inframammary folds, before and after uplift with implant. She was happy with the shape of her breasts in a bra but not with the size. She was a candidate for an uplift with incisions just around each areolus and insertion of implants.

(Actual patient of Dr. Bunkis) A 35-year-old mother of two before and after a breast uplift with a short scar technique. She was happy with her breast shape and size while wearing a bra. Implants were not indicated in this case.

As you can see, the topic of breast enhancement is a complicated one.

Any decision regarding which technique will be most desirable can only be made after a thorough consultation and a discussion of the options and patient expectations.

More information is available at: www.ocps.com

or: www.ocbreastenhancement.com

What’s most important is to find a surgeon who is well-versed in all of these techniques, and to choose the procedure that will give you the results you expect with the least possible amount of scarring.

Please feel free to call Dr. Bunkis at Orange County Plastic Surgery (949) 888-9700 to discuss your options.