What is a breast augmentation with lift?
For women desiring larger, perkier breasts, a breast augmentation with lift may be the perfect procedure. This combines the increased volume of implants with the lifting, tightening effects of a Mommy Makeover breast lift. This is perhaps the most common breast enhancement procedure involved in a Beverly Hills Mommy Makeover. Once a mother is done having children, her breasts are often deflated and sagging and no longer resemble her previous youthful, full breasts. This procedure is ideal for reversing those effects.
A breast augmentation with lift is essentially two procedures in one. It is reversing the two most common problems women face after having children. The breast lift portion addresses the sagging while the augmentation enhances the volume. Together, this is the most commonly done procedure in the Mommy Makeover armamentarium.
Historically this procedure was never done as a single surgery, but rather in two stages--the initial stage being the breast lift followed by the aug. It was felt this was the only way to accurately and safely accomplish the aesthetic goals. Today, in the hands of a very skillful surgeon, these procedures can be combined both effectively and safely.
Am I a candidate?
Candidacy for breast augmentation with lift is dependent on two factors. One is your taste, the other is your need. Often patients come into a consultation stating that they do not want a breast augmentation and only a lift in order to reverse the effects of pregnancy. However, many times a breast lift alone will be insufficient in restoring the volume of the upper pole or upper breast that a patient ultimately needs in order to have attractive breasts. That is why a consultation with your plastic surgeon is crucial in determining whether or not you are a candidate for a breast aug with lift.
Additionally, patients often feel that they do not want a lift and only an augmentation. That is to say, they are under the impression that an implant alone will lift their breasts. This is an error. If an implant is placed without doing a lift when it is necessary, the ultimate aesthetic outcome may be substantially worse than prior to surgery. Therefore, a breast augmentation with a lift requires the guidance of your surgeon.
Ultimately, candidates for a breast augmentation with lift have a combination of the following attributes:
- Breasts that have lost their shape and volume, resulting in a flat and long appearance, rather than projecting and round
- Nipples that fall below the breast crease (inframammary fold)
- Nipples that point downward rather than straight forward or horizontal
- Dissatisfaction with breast size or feeling one’s breasts are too small
- Loss of volume or shape following pregnancy, weight loss, or due to the aging process
- Asymmetrical breasts, in which one appears larger than the other
- Breasts that sit on the chest with a great deal of contact. In some cases, this contact is so significant that it will hold a pencil between
the sagging breast and the skin under the breast.
- The upper pole or top of your breast is concave or hollow
- Areolas that have become stretched or enlarged in conjunction with floppy breasts
Other factors to consider prior to undergoing a breast augmentation with lift:
- Women who may have children in the future should delay getting a breast augmentation with lift, as the pregnancy will to some degree ruin the
effects of the lift.
- Patients should know that lactation may be more difficult after a breast lift, adding another reason to wait until all childbirth is
- If you still express milk, you should wait at least 3 months after the last time you see milk expressed from your breasts
- Patients should be at their ideal weight after having had children, as losing pregnancy weight will lead to further deflation of your breasts.
Because of this, you want to do the lift after your breasts have fully settled into their post-pregnancy shape and size.
Before & Afters
Types of breast lifts
There are essentially three types of breast lifts. They differ based on where the incisions are made and where the final scars will be. The incision that selected is not based on what you want, but rather what you need in order to obtain the desired results. So many times, patients who want to avoid scars will either refuse a lift they need or worse, be told by surgeons that they can “get away with” a shorter scar. This often leads to an undesirable outcome, as well as wasted time, money and energy. Additionally, the undesirable outcome often leads to a revision surgery, so the patient can undergo the lift that should have been done in the first place.
In some rare cases, a revision lift is not even an option after the wrong lift is performed--all the more reason to select the correct lift the first time.
The three types of breast lifts are:
Donut lift, also known as a circumareolar or benelli lift, is when the incision is placed around the areola. This technique is generally used to correct mild sagging of the breasts.
The lollipop lift, also called a vertical mastopexy, is when the incision goes around the areola and down the front of the breasts in order to remove the excess skin. This technique is used to correct moderate sagging.
In the anchor lift, the incisions go around the areola, down the front of the breast, and within the breast crease. This technique is used to correct significant sagging of the breasts.
Asymmetry of the breasts can be corrected with all three techniques.
Breast implant types
In breast augmentation, there are two primary types of breast implants. These are:
This implant is made from a silicone shell filled with a sterile saline solution. The saline solution is injected into the shell after the shell has already been placed in the breast pocket.
This implant has a silicone shell and is filled with silicone. Today there are two main types—the semi-cohesive soft silicone implant, and the cohesive/gummy bear implants.
A cutting edge development in breast augmentation after breastfeeding, gummy bear implants offer an improved texture and appearance for qualifying patients. Be sure to ask your surgeon if gummy bear implants may be right for you.
While the gummy bear implants are considered the newer implants, they are not necessarily better. Newer doesn’t mean better, newer means different. They are simply another implant options with a host of advantages and disadvantages. Patients need the guidance of their physician to determine if this option is right for them.
Saline implants tend to be more round, more prominent and firmer in comparison to their silicone counterparts. Silicone implants tend to be softer, less projecting, and more natural appearing.
The above implants can be broken down into further characteristics. For example, the implant exterior may be textured or smooth. Additionally, there is the obvious consideration of size, and implants come in many different sizes. The size of an implant is measured in cubic centimeters. Every 150-200 cubic centimeters represents approximately one cup size. Yet another parameter is the profile, which refers to how much the implant projects forward. While there are various companies each with their own profile types, generally implants are classified as low, medium and high profiles. Again, each has an advantage and disadvantage and without a thorough examination there is no good way to know which is best for a given patient.
The most important factor when it comes to implants is safety. With the extensive amounts of research that’s been done, we now know based on many scientific studies that saline and silicone implants are equally safe. Historically, patients were concerned about silicone implants, but that issue was laid to rest many years ago, and silicone implants have not been associated with development of disease such as Lupus or breast cancer as feared in the past.
The exact type and size of implant will be determined during your initial consultation, as it is your doctor’s responsibility to help guide you on these matters. You should be given all options and fully educated on what you can expect from each type of implant. If you are given a bunch of implants and asked to fill your bra and then made to make a decision, you will likely make a mistake. There is a science to the art of breast augmentation and it is important you select the correct implant. Many of the most preventable complications with breast augmentation are implant related.
Implant location and placement
There are three locations where the implant can be placed.
Subglandular/above the muscle
In this instance, the implant tends to be more prominent, as it is closer to the skin and tends to have a more abrupt chest-to-breast transition. Additionally, this approach has a higher rate of capsular contracture, or scar tissue formation. If a patient has too little breast tissue to cover the implant, then rippling--being able to see or feel the implant borders--is much more likely in this location.
Complete submusclar or under the muscle
In this approach, the implant is totally under the pectoralis major muscle. The transition in the chest-to-breast is more natural. However, sometimes the muscle prevents the implant from settling into the bottom of the breast, causing the bottom of the breast to lose roundness and fullness.
Dual-plane or half-half approach
In this technique, you are essentially getting a hybrid of the above techniques. The implant is under the muscle, yet the muscle is released or moved out of the way so the implant can settle into the bottom half of the breast, filling it in a more natural way. This technique tends to be Dr. Rahban’s preferred approach.
Patients sometimes are concerned that releasing the muscle will lead to muscle weakness, which is not the case. The muscle release is insignificant and not functionally relevant in the majority of patients.
Used by Dr. Rahban during a case
Implant sizing is probably the most crucial step in pre-breast augmentation decisions. Usually patients are allowed to make whatever size selection they want, simply based on the fact that they are paying for the surgery. This is an incorrect approach to breast augmentation. We know that every chest has its own measurements, and there is a maximum size appropriate for each individual’s anatomy. Therefore your physician must measure you, then guide you as to the limits of your breast augmentation. Dr. Rahban strongly believes that sizing is not about what you want, but what you should have.
Dr. Rahban does not operate based on a patient’s desired CCs (cubic centimeters), nor cup size. In other words, he won’t operate to give you a certain CC or a bra size. He operates with the final shape and aesthetics of the breast in mind.
Most physicians will ask the patient to select the implant size prior to augmentation, and subsequently insert that implant intraoperatively. If this implant is incorrect, then the responsibility falls onto the patient. What Dr. Rahban does is different--he uses implant sizers during surgery. Here is what that means:
During the consultation, he asks the patient to choose several photos of the breasts she would like to have. These are before and after pictures of breasts without clothes so there is no confusion as to what the breasts actually look like. He then uses those photos as a guide during surgery to achieve the correct size for the patient.
During surgery, he has a full array of sterile “sizer” implants. He inserts a sizer and sits the patients up, continuously comparing them to the photos they selected. He will exchange sizers until he is confident that the size is consistent with the desired look--not cup size--the patient desired. As such, he is not bound by a limited number of implants he pre-selected or worse, what the patient thought was the appropriate size during the consultation. With this time consuming but thorough method, Dr Rahban has virtually eliminated sizing issues in his practice.
The error in operating based on cup size is that manufacturers don’t make breast implants based on cup size. They are simply measured in cubic centimeters, which doesn’t directly translate to cup size. In breast augmentation, the goal is a visual, cosmetic result. It is not a number or a bra size. Unfortunately, not all surgeons operate this way. Therefore, lots of errors are made during sizing, leading to unhappy patients.
Consultation for breast augmentation with lift
Note: while each surgeon approaches the consultation process differently, Dr. Rahban feels they should all have the same basic elements, ensuring patients leave very well informed regarding surgery. Below is how Dr. Rahban conducts a consultation.
Your consultation should be done by your plastic surgeon and not by his staff, such as his coordinator. In many cases, patients are offered free consultations, but you must understand that often means you’ll get a hurried consult. As a point of reference, Dr. Rahban on average spends up to an hour with each patient, reviewing not only what the patient came in for, but also explaining all the nuances such as the risks and alternatives to what that patient has requested.
There is no way to accelerate the dissemination of knowledge when it is so complicated and crucial.
During a consultation for a breast augmentation with lift, Dr. Rahban covers several crucial points. Firstly, he gathers data regarding what you consider to be the issue. After all, they are ultimately your results, and your satisfaction is the top priority. Second, after an examination, Dr. Rahban defines the exact problem, allowing you to better understand what your body has been through. Next, he lays out your options, including whether you need a lift, an augmentation or both. Subsequently he will include critical decisions such as what type of lift, where the implant should be placed, what type of implant should be used, and what size. Finally, he will discuss what you can expect from your breast augmentation with lift, both in terms of the cosmetic result, as well as the physical and mental aspects.
As an extension of this, Dr. Rahban also reviews what patients should not expect from surgery. He is well known for telling his patients the truth and establishing a healthy level of expectation. Most patient dissatisfaction is related to inaccurate understanding and expectation of their surgery. Dr. Rahban deals in full disclosure to prevent this from occurring.
In the interest of helping his patients fully understand the procedure, Dr. Rahban will take this opportunity to review all potential risks. While some risks are quite unlikely, he still wants his patients to be aware of the potential downsides of a breast augmentation with lift. All surgeries come with risks. Therefore, he believes the only time to engage in surgery is if the benefits far outweigh the risks. If you will only have a mild improvement, Dr. Rahban will most definitely recommend you do not undergo the procedure.
During a consultation, Dr. Rahban has one primary purpose—total patient education. He wants each patient to fully understand every nuance of breast augmentation with lift, as well as every risk and exactly how the procedure applies to them, allowing them to make the best decision for themselves. With his honest, candid approach, Dr. Rahban brings a new level of care to ensuring his patients know exactly how a breast augmentation with lift works.
Breast augmentation with lift procedure
Note: while no two surgeons perform this procedure identically, most techniques have a similar series of steps. Below is a brief overview of Dr. Rahban’s technique, allowing you to gain a more detailed understanding regarding how your surgery will be performed. The more you know, the more control you have.
The most crucial step in a breast lift is marking the breasts prior to surgery. The markings will determine how well the surgery is performed in terms of symmetry and overall shape. The goal with the lift is improving breast shape. Size, which often is confused with shape, has to do with implants and augmentations. The correct approach to this procedure is to perform the lift and then do the augmentation to fill the new shape, as opposed to doing the aug then building the lift around the new size. Shape should always take precedence over size. Hence, one should defer to smaller, better-shaped breasts if the skin envelope demands that, rather than larger, poorly shaped breasts and forcing the skin envelope.
Most errors in breast lift procedures are done during the marking section, as physicians either are quick or inaccurate with their markings. Additionally, some physicians feel it’s acceptable to do the markings during the surgery. However, Dr. Rahban finds this to be incredibly inaccurate, as patients are lying down through much of the surgery.
Next, prior to making any incision, Dr. Rahban likes to confirm that the markings done preoperatively are accurate. Therefore, with the patient asleep, he will temporarily staple his markings into place and sit the patient up, looking at each breast for its own shape as well as symmetry between the two. This crucial and often skipped step allows for one more opportunity to ensure that neither too much nor too little skin is removed during the procedure. And only after this step are any incisions made. Obviously this step is time consuming, but it is worthwhile in providing a stellar result.
Next, the incisions are made and all excess skin is removed.
Once the skin has been removed, exposing the underlying breast tissue, Dr. Rahban makes an approach to the pectoralis major muscle, beginning the augmentation portion. The muscle is identified, and a pocket underneath the muscle is created. Dr. Rahban makes this pocket by incrementally releasing some of the attachments of the muscle from the chest. This creates a dual plane placement, allowing the implant to settle in the appropriate location and giving a natural appearance.
At this point, Dr. Rahban will refer to the photos you have chosen, and will insert the size of implant he believes will accomplish the goal. He will then sit you up while you are asleep and look at the photos and compare to determine if the size is correct. If need be, he will repeat this procedure with various sizers until he feels confident that your size is consistent with what you selected, and that both breasts are symmetrical in size. This time-consuming step is what allows for more accurate sizing outcomes, hence patient satisfaction.
To ensure his patients get the exact right result, Dr. Rahban has a consignment of ALL implant sizes. He never wants to place an incorrect implant simply because he doesn’t have the right size. This is yet another unique indication of his commitment to patient satisfaction.
Once the size is selected, the permanent implants are placed in the pocket, and the breast tissue is incrementally closed over the implant. The breast tissue is sewn together in a way that gives the breasts a conical and round shape.
This is yet another crucial step that, if neglected, can lead to the second most bothersome complication, which is unsightly scars. Closure of incisions can be as simple as staples or glue, and as complex as a multiple-layered technique. Dr. Rahban feels strongly that closing the skin and breast tissue with multiple layers in a fastidious fashion is the single most important step in having scars that will be minimal and that will ultimately fade over time.
The final step is the placement and creation of the new nipple-areolar complex. With the patient sitting up, the desired location for the new nipple areolar complex is marked and subsequently opened in the outer skin. Underneath the outer skin, the existing nipple-areolar complex is surviving on its pedicle. This should easily and without tension be brought through this new opening to the skin’s surface and sutured into place. This key step is where many doctors falter, creating an oblong or irregular-shaped areola. Like with every other step, great care must be used in order to create a round and appropriately placed nipple areolar complex.
Preparing for a breast augmentation with lift
For patients undergoing a breast lift with implant, preparation begins about a month before the procedure. Our office will provide you with a full list of actions to take as well as what to avoid. Each item on the list is intended to ensure you get a beautiful cosmetic result and that the surgery is as safe as possible. A few basic preparatory steps are listed below to give you an idea of what will be expected.
- Stop taking certain medications, such as aspirin and anti-inflammatories, as these can contribute to excessive bleeding
- If you are 40 or over, a mammogram is necessary in order to make certain that your breasts are in good health and that no underlying disease is
missed. If you have a family history of breast cancer, a mammogram at an earlier age may be indicated.
- Quit smoking, as this can slow the healing process, especially as the nipple areola complex (NAC) is being relocated and its blood supply will
- Make arrangements for the recovery process, including details such as a ride home following surgery, which our office can help arrange.
- It must be at least three months since the last time you’ve seen milk come out of your breasts.
- Breast lift patients should be relatively close to their ideal body weight.
If you have any questions prior to your surgery, our office is available to you. Call or email us any time, and we will help with anything you need. Our goal is for you to have a successful surgery, which we believe is contingent on research and preparation. Your success is predicated on doing your homework and being prepared. We strive to provide total peace of mind for our patients, as well as a safe, successful procedure.
Healing and recovery
Note: the recovery listed below is according to Dr. Rahban’s routine. Other surgeons may have a different approach to the recovery process.
Directly after surgery, you will awaken from anesthesia, at which point you will have little to no pain, as both the general anesthesia and the local anesthesia are still present in the breasts. You will have on a surgical bra, as well as bandages underneath your bra. Dr. Rahban’s approach is to leave everything in place for one week until he sees you for your first post-operative visit.
During this initial period, many patients feel as though their incisions are getting dirty, causing them to wash the incision themselves. This is contrary to what should be done. When patients leave the operating room, the dressings are well secured and keep the incision sterile. Because most infections occur from contamination, patients who “clean” their wounds actually introduce bacteria from their hands and water, increasing the risk of early infection. Therefore, the incision will remain clean if the dressing is simply left alone, allowing the wounds to close on their own.
Note: While some doctors may use drains, Dr. Rahban does not with his breast lifts. He feels that with meticulous hemostasis or control of bleeding and accurate technique, drains are not necessary with breast surgery. Only in rare cases of complex revision does he use drains.
At one week, you will see Dr. Rahban, at which time your bandages will be removed along with most of your sutures. He will then begin telling you how to care for your incisions. Refer to Dr. Rahban’s scar management protocol for more information.
During the initial post-operative one-week period, the surgical bra will be snug and there will be moderate pain. It is normal to expect some fullness at the top of your breasts. Over the next 6 weeks, the fullness will settle, but the breasts will not fully settle for about three months. With the dual plane approach, the breasts eventually settle into a teardrop shape.
Most patients return to work after about 7 days. During this time, you will still be wearing your surgical bra, but it can be taken off to shower. It may seem counterintuitive, but there is nothing magical about this bra. It does not hold the breasts in a specific position, nor does it provide proper support. In fact, it’s what this bra DOESN’T do that makes it special. If a normal bra or sports bra were to be worn during this period, it may lead to the implants healing higher than one would like. Therefore, this surgical bra ensures the breasts heal properly and that you get the best Mommy Makeover Beverly Hills has to offer.
The second visit occurs at 2 weeks after your surgery, at which time your pain is significantly less, and the focus is on wound care. During this visit, Dr. Rahban will continue to ensure you know how to care for your incisions. As many of his patients come from out of town, it is usually this two week milestone that marks their return home. Ideally, he wants patients to remain close to his office for the first two weeks after surgery to monitor their healing and ensure they are on the right track.
At 6 weeks you should essentially have no more pain. Your scars should be well healed, and therefore you can begin to resume all previous activities with the exception of lying completely flat on your breasts, such as during a massage. Dr. Rahban doesn’t recommend this kind of activity until 3-5 months after the procedure.
By this 6-week mark, your implants have begun to settle and have a more natural appearance. However, they may still not have the final teardrop appearance that you are looking for. You will be able to resume all strenuous activities and exercise. Additionally, you will be able to buy your first set of bras, as you will be wearing the surgical bra until this point.
Note that at this juncture, your scars will start to become more inflamed, and perhaps more obvious, as your body is beginning the proliferation phase. It is now beginning to do its healing work.
Healing & Recovery Week 1
At 3 months your implants will have fully settled and you will have obtained your desired shape. That being said, your scars will most likely be slightly redder or more colored and inflamed. This is because your body is now at its peak of healing. Therefore, it is important for patients to understand the healing process and that it takes time for scars to fade. In fact, this process can take over a year. Please refer to Dr. Rahban’s timeline on wound healing for more information. [link]
After one year, Dr. Rahban schedules the final follow-up appointment. Dr. Rahban believes strongly in this appointment, because it allows him to do a final breast check and make sure that everything is how it ought to be. This also gives Dr. Rahban an opportunity to check on the scars, allowing him to know his final result. If a physician is not seeing you once you are completely healed, he can’t see his final results and therefore refine his technique. It takes a year for the wounds to heal, and your surgeon should be seeing you at that time.
At this point, Dr. Rahban checks the integrity of your breast implants and makes sure there is no scar formation such as capsular contracture or any other complication such as rupture.
On average, it’s recommend that implants be replaced every 10 or 15 years. While there is no exact time, it’s good to remove them before they break. If they do break, it is not dangerous, but replacing them becomes a bit more complicated.
For his out of town patients, Dr Rahban is flexible and will schedule follow ups around their ability to visit him. He knows that travel and time off of work requires coordinating, so his staff will make sure to assist with follow ups. If need be he can even utilize telemedicine technology such as Skype or Facetime.
Your relationship with Dr. Rahban continues long after your breast augmentation with lift is over. At any point after your surgery, he and his office are available to help with any questions or concerns that arise. Even several years later, his door is open to patients who have concerns about their implants.
Risks of breast augmentation with lift
Breast augmentation with lift risks include but are not limited to:
This means the right and left breasts will not be identical in size or shape. No two breasts are ever identical before surgery, nor will they be after surgery. The goal, however, is for the breasts to be very close in size and shape. Hence, if there is any asymmetry to begin with, Dr. Rahban will attempt to correct it. This may include using different sized implants, and/or the removal of more tissue from one breast.
Nipple-areolar complex necrosis, also known as gangrene
While this is the most dreaded complication, it is extremely rare. In order to lift the nipple areola complex during a breast augmentation with lift, the nipple-areolar complex must be released from some of its surrounding tissue to allow it to be lifted. Therefore, great care must be taken in order not to be overly aggressive. Other factors which may increase the risk of this complication include:
Rippling comes in two forms: palpable and visible. Most women have some degree of palpable rippling. That means when you feel your breasts, you can feel the implant to some degree. This is more common with saline implants than silicone implants. This usually occurs along the bottom of the breast near the inframammary fold as well as in the axilla or side of the breast, where there is no muscle present. Visible rippling occurs much more seldom and usually occurs in very thin patients who have very little breast tissue covering their implants. Visual rippling usually occurs more on the outer part of the breasts near the axilla, or armpit.
Over time, breast implants can rupture. However, the rupture rate with the new generation of implants is quite infrequent and rare. Despite this, it is recommend that patients replace their implants every 10 to 15 years.
While an inevitability of surgery, the issue is not whether you will have a scar, but rather the quality of your scar. The goal is for you to have a well-healed, faint or fair scar with time. In order to prevent the unsightly scar that so many people are worried about, Dr. Rahban takes steps to minimize it.
Dr. Rahban believes in a 50-50 rule. Fifty percent of scar healing has to do with the technique of your surgeon’s closure, or how well the incised tissues are brought back together. The other fifty percent is the patient’s biology. Because a patient has little control over her biology, there is a lot of emphasis placed on your surgeon and his closure technique. While many surgeons place their emphasis on post-operative scar management, there is very little science that any of these modalities actually work. Therefore, Dr. Rahban focuses on an unusually fastidious closure technique to ensure that all tissues heal with minimal scarring.
Please refer to his timeline on wound management for more information.
This is a very rare complication. Despite this, we take action to minimize the risk as much as possible. This primarily includes having the patient stop all medications that promote bleeding at least two weeks in advance, such as anti-inflammatories, aspirin and supplements.
Also quite rare, infection is thoroughly combatted before, during and after surgery. The night before surgery, we have patients wash themselves with an antiseptic soap. We give patients antibiotics directly prior to surgery, as well as after surgery. Additionally, Dr. Rahban has very strict post-operative instructions regarding wound management that he believes reduce the risk of infection.
Loss of sensation to the nipple
Loss of sensation to the nipple has nothing to do with the incision used in a breast lift. The majority of the sensation to the nipple comes from the fourth intercostal nerve located near the armpit within the breast pocket. Most loss of sensation is due to picking too large an implant and therefore damaging the nerve when the pocket for the implant is created, hence why Dr Rahban puts so much emphasis on sizing before surgery.
Decreased breast milk
With all three types of breast lift incisions, some degree of breast tissue is incised, thereby cutting breast milk ducts. Therefore, some degree of breast milk reduction can be anticipated. Unfortunately the degree of reduction is difficult to predict prior to surgery. Many patients are still able to breastfeed after a breast augmentation with lift.
- General poor health such as diabetes and heart conditions
- Adding an implant. This can increase the risk of this complication because it creates tension under the NAC, thereby reducing some of its blood
flow. This is why Dr Rahban is opposed to overly large implants with lifts. He spends a lot of time with patients going over sizing for this
When an implant is placed within the body, the body recognizes it as a foreign object. Therefore, it tries to protect you from the foreign material. It does this by creating a capsule or scar tissue around the implant. Any medical device that goes into your body, such as a pacemaker, a prosthetic knee, or a heart valve, causes the body to create a capsule or scar tissue around it. Therefore, all women with breast implants have this capsule which is normal.
For reasons that aren’t clear, some women create a thicker capsule than others. This is not a rejection, but rather the body making a more aggressive scar tissue envelope. This can become of concern to the patient when the capsule causes the implant to feel firm and sometimes displace or move the implant upwards, creating an unsightly breast. The degree of capsular contracture can vary from mild to severe. When it is severe, the only solution is to remove the scar tissue and replace the implant. While this phenomenon can recur, it usually does not.
Massaging the breasts has never been proven to reduce the rate of capsular contracture. While many patients think that massaging the breast will reduce the risk of capsular contracture formation, unfortunately there is no science that shows is the case.
The rate of capsular contracture when the implant is placed below the muscle is approximately 5% to 15% and approximately 40% when placed above the muscle.
Dr. Rahban’s philosophy
“I’m very particular about the way I close your breasts. Most patients are primarily frightened about the scars, and that has everything to do with the way you close. Some doctors blame their patients as being bad healers when in reality the surgeon is a bad closer. Since I don’t allow my tech to close, which is common with other doctors, I maximize the chances for an optimal outcome. No one can guarantee a good scar but a fastidious closure will certainly help, and that’s really one of the biggest elements.
“Also, I’m very specific about making sure you get the breast lift that you need and not the one you want. As many patients understandably want to avoid scarring, surgeons may agree to a lesser lift that won’t get the correct result. They do this in order to book the procedure, leaving the patient dissatisfied and ultimately needing a revision to correct what should have been performed from the beginning.
“A poorly created nipple areola complex is a telltale sign of a poor breast lift. Often this is due to inaccuracy at the time of inset. I spend an unusual amount of time on this step, as I believe it to be a critical element of a beautiful outcome.”
I won’t allow you to make a bad choice. Sometimes patients want something that isn’t right for them. If your size selection is too big, I will
tell you. Most complications occur based on having an implant that is too big. Loss of sensation to your nipple, bottoming out, etc. It’s all
about bad choices.
“I use implant sizers during your surgery to help select the appropriate size. While this is a time-consuming step, it minimizes the chances of
“I often use the dual plane technique when performing a submuscular augmentation, which I believe allows the breasts to settle into a much more
natural teardrop shape rather the half melon look many patients dread.”
Cost of breast augmentation with lift
There is no standard cost for a breast augmentation with lift as there are many unique variables. Below is a list of the elements that will determine the cost of your procedure so you understand what exactly you are paying for.
The skillset of your surgeon. Is he or she a plastic surgeon or a cosmetic surgeon? Is he or she board certified? A board certified plastic surgeon will often be more expensive.
How long it takes to perform the procedure. Generally the faster your surgeon, the less facility and anesthesia fees and the greater the surgeon’s profit. Therefore, surgeons have an incentive to work more quickly. When it comes to surgery, faster is not better. Be sure to ask your surgeon how long the procedure will take and be wary if it seems too quick.
The average times for breast lift with implants are:
- Donut lift with implant - 2.5-3Hrs,
- Lollipop lift with implant - 3.5-4.5Hrs,
- Anchor lift with implant - 4-5.5Hrs.
The anesthesia provider. There are many types of anesthesia providers. An anesthesiologist who is a medical doctor will be more expensive than a nurse anesthetist. Do your research and find out who provides anesthesia for your plastic surgeon. Dr Rahban is partial to using an anesthesiologist as opposed to a nurse anesthetist.
The facility in which your operation is performed. Unfortunately, surgery centers and hospitals are not all created equal. The more sophisticated the facility, the more expensive its hourly fee. Facilities that are Medicare-certified tend to be more costly as well.
Questions to ask your surgeon
Below are specific questions to ask your surgeon during your consultation. Each of these will allow you to understand his or her approach and thus make an informed decision. To print these questions so you can ask your surgeon, see link below to download a copy take with you to your consultation.
Do you mark my breasts prior to surgery or do you wait until I am lying down?
The most crucial step in a breast lift is marking the breasts prior to surgery. The markings will determine how well the surgery is performed in terms of symmetry and overall shape. Some physicians do the markings during the surgery. However, Dr. Rahban finds this to be incredibly inaccurate, as patients are lying down and their breasts are not sitting naturally.
Am I a candidate for a dual-plane breast augmentation?
With the dual-plane approach, the implant is under the muscle, yet the muscle is released or moved out of the way so the implant can settle into the bottom half of the breast, filling it in a more natural way. This technique tends to be Dr. Rahban’s preferred approach.
How do you help me determine which size is right for me, both cosmetically and physically?
During surgery, he has a full array of sterile “sizer” implants. He inserts a sizer and sits the patients up, continuously comparing them to the photos they selected. He will exchange sizers until he is confident that the size is consistent with the desired look--not cup size--the patient desired. As such, he is not bound by a limited number of implants he pre-selected or worse, what the patient thought was the appropriate size during the consultation. With this time consuming but thorough method, Dr. Rahban has virtually eliminated sizing issues in his practice.
Do you sit me up during surgery so you can see how the implants naturally sit?
At this point, he will refer to the photos you have given him, and will insert the size of implant he believes will accomplish the goal. He will then sit you up while you are asleep and look at the photos and compare to determine if the size is correct. If need be, he will repeat this procedure with various sizers until he feels confident that your size is consistent with what you selected, and that both breasts are symmetrical in size.
Do you use a Keller Funnel?
When inserting the implant, especially silicone implants, the implant is large and the opening is small, requiring force to insert the implant into the pocket. This jeopardizes the integrity of the implant, and often causes damage to the skin of the incision. Dr. Rahban uses a product called the Keller Funnel™ which is a device that facilitates the insertion of the silicone implant into the pocket with great ease.
Do you close my incision or does someone else?
In closing the incision, Dr. Rahban carefully sutures each underlying layer from the inside out, maximizing support. It is crucial that your surgeon personally closes both breasts, as there are some plastic surgeons who allow a surgical tech or surgical assistant to close.
Do you use layered closure?
Closure of incisions can be as simple as staples and/or glue, and as complex as a multiple-layered technique. Dr. Rahban feels strongly that closing the skin with multiple layers in a fastidious fashion is the single most important step in having scars that will be minimal and that will ultimately fade over time.
Do you offer a second consultation prior to my procedure?
Every patient goes through a thorough pre-operative process. This begins with a pre-op visit two weeks prior to surgery. This is similar to a second consult. During this time, you will go over the details of your surgery with Dr. Rahban, and you will get a second opportunity to ask questions and go over your procedure, thus ensuring a complete understanding.
How many follow-up appointments do we have?
After a breast augmentation with lift, Dr. Rahban schedules a total of five follow-up appointments. Most plastic surgeons schedule two follow-ups, during which time you may not even see the doctor. During every follow-up appointment, Dr. Rabhan sees his patients personally.