The Truth About Breast Lifts
After decades of wanting bigger, rounder breasts, women are increasingly choosing altitude over amplitude. And modern science has a new array of breast-lift techniques to give them exactly that.
By Joan Kron
In the popular conception of breast surgery, women who seek out the operating room are generally there for the breasts they never had. Whether you always wanted the top half of your hourglass to be bigger or smaller, there was a surgical option for you. Now another group of women is growing rapidly. In the past 16 years, the number of patients opting for breast lifts has risen almost 600 percent, according to the American Society for Aesthetic Plastic Surgery. This suggests that the newest trend in breast surgery isn’t the quest for what you never had, but instead for what you’ve lost. “Patients say, ‘I want my own breasts back,’” says Christina Y. Ahn, an associate professor of plastic surgery at NYU Langone Medical Center in New York City.
This desire to undo the work of gravity usually begins with noticeable sagging. “Essentially, the envelope of skin encasing the breast and the ligaments beneath have stretched; the filling has shrunk, giving a pancake shape; and the nipple is facing down rather than straight ahead,” says Roger K. Khouri, a former professor of plastic surgery at Washington University in St. Louis, who now practices in Miami. Pregnancy and breast-feeding can speed up this migration southward, and so can weight loss, since fat is a major component of many women’s breasts.
Breast-lift surgery, or mastopexy, is an attempt to reverse the process by cutting away excess skin, redistributing the filling, and restoring the original projection of the breast—and the methods of doing that successfully represent a new era of innovation. Doctors perform mastopexies either alone or combined with a breast reduction or augmentation. They may use synthetic mesh, barbed threads, or the patient’s own skin to support the breast on the bottom and fat suctioned from other parts of the body to add fullness on top. Patients often actually lose a cup size, according to a review of 20 mastopexy cases published in Plastic and Reconstructive Surgery last summer.
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In most cases, the surgeon raises the nipple by making a semicircular incision along the top of the areola and pulling it upward, while remodeling the tissue through another incision that runs downward to the base of the breast. In some cases, the procedure requires an additional small horizontal incision at the base. Many women don’t want scars on this part of the body, but they are unavoidable, says William P. Adams, Jr., an associate clinical professor of plastic surgery at the University of Texas Southwestern Medical Center in Dallas.
Just as a hidden steel wire can offer support in a bra, surgeons have experimented with everything from silk to synthetic skin to make sure these results last. One of the most promising materials is GalaFlex, an absorbable polymer that is spun into a strong filament and then woven into a mesh that is four to five times stronger than the natural breast. “We put a crescent-shaped piece of it in the lower pole of the breast, and the mesh goes away in one to two years, leaving behind the patient’s own tissue that has grown into it,” explains Adams, who is testing the material (which is FDA approved but still being studied). The mesh isn’t cheap, however—it can add $1,500 to a standard breast lift.
In 30 breast lifts that Adams has performed with GalaFlex, patients had stretching of just 10 percent after one year, versus twice that in the control group. As with all breast-lift procedures, there is the possibility of relapse, or “bottoming out,” which occurs because the skin and ligaments holding up the newly lifted breasts have already stretched once, before the operation, and may do so again. Approximately one in ten women requires a second operation, but individual surgeons with lots of experience report much lower rates of relapse.
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Amanda, a 34-year-old financial-services consultant, took part in a GalaFlex clinical study a year and a half ago. “I had misgivings about cosmetic surgery,” she says. “Before I had the operation, people said to me, ‘Why change your body?’ It’s so easy for others to say that. But we live in a world where appearance matters.” After her surgery, though, Amanda is thrilled. “I bought a red bikini—without an underwire. I’ve not been able to do that since high school. My breasts are back where they belong.”
Doctors are using another technique that shows promise in women who have limited sagging—meaning their nipples are no more than an inch or so below the base of the breast. Called Refine, it supports the breast from within. Two strong, partially barbed sutures are placed vertically in each breast so they form an upside-down hammock. They are anchored at the top with a small incision over each breast, below the clavicle. Once implanted, the barbs on the lower ends of the threads catch some tissue and can be raised until the nipple on each side is set at the desired height. Refine raises the sagging breast and provides more volume in the upper area, says Jack Fisher, an associate clinical professor of plastic surgery at Vanderbilt University Medical Center in Nashville, who was one of eight surgeons involved in the early studies. The threads can also be used for extra support after a surgical breast lift.
As in all surgical procedures, experience with the technique is important because, according to the manufacturer, while the threads can be easily adjusted or removed during the procedure, removing them later can be difficult. Though Refine is a virtually scarless procedure—something women want—barbed sutures used in recent years for face-lifts were problematic, causing pain and sometimes asymmetrical results, and were abandoned, so some surgeons are taking a wait-and-see approach.
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Also showing promise is an all-natural method for subtly reshaping the breasts for those with an aversion to silicone. The process of injecting a woman with her own fat was banned in 1987 because of unpredictable results and the formation of calcification cysts in the breasts that caused false positives in cancer screenings. But with advances in mammography technology, that ban was lifted in 2009, and the practice has resumed. Today, most doctors say that fat injections alone are not enough to lift the breast, but the results when fat is used in conjunction with a surgical lift are impressive. “It can fill out the upper portion of the breast and create better cleavage,” says Ahn.
Some surgeons start their patients out with an off-label use of Brava, a vacuum device that is approved by the FDA for breast enlargement, to increase blood supply and create a space for fat that has been suctioned from the patient’s back, hips, or thighs. This is painstaking work: Injecting the fat into precisely the right spots to create natural-looking contours takes up to one and a half hours (at a cost of around $900, in addition to the surgeon’s fees, with a national average of $4,200, plus operating-room and anesthesia charges). The risks, though small, include the calcification cysts (which doctors now consider harmless) and lumpiness. Another factor: The added volume in the breast can fluctuate with weight gain and loss.
There are, of course, many women who still undergo traditional breast lifts without mesh or injections. Missy, a 34-year-old full-time mother, is one. “I had nursed two kids. I felt deflated and matronly,” she says. “I hated bra shopping. I was always looking for the perfect push-up bra.” She was relieved when her doctor, Michael Law, a plastic surgeon in Raleigh, North Carolina, told her that she had enough tissue in her breasts for a surgical lift that would not require an implant or added fat.
Fifteen months after the surgery—a two-hour procedure under monitored sedation (though general anesthesia is often used)—Missy says she no longer needs an underwire bra. At size 34C, she is one cup smaller than before the surgery. Her scars are faint after six treatments with a pulsed-dye laser and six months of daily use of a silicone gel. And more than one year after the operation, she is also out of the risk zone for early relapse. The biggest reward of Missy’s breast lift, however, is the way she feels about herself. “I can wear sundresses without a bra again,” she says. “I feel more feminine, more comfortable in clothing, in a bathing suit—and in my naked body.”
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photo: Carter Smith
