When getting a mommy makeover, how do I know if I need a breast lift or implants and if I do the breast lift how many cup sizes will I lose?

When contemplating cosmetic surgery of any kind, it’s natural to feel a little nervous about what you can expect through the recovery process and onward to the final result. Patients who are anticipating a more ambitious, complicated, or combination procedure are more likely to be worried about the expense, recovery, outcome, and possible complications. During a recent Instagram Live session with the founder and Chief Medical Officer of Atlantic Coast Aesthetics, Dr. Thomas Pane, a viewer asked: “When getting a mommy makeover, how do I know if I need a breast lift or implants, and if I have a breast lift, how many cup sizes will I lose?” This is a great question because it allows Dr. Pane to cover a lot of ground and a lot of facets of cosmetic surgery at once, to give a more comprehensive answer.

With regard to implants, specifically, the need or lack thereof for them will depend on a couple of factors. When you combine a breast lift with implants, this is one of the higher complication rate procedures ACA does. With that said, our rate is pretty low.

If you have what is known as grade 3 ptosis of the nipple, where the nipple is pointing at the floor, that’s too much drooping to do an implant at the same time as a lift. The key determining factor is in how high you’re raising the nipple area. If it needs to be raised more than about 6-7cm, especially when implants are done at the same time, there can be problems such as sagging of the breast over the implant, and then the implant has to be redone.

Another, more serious problem is that things can break down and lead to a healing problem. In many cases, this is relatively minor. The tissue breaks down and then reheals, but not quite as intended. One of the more serious versions of this is the exposure of the implant. That doesn’t usually happen in cases where patients avoid cigarettes after surgery or the surgeon doesn’t try to push too hard to make the implant/lift combination work.

Dr. Pane stresses that he’ll be able to tell at the in-person consultation whether a breast lift with implants, a lift alone or another solution will be best for a given patient. Especially for patients coming in from out of town, he says, “Go ahead and set it up with the implant if the coordinator thinks you might need it, but it’s easier to downshift than to add on. If there’s too much drooping, we might do the lift by itself and do the implants later. You may even get some money back for that! For lift by itself, sometimes I don’t take out any breast tissue at all, just the skin. It depends on how tight it’s going to be when it’s closed. I’ll leave you as big as I can for the patients who want to be lifted but tell me they don’t want to be smaller. You might still go down a cup size because all that loose skin might fill up a D cup but when it’s removed you go down to a C. Bear in mind cup sizes are not precise. If you’re too droopy to put in an implant at the same time, I’ll leave you as big as I can. I only take tissue out if I need to, to get it to close without tightening. You shouldn’t go down much, because we’re preserving the actual breast tissue, we’re just moving it up.”

Concerning what patients should expect from the outcomes after surgery, Dr. Pane says, “There are a couple of maneuvers I do, I don’t want to say they’re proprietary but there are a couple of things I can do, to make it look good. We’ve often had patients report people around them thought the patient had had implants when I didn’t place implants at all!… People need to remember that when you’re doing a lift and implants at the same time, it’s hard to go to a big implant in one stage too, so often I’ll do the lift with a smaller implant and then move to a larger size later. Usually, I’d start with a 200-300cc implant, but can occasionally make 500-600cc or larger work if the dimensions of the breast allow for it. The trick here is not to push it and try to fit in a larger implant than the breast dimensions permit.”

Regarding aftercare, Dr. Pane says he’s very particular about the sort of postoperative behaviors patients may engage in—especially smoking cigarettes. “If you smoke, especially with a full lift with implant, DON’T smoke at all for at least for six weeks postop plus a couple of weeks before. I don’t want you to get the surgery if you can’t do that. Even 1-2 cigarettes can interfere with healing, because it decreases blood flow to those two flaps. This can result in an open wound, and it’s really not good if we have an implant in there and that should get exposed. We haven’t had one of these happen in several years, and when you consider the number of breast surgeries we do, that’s pretty significant. There can be small breakdowns where the two flaps come together, maybe you get some unusual scarring either at the bottom of the T or around the areola, but it’s usually small, barely noticeable and normally heals in over time so it’s not a big deal. But smoking can definitely make the healing process harder and lead to problems, so especially in this case you’ll want to avoid smoking.”

If you have a question, concern or interest in any area of cosmetic surgery, Dr. Pane and the staff of ACA welcome the opportunity to discuss your questions with you. Simply click here to contact us; follow us on Twitter, Instagram, Facebook and LinkedIn; or call us at (561) 513-4763. Your question might even help us to inform and educate others as the topic of an upcoming Ask Dr. Pane segment. Remember, at ACA, we believe the only bad question is the one you DON’T ask!