Let’s face it – many women who have had children and who have lost breast volume not only need an implant but also would benefit from a breast lift. An implant alone will give a limited degree of lifting of the nipple – about ½ inch – and a higher profile implant will give more fullness in the upper breast than a lower profile implant, something that also gives the impression of an uplifted breast. But what if that is not enough? You are then faced with the reality of needing an additional scar on the breast for the uplift. The circle lift and the crescent lift offer two alternatives and each has its advantages and disadvantages. The great thing about both, though, is that the final scar lies just at the junction of the darker areolar skin and the lighter normal breast skin that makes it very hard to see.
As shown in the diagram, a crescent lift is done by removing a “crescent moon” piece of skin from the area just above the top of the areola. When the skin edges are then sewn together, you get a lifting of the nipple to a limited degree. In reality what often happens is that the skin of the areola stretches out, giving a scar that is frequently less than desirable and often producing an oval shape to the areola that many patients do not find to be attractive.
The circumareolar or circle lift, as the name implies, involves a circular scar around the nipple. A donut-shaped piece of skin is removed from around the areola. This skin removal can even remove areolar skin if the areola is stretched in size and you are trying to reduce its diameter. After the skin is removed, a permanent stitch is passed just beneath the skin of the outer circle of skin and is then tightened down, much like a purse string is tightened. In this fashion the outer circle of skin is brought down to touch the areolar skin edge, and the skin edges are then sewn together. The overall effect is to slightly lift the breast, to lift the nipple and areola, and to reduce the areolar size. One needs to be careful not to overdo it; otherwise there will be excessive flattening of the breast and a great deal of tension on the scar that can lead to a wide, thickened scar as well as a “puffing out” of the areola.
Which one of these lifts is for you? Neither may be if you have:
• Nipples that are pointing down
• If the nipple is more than ½ inch below the fold at the bottom of the breast
• If you cannot see skin beneath the bottom of the areola when looking at your breasts in a mirror
If these are not the case, you may be a candidate for these more limited lifts. Your plastic surgeon would be your best resource when you decide which one is for you.
On a final note, many patients who are not ideal candidates for a limited breast lift opt to have it done because they do not want the longer scars from more extensive lifts and they reason that some lifting is better than none. As long as the plastic surgeon does not try to overdo it, the final result can be quite pleasing.
Should you have further questions, feel free to contact my office.
George Sanders, M.D.
