What is a Mommy Makeover breast lift?
A Beverly Hills Mommy Makeover breast lift, otherwise known as a mastopexy, is a cosmetic procedure designed to lift and reshape the breasts while placing the nipple in a more desirable location. In the world of Los Angeles Mommy Makeovers, the breast lift is a crucial procedure. After pregnancy, the breasts become engorged to accommodate breastfeeding. Then, whether you breastfeed your baby or not, the overall breast volume eventually reduces, often leaving saggy, stretched skin with no support. Breast feeding, especially for long periods of time, can result in greater change and more sagging.
A Los Angeles Mommy Makeover breast lift, as opposed to a Mommy Makeover breast reduction, removes excess skin only while not touching underlying breast tissue. Depending on the amount of breast volume you have, a breast augmentation may or may not be necessary to fill out the new shape. In other words, the breast lift gives the new shape, while the implant gives it its volume or fullness. Additionally, the areola size may be reduced, as it has often become enlarged or stretched out. The result is youthful, perky and beautiful breasts that no longer succumb to the effects of pregnancy.
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 Mommy Makever 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.
Am I a candidate?
If you’ve become unhappy with the shape or sagginess of your breasts, a breast lift after pregnancy may be the perfect procedure. It is important that patients understand exactly what a breast lift addresses. While a consultation with a plastic surgeon will ultimately determine if a breast lift is right for you, if you experience one or more of the following issues, you are likely a candidate for a breast lift:
- Your breasts have lost their shape and volume, resulting in breasts that are flat and long, rather than projecting and round
- Your nipples fall below your breast crease (imframammary fold)
- Your nipples point downward rather than straight forward or horizontal
- Your breasts sit on your 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.
- Your upper pole or top of your breast is concave or hollow
- Your areolas have become stretched or enlarged in conjunction with floppy breasts
- Breast asymmetry, in which one breast appears lower than the other
For your consideration, there are further factors that must be in place to undergo a breast lift:
- Women who may have children in the future should delay getting a breast lift, as the pregnancy will to some degree ruin the effects of the lift. Additionally, patients should know that lactation may be more difficult after a breast lift, adding another reason to wait until all childbirth is completed.
- If you still express milk, you should wait at least 3 months after the last time you see milk express 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
Breast lift consultation
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 breast lift consultation, Dr. Rahban covers several crucial points. Firstly, he gathers data regarding your personal cosmetic objectives. Second, after an examination, Dr. Rahban defines the exact problem, allowing you to better understand what has caused the current appearance of your breasts. Next, he lays out your options, including which type of lift you need, and whether or not you need an implant in order to get your desired results. If an implant is selected, Dr. Rahban will additionally discuss what type of implant to use, where to place it and what size is most ideal. Finally, he will discuss what you can expect from your breast 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.
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 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 the nuances of breast lift surgery, 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 lift works.
Breast 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. 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 strongly that they will 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.
Next, the incisions are made and all excess skin is removed.
Once the skin has been removed, exposing the underlying breast tissue, the nipple-areolar complex (NAC) must be carefully and incrementally released on its blood supply in order to elevate it into a more desirable position. As the nipple is beginning in an undesirable position, the only way to raise it is to release it from its surrounding tissues. However, if this is done incorrectly or too aggressively, the blood supply to the NAC will be insufficient, leading to one of the most feared complications: NAC death or necrosis.
Now that the NAC is released, the next step is to bring the surrounding tissue together in a desirable shape and suture the breast tissue in a more projecting or cone-like shape.
The next step is to bring the outer skin together and close all the incisions. 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 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.
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.
Depending on the type of breast lift, the time in the OR will vary. A donut lift should take between 2 to 2.5 hours. A lollipop lift should take 3 to 3.5 hours. An anchor lift should take 4 to 5 hours.
Preparing for a breast lift
For patients receiving a breast lift, 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
- 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. These are all components that Dr. Rahban will go over with you during your consultation to ensure that you obtain the outcomes you want from a Mommy Makeover Los Angeles mothers can rely on.
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 tissues healing higher than one would like. Therefore, this surgical bra ensures the breasts heal properly and that you get the best Mommy Makeover Los Angeles can lay claim to.
Healing & Recovery Week 1
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.
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.
At three months, the final shape of your breasts will be obtained. That being said, your scars will most likely be slightly redder or more colored or more inflamed. This is because your body is now at its peak of healing. Therefore, it is important for patients to know that their breasts look their best after one year, at which point the scars will have fully healed.
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. Most doctors should be able to see their patients at the end of a year so they can assess their work. 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.
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 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 breasts.
Breast lift risks
Breast 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 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 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:
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
As mentioned previously, the loss of sensation to the nipple has nothing to do with the incision used in the breast augmentation. 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. Of course this is primarily applicable when one gets a breast implant with her breast lift.
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 reason.
Dr. Rahban’s approach
"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."
Cost of a breast lift
There is no standard cost for a breast 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 time for breast lift is: 3-4hrs.
- 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.
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 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.