Written by Fawnia Soo Hoo and published September 22, 2015 on Refinery29.com
When conversation turns to breast surgery, breast augmentation (or the “boob job”) is usually the main topic of discussion — whether it’s guiltily participating in tabloid-driven speculation (sorry!), discussing the pros and cons of it with our friends, or even talking about it more seriously with our doctors. Breast reductions are commonplace in conversation (and in life) as well. But lately, we’ve been hearing more and more about mastopexy or breast lifts. Rumors have spread that Gisele Bündchen recently underwent the surgery, a French woman in the beauty industry revealed to us that her friends in Paris are opting for this procedure over augmentation, and we’ve heard that women are getting breast lifts along with breast reduction surgery.
Though we don’t think anyone needs plastic surgery for non-medical reasons, we know it’s a personal choice and respect whatever anyone chooses to do with his or her own body. And, most importantly, we want everyone to have the tools to make an informed decision. (Or just have some basic understanding the next time the topic comes up over drinks.)
The breast lift sounds straightforward enough, but the details are quite different from those of a boob job, from what to think about beforehand, to the surgery itself, to the end results. Here, three experienced plastic surgeons — who specialize in breasts and work with them 24/7 — talk us through the breast lift.
The difference between a boob job, a breast lift, and a breast reduction.
A mastopexy or “breast lift” reshapes, tightens, and lifts breasts with ptosis — colloquially known as “sagging” or “drooping” — by removing excess skin and repositioning the nipple. In other words, a breast lift does not add volume, so it will not make your breasts bigger like implants will. “When you have a typical lift, it’s usually a woman who likes the volume of her breasts. We’re simply lifting the tissue,” says New York City-based Daniel Maman, MD. That said, a lift can give the impression of bigger boobs. “You’re taking a breast that was hanging or very loose and making the skin pocket much tighter, and it sits up much higher on the chest,” says Dr. Maman.
Breast lifts and breast reductions actually often go hand-in-hand. While a breast lift just, well, lifts, with a breast reduction the doctor will remove breast tissue, maybe remove skin as well, and then lift. “A breast lift is always performed with a breast reduction; when we do a reduction it’s also a lift procedure,” says Dr. Maman. “Same technique, same incisions, but at the same time we’re removing extra tissue to reduce the volume of the breast.”
Women in all life stages seek breast lifts.
Many women seeking lifts are unhappy with the state of their breasts after childbirth and breast-feeding, but Mia Talmor, MD — the first female surgeon appointed to the full-time faculty at New York-Presbyterian Hospital — emphasizes that it’s misleading to think that the only breast-lift seekers are moms. She points out that a woman’s breasts can change throughout life in general, due to weight gain or loss, certain types of skin conditions, or even sun damage. “A lot of women develop initially and their breasts sag a bit. [The breasts are] not perfectly pert,” she explains. “Those women very often say to me, ‘I’ve never liked my breasts. I’ve always felt like they were older than my body, and what can we do about that?’ So I think genetics plays a huge role in it, and maybe a bigger role than nursing.”
How to find the right surgeon for you.
As plastic surgeons have strongly suggested while telling us everything we need to know before getting a boob job or a nose job: Make sure that you find a surgeon who is board-certified by the American Board of Plastic Surgery (those exact words, cool?). You can easily check via American Society of Plastic Surgeons or Certification Matters.
Also, choose a plastic surgeon whose specialty is breast surgery. “There certainly are a lot of plastic surgeons that will, let’s say, only do facelifts or only do rhinoplasties,” cautions Dr. Maman. “That wouldn’t be smart for someone to go to them for breast surgery. Even though they may do it, that doesn’t mean they do it every day.” He even suggests that patients seek out doctors who excel in “revisional breast surgery,” meaning second or even third surgeries. “It’s always easier to do the first operation,” he says. “The question is whether you can fix other people’s work as well, because those operations are always more challenging.”
Have a thorough consultation with your doctor before surgery.
Meet your doctor for a pre-surgery consultation to gauge your comfort level with each other, and make sure that your doctor is really listening to and hearing your concerns and goals. Ask to see LOTS of before-and-after photos to make sure you’re on the same page aesthetically and, more importantly, to assess the surgeon’s skill and technique. “You have to really look at the breast from the side” when checking out photos, Ohio-based Lu-Jean Feng, MD, advises. “Is the side shape attractive? How is the scar? [Ask to see] what the scar is like immediately after the procedure, and what’s the scar like at six weeks, and what’s the scar like at one year.” (More details on scarring in a bit. That part deserves its own section.)Dr. Feng is a big proponent of logging onto Realself.com, basically a Yelp for patients and plastic surgeons where they can interact in a community forum. “They have chat groups, so that you can be in touch with patients who have had the procedure,” she says. Dr. Talmor goes the old-school way and sometimes suggests that a prospective patient meet with a current one for a referral.Manage your expectations.
Definitely bring in photos of breasts that you’d like yours to resemble after surgery, but also have realistic expectations. “Breasts are extremely different, and oftentimes women will bring in pictures of breasts that [belong to] women of totally different body shapes, sizes, or ages,” says Dr. Maman. “So I don’t discourage patients from bringing in photos because it helps me set realistic expectations for the patient. If, in their mind, they’re going to look like Angelina Jolie, but in reality if I can’t achieve that, it’s good to be able to tell them, ‘You’re never gonna look like this.’ Or, ‘You know what? Your breasts are actually pretty similar to the picture that you’re showing me, and I think that’s a realistic expectation.’”Ask what type of incision your surgeon will use.
Find out what type of incision your doctor will be using for your breast lift, and make sure that it’s what Dr. Talmor refers to as a more “modern operative approach” and not the outdated and very rare “free-nipple graft,” which essentially removes the nipple. “You want to make sure you’re comfortable with the technique that the surgeon is using,” says Dr. Talmor. “And most of my patients will ask, ‘Are you moving my nipple, or are you cutting it off and putting it back on?’ and that’s an important question to ask.The three main types of breast-lift incisions: The procedure for you depends on a multitude of reasons, such as how much skin needs to be removed, how elastic your skin is, and how much the nipple needs to be repositioned. Dr. Talmor explains that a surgeon will look at the nipple and grade its position on the breast in relationship to its bottom and center. “There certainly is an art to getting a nice shape and making sure that the shape is appropriate for that patient’s body,” Dr. Maman says. “So again, it’s not one-size-fits-all.” The American Society of Plastic Surgeons has a helpful visual on where the incisions go.
The vertical or “lollipop” lift involves a circular incision around the areola and one vertical line down the middle of the breast to the crease under the breast. This technique tends to be done if the nipple needs to be moved more than 2 cm (about .8 inches), says Dr. Talmor.
Dr. Maman describes the “anchor,” or inverted-T, lift as the “the old, classic incision that’s been done for 50-plus years.” This technique, like the lollipop, makes incisions around the areola and down the middle of the breast, but also makes a crescent-shaped incision along the crease under the breast, or the “inframammary fold.” This procedure is for women with more skin that needs to be removed, and who possibly need tissue reduction as well. It’s more intensive and creates more scarring than the lollipop, and might require more healing time.
For the most minimal amount of lifting, there are also the periareolar and the circumareolar incisions. The periareolar technique makes a small incision along the top of the areola, not all the way around. The circumareolar or “doughnut” makes two circular incisions around the areola.
Know that a breast lift will involve scarring.
Due to the incision(s) required, breast-lift surgery will involve scars and you have to mentally and emotionally come to terms with that fact. “You’re trying to get your breasts to look lifted, like you’re in a bra when you’re nude, and the trade-off for that is a scar, which is going to be visible when you’re nude,” Dr. Talmor says. One way she helps manage patients’ expectations and really drive the point home is by showing “after” photos of scars. (Although she does point out that most patients are pretty satisfied with the imperfect results.) “I think the question is: Will you be happy to have made the choice to have surgery, even if you [have a slight] scar?” she says.
Of course, it is possible for scars to fade and become barely noticeable over time. “The way that a scar heals is usually dependent on the patient’s genetics,” says Dr. Maman. A post-surgery topical scar-treatment regimen might also help minimize the look of the scar. Dr. Maman has his patients follow a special system that includes medical-grade silicone creams and tapes for three months after surgery. Dr. Feng suggests silicone-based scar treatments, including Obagi Dermatix, Scarguard MD, and Mederma, which you can pick up at your local drugstore. “Mederma works perfectly fine,” she says. “It softens the scar.”
You can go back to work in just a few days.
Depending on your surgeon, you might have small drains placed at the bottoms of your breasts to remove fluid. These will be taken out two to three days after surgery. You’ll also have to wear bandages to support the breasts as they heal. In general, “the breasts will take care of themselves,” says Dr. Feng. “It will heal in about two weeks.” She says you could even go back to work — if it’s a desk job — two to three days after surgery. And for you SoulCycle addicts? “We get them back to exercise within two weeks,” says Dr. Talmor.Know the risks involved with the surgery.
Make sure your doctor discusses all the riskswith you during your preoperative consultation. Dr. Talmor lists the ones to keep in mind: “Scarring. Asymmetry. Recurrence, which means that the breasts will sag again after they’re lifted, depending on the quality of the skin and on how elastic the skin is. Major complications are very, very, very rare, like bleeding, infection, or wound-healing problems, but those are the other things we think about.”
What to do and think about before surgery.
For patients in their 30s or above, Dr. Talmor suggests having a mammogram and sonogram beforehand. (Talk to your primary-care doctor, Ob/Gyn, or radiologist to get a personalized recommendation on this — depending on your risk factors, they may or may not think it’s necessary.) “The surgery does give you a little bit more scarring, so you want to get a baseline exam just to make sure there’s nothing abnormal,” she says. “Because if there were something abnormal on a mammogram or sonogram, it could be addressed at the time of the breast lift.”
Crucial: If you smoke, quit! As our friendly doctors have told us time and time again, smoking impairs circulation, thus possibly negatively affecting how your post-surgery wounds heal. Dr. Maman also points out that smoking could cause problems with nipple sensation after recovery. He tells his smoker patients to quit six weeks prior to surgery. “We’ll nicotine-test them on the morning of surgery, and cancel them if we catch them smoking,” he warns.
For women who have been breast-feeding, Dr. Maman suggests waiting a year before undergoing any type of breast surgery. Speaking of which…
A breast lift shouldn’t affect your ability to breast-feed later.
“If you’re doing a pure lift where you’re not removing any volume, your ability to breast-feed does not change at all,” Dr. Maman assures us. Dr. Talmor and Dr. Feng are on the same page. Again, knowing which incision technique your doctor will use before surgery is crucial. Moving and repositioning the nipple — and not cutting it off, or doing the free-nipple graft — will preserve the nerves that allow for nipple sensation and breast-feeding. “But you have to be pretty careful and cognizant of those issues,” Dr. Talmor says. “And they are questions to ask during the consult, for sure.”
The reason you might want to wait on a breast lift.
If you’re planning on having kids in the immediate future, it might be a good idea to wait on that breast lift. Your breasts are going to change once you have kids, says Dr. Talmor. “Your body goes through such an enormous change when you get pregnant, and when you get engorged if you are nursing. So your skin is going to go through that stretching process again, and almost always there’s going to be a change in the shape,” she explains. “You’re going to have some sagging after. We’ve done this significant cosmetic surgery, and then we have to redo it to preserve the result. So I think that’s a waste.”
This is not to say that Dr. Talmor completely discourages women who haven’t had kids and aren’t planning on it for a while to hold off. “If it’s going to be many years before their body will go through that change, then it’s a reasonable thing to consider,” she says.
What it’ll cost you.
Since a breast lift is considered cosmetic surgery, insurance will not cover it. In 2014, the American Society of Plastic Surgeons found that the average cost of a breast lift is $4,377, not including anesthesia, operating-room facilities, and various other related expenses. Also, the cost varies depending on your location, your specific surgical requirements, and your surgeon. Per Dr. Feng’s suggestion, Realself forums discuss costs of surgeries in your city.
Or consider implants.
Implants will also give your breasts a lifted look — but without the scarring — says Dr. Talmor. She adds that sometimes her patients come in specifically asking for lifts, because they don’t want a “foreign body” inside their own. Dr. Maman also does what’s referred to as an “augmentation-mastopexy,” or a lift and implant at the same time, which appeals to women who want to both fix sagging and add more volume. “We would do a lift and, at the same time, put an implant underneath the lift,” he says. If you’re considering implants, please visit Boob Jobs 101 for a primer.