Breast Lift - with implants or not? (Ep. 47)

A breast lift is one of the most common plastic surgery procedure year after year, regardless of whether or not an implant is used.  Using an implant can change the operation (and results) significantly.
In this show, I discuss the how's, why's - and the why not's - of breast lift surgery.
If you or someone you care about is interested in breast lift surgery, this episode is a "don't miss"!

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Hello and welcome to The Trillium Show with Dr. Jason Hall!

This podcast is all about navigating the changes in our lives, whether they be through plastic surgery, adopting new habits, or making positive life improvements. Dr. Jason Hall, a renowned plastic surgeon and lifestyle expert, is here to guide us through the ups and downs of transformation.

Throughout this series, we'll explore topics such as body positivity, self-confidence, healthy living, and much more. Dr. Hall will share his expertise, as well as invite special guests to join us in the discussion.

So, whether you're considering plastic surgery or simply looking to make positive changes in your life, this podcast is for you. Get ready to be inspired, informed, and empowered on The Trillium Show with Dr. Jason Hall.

Jason: One of the most popular
procedures year over year in my

office is a breast lift with implants.

Most of my patients are
kind of in my demographic.

They're women that are done having kids.

Kind of want to improve and
get back the shapes that they

had before kids stole that.

That typically means lifting the
breast back up on the chest, reshaping

it, and adding a little bit more
volume in the shape of an implant.

I want to talk a little bit about that
procedure, what it is, what it isn't.

recovery time off of work and
all of that to give you a good

understanding of what that is.

So breast lift with
implants, what are the goals?

Well, the goals of a breast lift are to
improve the nipple position on your chest.

We want to get that nipple back up above
the breast crease to a more youthful spot.

We want to reshape the breast around
that nipple that's now in a new spot.

We want to reduce areola that
get large with pregnancy.

That's one of the things when we're
talking about lifts and implants,

that's typically one of the first
questions like are you going to

make my nipples a little smaller?

And the answer to that is yes,
is that is a part of a lift

with or without an implant.

And then lastly is to remove excess
breast skin that kind of sits between

the nipple and the breast crease.

That skin and breast tissue
that can get stretched out

over time and drop and descend.

So we want to remove that.

Just as important though to know what
a breast lift with an implant does do,

Let's talk about what a breast lift
doesn't do because it's important to

understand that and we spend a lot
of time in our consultations talking

about what doesn't happen so that we
can make plans if that's something

that you're interested in to improve.

So that we can make plans if one
of the things that it doesn't do.

is one of the things that you're after,
that we can make plans to accomplish

those goals because you don't want
to go through all of this surgery and

then look and say, well, I thought
that it did this and it doesn't.

So what does a breast lift not do?

Big thing is a breast lift
doesn't improve hollowness in

the upper pole of the breast.

Most women Will require some sort of
volume augmentation, either in the

form of an implant or in the form
of fat grafting to be able to fill

out that upper pole of the breast.

Upper pole hollowness isn't corrected
with a breast lift by itself.

You have to have an implant for that.

The second thing that it doesn't do is a
breast lift won't improve stretch marks.

If you've got stretch marks in
your breast, that is the result

of damage to the dermis or the
underlying part of the skin.

That will not get better
with a breast lift.

And if we add an implant, it may
actually make that a little bit worse.

So that's something that
you have to be ready for.

The other thing that it
won't fix is side boob.

If you've got breast tissue or fat
that's accumulated under your arms.

Typically, a lift will help improve that.

Oftentimes, we have to add liposuction
or some other treatment to your

chest to help improve that side boob
and get rid of that when we do our

breast lift or lifting implants.

Likewise, poor skin quality
, kind of loose, saggy skin.

Is actually something that we talk a
lot about because that is largely what

causes you to need a breast implant.

We don't change that skin
or tissue quality over time.

And so that's something we have
to talk about how we're going to

handle that both in our initial
surgery and planning for later.

And then lastly, if you're someone who
has a long torso and your breasts sit

down at the bottom part of your torso,
your breast crease is fairly low.

That will not change.

Your breasts will still
sit low on your chest.

You'll still have a long distance
between your collarbone and

the top part of your breast.

Even if we add an implant.

Your breast kind of has a footprint
like your foot does, and we

can't change that footprint.

So if you're a woman who has breasts that
sit low on our chest, they're still going

to sit low on your chest when we're done.

So now that we know what a breast
lift accomplishes, what a breast lift

doesn't accomplish, let's talk about
how the procedure is actually done.

With breast lifts, there are three
incision types that you'll see if

you're digging around on the internet.

You can call them the
small, medium, and large.

There is the donut or
just around the areola.

incision, which really is a
bad incision for a breast lift.

It doesn't accomplish much
in the way of lifting.

It's more used when we're using an
implant to just tighten up a little bit

of skin around that area, maybe move it
a centimeter or two, but not getting a

whole lot of lift out of that incision.

Then you move up to
the medium or lollipop.

style incision where we
add a vertical incision.

So around the areola and then down from
the areola to the breast crease, that is

the second type of incision that is for
women who need a little bit more lift

to recenter that nipple on your chest.

And then the third incision and probably
the one that people are the most familiar

with is the teddy bear or ship's anchor
incision where we take that lollipop

incision and then add an incision in
the breast crease of variable lengths

depending on how much extra tissue there
is in that lower part of the breast

between the nipple and the breast crease.

Those incisions typically heal well.

The incision that everybody seems to be
worried about is that vertical incision.

And those heal fairly well, provided
there's not a lot of tension on them.

Tension is really the enemy
of good wound healing.

And that's why during our consultation
and When we're talking about adding

a lift and implants, that procedure
can be done in a single stage, but

we're kind of walking a tightrope.

You're walking a tightrope between
too little tension and breasts

being sag, still being a little bit
saggy, too much tension and scars

getting wide or worse coming apart.

And so we want to navigate
that balance beam just right.

And plan for later, if things are
a little bit loose, to revise that

scar, do a little bit of tightening
later once everything is healed.

Because falling off the other side
of that balance beam where things

are too tight, you can get into
some really long term problems.

The other option there is doing
it in two stages, which a lot of

women don't want to do, but we talk
about that during consultations

because that is another option.

Surgery for breast lift with an
implant or breast lift alone takes

between three and four hours.

In my practice, I'm operating by myself.

I don't have somebody cutting and
sewing and, you know, I'm doing one

side and they're doing the other.

It's all me.

So it takes between three or four hours.

You're at home the same day.

We typically don't use
drains for these anymore.

nObody wants them.

And drain tubes are typically
not something that we

use for these procedures.

I operate here in our
private surgery center.

Once surgery is over we, you
spend about 30 minutes in the

recovery room, go home the same day.

I tell patients, you're
going to lose the morning.

You're You get a little bit of medication
before surgery, you, last thing you really

remember is talking to me and having
me mark things right before surgery.

Next thing you know, you
wake up on your couch.

For women that have had other procedures,
hospitals and other surgery centers

the surgery day is fairly pleasant.

You don't really remember a whole lot.

Recovery in plastic surgery
is very surgeon dependent.

There's a lot of, what works for
me that surgeons get into during

their post op recovery time.

For my patients with a breast lift,
breast lift with implants, there's

Surgical tape that covers your incisions.

There's no stitches that have to come out.

You can shower the next morning.

Actually, I encourage you to shower
the next morning because you want to

be clean, but you feel more human once
you've kind of been able to take a

shower, wash some of the funk off and
freshen up a little bit that next day.

There are no restrictions in terms
of what you can and can't do from

a range of motion standpoint.

A lot of women ask me if
they can wash their hair the

next day, the answer is yes.

What I don't want you doing is
lifting anything, is doing any

movement where your chest muscles or
arm muscles are loaded, and you're

trying to reach up, you're lifting
something heavy up above your head.

or trying to pick things up off
the floor, that includes kids.

So for moms who are having this, who
have young kids, you either want help, or

you want to let your children climb into
your lap, stand up with them, instead

of trying to pick them up off the floor.

Things are going to look weird
that first week after surgery.

There's no two ways around it.

Things swell.

Things swell.

You may have a teeny bit of
bruising if we're doing some

liposuction but you, they look weird.

If we're using implants, the top
part of your breast can swell.

It can make your nipples look like
they're pointed down a little bit.

All of that is normal.

Obviously if it's something
you're concerned about, I want my

patients to let me know about it.

If you're somebody else's
patient, let them know about it.

that is relatively normal right after
surgery in terms of working and return

to work kind of depends on what you do.

If you have a desk job, you work at
a computer, you can work remotely.

Typically after a week, , you're
not taking narcotic medication.

You're able to kind of go
back to your normal routine.

If you've got a very physical
job, I recommend people

taking about two weeks off.

You can always go back early if you feel
great and you want to but depending on the

nature of your work, one to two weeks off.

Now, I don't want anybody
doing any exercise.

So lifting more than about 10 pounds or
bouncing, those are the two restrictions,

lifting and bouncing for six weeks.

Really want those implants to heal before
we start stressing those implants at all.

There's a I did a podcast back in a couple
of months ago about sex after surgery.

You can listen to that one.

That's always a question.

The bouncing really comes in there.

In terms of new clothes, wait
three to four months until you

start going swimsuit shopping.

You start going bra shopping,
things are going to be swollen.

You don't want to buy a bunch of
new stuff when you're still swollen.

Especially if it's expensive stuff.

And then the swelling goes down
and your new stuff doesn't fit.

So wait three to four months
before you start going shopping.

Scar treatments are variable.

Now that's kind of the next thing
is what do we do about scars?

We can start topical scar treatments
as early as a week after surgery.

aNd that's topical scar treatments.

We recommend a silicone tape or
silicone gel over your scars.

We can also start laser
treatments as early as a week.

So as soon as our surgical tape comes
off, we can start treating scars.

If you have had problems with scarring
in the past or just want to be super

aggressive we can start that pretty early.

So a common thing that comes up is,
why would I not want to do this?

And this is really where we get
into the reason that you shouldn't

have a lift and or implants.

We talk in terms of relative
and absolute contraindications.

So relative contraindications mean,
eh, probably not the greatest idea.

You run the risk of either some
medical problems or a cosmetic

outcome that's less than perfect.

And then you've got absolute
contraindications, which

means it's really not a good
idea to have surgery at all.

So, relative contraindications
to a lift, certainly a lift with

implants, is poor tissue quality.

And, thin, saggy, sad breast tissue.

Thin skin with lots of stretch marks.

The chances that you are going
to need a revision later, no

matter what we do, is pretty high.

Like I said at the very beginning,
we can't treat poor quality tissue.

If you've got, collagen that
has kind of melted away.

If your skin is thin, there's nothing
that we're going to do for that.

And so going into that, if that's,
if you're kind of in that camp, it

doesn't mean we can't do surgery.

It doesn't mean we can't
get you a good result.

It means that we have to be careful
and plan for the fact that your skin

is going to relax after surgery.

Once the swelling goes
away, it is going to relax.

And so that means being conservative
in implant choices, not putting a

huge implant in trying to stretch
things out because that's just

going to make the problem worse
means not pulling things too tight.

It means accepting that there's a
possibility that Six months a year down

the road, we're gonna want to come back.

That tissue will have sagged a little
bit and we're gonna want to come

back and tighten that up a little bit
more to get the result that we want.

So does it mean no surgery?

No.

It just means we need to
understand that a second little

tuck up may be needed at a year.

If you have medical problems.

that make anesthesia dangerous.

And this is a relative
contraindication to everything.

If you've got medical problems
that make anesthesia dangerous,

we need to think about that.

This is surgery that you want,
not surgery that you need.

And so we don't want to take medical
risks with your health just to

give you better looking breasts

smoking.

And this is one that comes up a lot is it
causes problems with microcirculation and

when we're doing a breast lift, certainly
when we're doing a breast lift with

implants, nicotine impairs the ability
for your body to heal those incisions that

we need to heal to get you a nice result.

A lift with implants is typically
in my book, a no no for having

cosmetic breast surgery like this.

You have to be nicotine free.

We want to optimize your results.

So six weeks before, six weeks
after surgery, no nicotine at all.

That includes nicotine gum,
nicotine pouches, things like

that., Cigarette smoking, nicotine
is a no for this kind of surgery.

So we'll wait until you're T we
can get you off before we proceed.

In a new relative country.

And it's certainly something we have to
talk about is Ozempic and these Monjaro

and Tizipatide and all these other things.

And the reason that those are
problematic is not for healing

necessarily, but is for anesthesia.

They cause your gut to slow down.

When our anesthetist are putting you
to sleep, your stomach has to be empty.

Otherwise we run the risk of,
essentially vomiting with you asleep,

which can get in your lungs and cause
really nasty inflammatory problems.

It can land you in the
hospital and the ICU.

Ozympic, we really need to stop those
things about six weeks before surgery.

Let your gut kind of come back online,
start functioning properly so that we

don't run the risk of anesthesia problems.

Now that we've gotten through
the kind of contraindications for

surgery, talk about some of the risks.

Typically in cosmetic surgery,
the idea is that we want to get

our complications down to zero.

Now as surgeons, we understand
that can't happen as patients.

You need to understand that there
is a chance you will have a problem

after surgery, but we try and
minimize those as much as possible.

So what are the bad ones?

What's the worst thing that can happen?

It's kind of how my parents brought me up
with think about what's the worst thing

that can happen before you do anything.

The worst thing that can happen is that
we do a breast lift with implants and

we either have dead tissue, things die.

We get too aggressive and stretch
things too far and they die.

oR we get an infection and end up losing
implants, get infected, exposed, and we

have to take them out and start over.

And so fortunately those
complications are really rare.

They do happen, but they're really rare.

And they're more common in
patients who have healing problems.

So things like diabetes, patients who
smoke, which is one of the reasons that.

Smoking is kind of a foreboding thing
around the time of surgery, or patients

who are on some immune modulators.

So taking medications for
rheumatoid arthritis or ulcerative

colitis or inflammatory bowel
disease or things like that.

Those are things that we have to
really be careful with because they

can cause healing problems that can
result in some really disastrous

complications from a cosmetic standpoint.

Blood clots around the
implants, a hematoma.

Those are really also very rare.

Fortunately, those require a trip
to the operating room to drain.

The more kind of annoying problems.

that can happen after
surgery is sensory loss.

Around the nipple sensory loss can happen.

Typically, the likelihood of that
happening goes up the further

we have to move the nipple.

So the more we have to do to kind
of move the nipple around and get

it re centered back on your chest.

the more likelihood you are
to have some sensory changes.

Now we don't take the nipple off.

That's another common question.

People do you take the nipple
off and put it back on?

It stays attached.

And that's why what we really have
to be careful with is that kind of

keeping the nipple on that leash
to move it around on the inside.

That's where some of the
nerves and blood vessels live.

And the smaller we make that
leash, the more, chances of

problems we're going to have.

And some patients with, you know, we
have to make that leash really long.

It can be a real issue.

And we talk about that before surgery.

Scar healing is another one that
we kind of touched on earlier.

And scar healing is one of those things.

If we want to be aggressive,
we can start early.

Otherwise, we watch mother nature
take a course and can course correct

if we see things going the wrong way.

That is breast lift and
implant surgery in a nutshell.

I tried to be as thorough about this and
let you know what to expect as possible.

Obviously, with medicine.

surgery, cosmetic surgery,
everybody's different, everybody's

plans a little different.

And if this is something that you are
interested in, we will go through all of

this in detail at your consultation, but
wanted to give you an overview of things.

So you know what you're getting into
before you go in for your consultation.

If you have any questions, as always,
shoot me a DM, shoot me an email.

Thanks for listening.

And we'll talk to you soon.