Breast Lift / Mastopexy Information Resource for Southern California, including Orange County, Los Angeles, Newport Beach, San Diego, and Beverly Hills.
Breast Lift
Consultation for Breast Lift
Outlined below is what you can expect from your breast lift consultation. Read carefully, as there are many suggestions that will save you time, answer questions, and help you convey to your plastic surgeon what you want to accomplish.
Health History
All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used, but also applies to local anesthesia. Breast augmentations are usually done under general anesthesia. Only rarely, in cases where the implant is placed above the muscle, can local anesthesia be utilized. Prior to meeting with Dr. Cruise, you will be given a health history questionnaire to fill out in the waiting area. There are five areas of your health that you will be asked about. Be sure to answer questions in detail so that your surgery and anesthesia can be optimized for you.
General Health
General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems. Also, be sure to let Dr. Cruise know if you have ever had a blood clot.
If you have medical problems, Dr. Cruise will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.
If you know that you have a health problem or are over 50 years of age, you can often save time by bringing a letter from your private physician to your cosmetic consultation stating what the health problem is, how it is being treated, and whether you are able to tolerate general anesthesia safely.
If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating that you are able to tolerate surgery.
If you are not able to tolerate general anesthesia, it may be possible for your breast augmentation to be done under local anesthesia if the implant is placed above the muscle. This must be discussed with Dr. Cruise.
Past Surgical History
The questionnaire asks about previous surgeries. Be sure to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries, especially if you do not like the result and are interested in revision. With breast augmentation, it is especially important to mention all breast surgeries, including breast biopsies.
Medications
Be sure to list all medications you take, including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin- containing products at least 10 days before surgery. Tylenol is a good alternative. Here is a partial list of aspirin-containing products and other products to be avoided prior to surgery.
Allergies to Medications
It is important that you list any medications that have caused you to have allergic reactions in the past so that these medications can be avoided. Of particular importance is what kind of reaction you had, especially if you had trouble breathing. Nausea is not an allergic reaction, but it is important to mention as well.
Smoking, Drinking and Drug Use
These three will certainly affect your surgery and must be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result overall. With large procedures such as a face lift, neck lift, tummy tuck, or breast lift, smoking must be stopped at least 2 to 3 weeks before and after surgery. Otherwise, there could be disastrous results such as non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction, smoking will certainly affect the overall result, but this may or may not be noticeable. In this case smoking cessation is strongly advised but is not mandatory.
Specific Breast Issues
During your consultation you must be very accurate about any breast problems. Of particular concern is a history of breast masses and/or breast cancer. If you are over the age of 40, your plastic surgeon will require that you have a mammogram documented by bringing a copy of the results with you to your consultation. If you or a family member has a history of breast cancer, this might be a requirement at the age of 35 or even 30.
Breast lifting, with or without augmentation, has no effect on breast cancer. The only potential problem is mammogram screening. Mammograms are harder to read when there is an implant or if you have had previous breast surgery. This problem is minimized by taking special mammogram views, called Eckland views, which show the breast tissue in multiple planes to try to "see around" the implant. This technique works very well, but there still is a small (less than 10 per cent) amount of breast tissue that remains unseen. Mammograms are less affected when the implant is placed under the muscle if an implant is used in conjunction with the lift.
What Do You Want To Change?
It is important to understand the goals of breast lifting and to make sure your plastic surgeon understands what you want. Are you happy with the volume of breast tissue that you have but want your breasts to be lifted to where they once were? If so, then a lift alone is probably all that is necessary. If you would like a lift with a somewhat more dramatic effect, then a concurrent augmentation may be more appropriate. This will be discussed in more detail in the Physical Exam section. See the section Breast Augmentation if you are considering an augmentation with your breast lift.
Physical Exam
Height, Weight, and Bra Size
Typically, your exam will begin with your height, weight, and bra size. You should be as accurate as possible. If you have been pregnant or have had a significant weight change be sure to let your plastic surgeon know.
Tell your plastic surgeon what size you would like to be. For example, "I am a 34 B and would like to be a 34 B but with the breasts lifted." Or, "I am a 34 B and would like to be a 34 D with my breasts lifted." While cup sizes are highly variable depending on manufacturer, this does give the plastic surgeon an idea of what you are looking for.
Observation
The second part of the exam involves evaluating the breasts for size, shape, and symmetry. It should be pointed out that all breasts are asymmetrical. Some are extremely so while others have only minimal differences. Common causes of asymmetry include size differences, sagginess, nipple location, areola size and shape, scoliosis, and chest wall asymmetries. If a woman has breast fed, it is not uncommon for the breast she used most often to sag more than the other. These asymmetries will be markedly improved, but perfect symmetry is an unrealistic goal.
Palpation for masses
Typically, your plastic surgeon will perform a quick breast exam. Monthly self-exams are extremely important and are, far and away, the best way to detect cancers that are in the early, easily treatable stage.
Measurements
All plastic surgeons will take measurements. Most will take pictures; others will directly measure and write everything down. Here are the most important measurements.
Distance from sternal notch to nipple.
This distance determines sagginess of the nipple. Normal distances are less than 21 to 22 cm. Over 21 cm usually means there is some component of sag. Minor sag such as 21 to 22 cm can be corrected with augmentation alone, but anything more usually needs some type of breast lift in conjunction. See the section on Breast Augmentation for more information.
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Distance from nipple to inframammary fold (IMF)
This distance determines if there is a bottoming-out of the breast. It increases as the breast tissue falls downward. Typical lengths are less than 6 cm in the youthful breast, but may be longer in large breasts and still be acceptable.
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Relationship of nipple to inframammary fold (IMF)
This is, perhaps, the most important measurement. It determines whether the nipple is on top of the breast or has fallen. The ideal breast has a conical shape with the nipple on the top. The nipple should be at least 3 cm above the IMF. When the nipple falls below the IMF, it should be lifted. Nipples that are at the same level as the IMF may potentially be corrected by augmentation alone. This must be determined by your plastic surgeon.
Width of breast
This measurement is important in determining the maximal size of implant that will fit on the chest wall if an augmentation is also going to be done. This measurement can be anywhere from 11 cm to over 16 cm.
Separation of Breasts
This is the distance between the breasts. Most people relate it to cleavage but cleavage also is dependent on breast size. Typical separation is about 3 cm. This distance does not normally change significantly with a breast lift unless an augmentation is also performed. It can be made closer by elevating the pectoralis major muscle along its medial border. Point this out to your plastic surgeon if this is important to you.
Areola size
The areola, the colored area around the nipple, is often enlarged after pregnancy. It may also change shape. Ideal areola size is subjective. Areola reduction is often done at the same time as breast lifting.