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Case Study: The Pseudolifting Effect of Breast Implants

 

Background: There is a common perception that an implant can lift up a sagging breast. The reality is that nothing could be further from the truth. In most cases of sagging breasts (breast ptosis) an implant will actually making the breast shape worse. It will fill out the upper pole of the breast while having no positive shape effect on the downturned breast tissue which contains the nipple. This is why a lift with an implant is almost always needed for reshaping and lifting of the sagging breast.

There are a few instances of apparent breast sagging, however, in which an implant can have a breast lifting effect. If the breast mound is small and the sagging is largely restricted to the nipple, implant enlargement can create the perception of an uplifted breast. By making the breast base diameter bigger in both a vertical and horizontal dimension, the location of the nipple on the mound is changed as the mound is expanded.

Such positive benefits of an implant alone on a sagging breast almost always occurs when the initial breast size is small. Large breasts create a big sleeve of overhanging breast tissue as it has shrunken due to pregnancy or weight loss. This type breast already has a small base diameter and the droop is more nipple-related than mound-related. With careful assessment one can see that the low hanging nipple position does not fall below the level of the inframammary fold. (lower breast crease)

Case Study: This 40 year-old Hispanic female wanted breast enlargement after having had two children. She never had large breasts even though she had a wide chest. She wanted silicone implants and wanted at least a D cup breast size afterwards.

Under general anesthesia she had 550cc high profile gummy bear silicone implants placed through lower breast fold incisions. Using a no-touch funnel device technique, the implants were inserted through 3.5 cm long incisions in a dual-plane submuscular position. At least half of her mound expansion was on the lower pole with the creation of a new lower breast fold.

With implant augmentation in the smaller droopy breast, the entire lower pole of the breast is expanded lower. This makes a new inframammary fold location well below the location of the presurgical smaller breast mound. This is how the breast becomes ‘lifted’. The nipple position actually stays relatively the same, it is the breast mound around that changes. With a larger and lower breast mound the nipple ends up acquiring a central position. This could really be called a pseudolifting effect.

The expansion in the breast mound also creates an important issue for the actual placement of the breast implants. Since the breast mound will lower the existing inframammary fold, it is important to make that consideration into the incision location. The inframammary fold incision will need to be made at 2 cms. lower than the existing breast fold. If this is not done the incision will end up above the fold and on the actual lower pole of the breast is a more visible location.

Case Highlights:

1) It is a common belief that breast implants can lift a sagging breast which is rarely true.

2) Very small breasts that have a little droop due to involution, however, can be effectively ‘lifted’ with breast augmentation alone.

3) Larger breast implants achieve their lift by enlarging the lower pole of the breast making the nipple appear higher on the new breast mound.

Dr. Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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