Is there such a thing as a “Scarless Breast Lift”? Breasts droop for many reasons such as pregnancy, weight loss, and advancing age, but the common thread in all of these cases is that the supporting ligaments of the breasts and the overlying skin have been stretched out. These supporting ligaments, called Cooper’s Ligaments after an English surgeon from the 1800’s, are thin bands of tissue that pass from the underlying pectoralis major muscle, through the breast, to the undersurface of the overlying skin, giving support to the breast tissue. They are like a root system that passes through the breast tissue, giving it shape and supporting it. If they are stretched out by pregnancy, weight gain, or age, the breasts will tend to droop. The larger and heavier they are, the greater the degree of drooping that occurs. As the ligaments stretch or weaken, the skin initially offers some resistance to drooping of the breast, but it will also stretch out with time.
How can one correct this situation without a scar? The most obvious approach would be to tighten Cooper’s Ligaments. If you try to surgically shorten them, however, they tend to restretch rapidly and there is the issue of scarring. Newer non-invasive techniques that involve lasers designed to create collagen inside the breast are being tried. There is also a recently developed technique that involves the use of permanent sutures that pass through the breast and are tied to another permanent suture placed just below the collarbone. This supports the breast tissue as a “Man-Made” Cooper’s Ligament, although the duration of the effect is uncertain.
Although the scarless techniques just mentioned may offer some benefit to the woman with a minimal degree of drooping, they are of little help to women with more of a problem. For these women who have a great deal of excess skin, the best approach involves surgically tightening the skin overlying the breast that results in a lifting of the breast. All of these procedures, however, create scars and are therefore not scarless. Surgeons attempt to decrease the detectability of the scars by minimizing their length or by hiding them in the fold beneath the breast or around the areola where they are not as easily seen. These operations that surgically tighten the skin create a “pushing up” of the breast, as opposed to the Cooper’s Ligaments that “pull up.” As a result, surgical breast lifts produce breasts that tend to be flat on the top, something which plastic surgeons seek to overcome in a variety of ways. These include the insertion of breast implants to fill out the upper breast, upward suspension of the breast tissue by means of an internal mesh, or ingenious tunneling of breast tissue beneath the pectoralis muscle that allows the muscle to hold the breast up. In this country, however, the use of implants is the most widely used and time-proven technique.
On a final note, there are some tricks that I use to give a breast lift that is almost scarless.
• If there is not a great deal of drooping, inserting an implant through a minimal incision will itself give an uplifted look to the breast, much as blowing up a balloon lifts the balloon. The resulting scar is virtually “scarless.”
• One can also lower the fold at the bottom of the breast at the time of implant insertion that will result in a lift of the nipple.
• Finally, the Circle Lift technique – takes out a “donut” of skin from around the areola and then pulls the outer skin edge into the areola in a purse string fashion – will lift the nipple and breast to a limited degree and produce a scar that tends to fade into the edge of the areola and is difficult to see in most cases.
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