The Question

Breast augmentation and its related procedures continue to be one of the most popular subcategories of cosmetic surgery, routinely ranking in the top five procedures for women and seldom out of the top three! Because of this popularity, we get a lot of questions about breast augmentation and what patients should expect from their procedures. One great example is the focus of this week’s Ask. Dr. Pane segment. The patient asks, “Is a breast lift needed if you downsize to smaller implants?”

The Case

This patient provided photographs of her current bustline for examination. Dr. Pane observed that the breasts and nipples are pointed slightly downward. The patient states she currently has approximately 400cc implants. It is not known whether the existing implants are over or under the pectoral muscles from the description the patient provided.

The Answer

This is a very common situation, according to Dr. Pane. Most patients electing to go downward in size with breast implants may require some form of a breast lift, because of how the mammary tissue is stretched with the implant in place. However, there are a number of factors which may reduce or eliminate the need for a breast lift, including:

• whether the implant is located above or beneath the pectoral muscle
• what type of tissue is affected
• what sort of scar capsule the patient has developed around the implant
• the overall condition of the skin and underlying tissues
• the patient’s healing capability
• overall medical history
• weight gain or loss

and other possible areas of concern. These cannot be properly evaluated from photographs and require an in-person clinical consultation to assure optimal results.

In some cases, the patient will not need a breast lift, although this is far less common. The patient’s overall build, affected tissues in the area of the implants and the natural attitude of the breasts are primary determining factors which, again, cannot be properly assessed outside of a clinical evaluation. For this reason, Dr. Pane prefers to proceed from the assumption that the patient will need a breast lift, so as not to set improper expectations. It is always easier to go downward what determining what is required than to have to revise the assessment upward. Anyone who has gone to a mechanic for an estimate and ended up with a bill two or three times the initial quote can see why Dr. Pane prefers the opposite method!

In this patient’s case, Dr. Pane says in all likelihood, she will need a breast lift once the existing implant is removed. In addition, she will probably want to go down significantly in size, as a “jump” of 25-50cc’s usually doesn’t give an immediate, visible result and after a secondary procedure, it is natural to want to see a result as soon as possible. Dr. Pane said in this case, he would recommend at least a 100cc reduction in implant volume. Once the new implant is placed, then he can properly evaluate whether a lift will be necessary.

Based on his initial impressions of the photos she sent, she would be wise to anticipate the breast lift will be a part of the procedure because of the downward angle of the breasts and the inevitable excess tissue which will be present after the implant is changed out. However, the size of the implant she chooses, her tolerance for scarring and how visible the scars will be both in and out of clothing will also impact how this procedure is done.

After a secondary procedure for corrective or modification purposes, patients are at an increased risk of postoperative complications. For this reason, it is even more important that patients comply rigorously with all pre- and postoperative directions, including proper use of antibiotics, painkillers and avoiding sunlight, pollutants, drinking alcohol and smoking. This helps prevent infection and irritation of the surgical site and helps facilitate healing, to ensure the best possible outcome and the most aesthetically pleasing results.

RealSelf Patient Reviews of Thomas A. Pane, MD

If you’ve had questions about cosmetic surgery, but were unsure who to ask, the staff of Atlantic Coast Aesthetics is pleased to speak with you about your interests, concerns and questions. Simply follow us on our social media accounts at Facebook, LinkedIn, Twitter and Instagram; call us at (561) 422-4116; or email us through our website’s contact page. Your question may even be selected as the focus of an upcoming Ask Dr. Pane segment, allowing us the chance to inform and educate other patients who share your same curiosity. Remember, at ACA, we believe the only bad question is the one you don’t ask!