Do I Need a Reduction or Just a Lift?

Breast enhancement surgery is the most common category of cosmetic plastic surgery.  It encompasses breast augmentation, breast reductions, breast lifts (or mastopexy), or combinations of the three.

Sometimes, deciding which procedure is the most appropriate for your situation can be confusing and daunting.  One of the most commonly asked questions by patients is “Do I need a breast reduction, or just a lift?”.  This article aims to clear up some of this confusion for you.

Typically, women’s concerns regarding their breasts fall into two categories :

• Their breast size (too big/too small), and
• Their breast shape – typically that their breast have descended on their chest wall, either because of gravity, breastfeeding, or changes in their weight.

Often women will have concerns relating to both their size and shape and may need combination procedures.  The following is a broad outline of available treatments for issues with breast size and shape.

1. If you are happy with the size of your breast and happy with the shape of your breast:

• Then you’re perfect just the way you are. 

2. If you are happy with the size, but not the shape of your breast:

• Then you need an operation to place the breast tissue and skin back onto the correct place on your chest, without removing any of your great tissue.
• This procedure is called a Mastopexy.

3. If your breast is too small, and you’re happy with the shape of your breast:

• You only need some extra volume – Either implants for larger volumes, or fat grafting for smaller volumes, or a combination of both (hybrid).
• This procedure is called a Breast Augmentation

4. If your breast is too small, and the breast tissue is descended off the chest wall:

• You’ll need extra volume to make your breast the correct size, and a mastopexy (or breast lift) to place the breast tissue and skin back onto the correct place on your chest. 
• This procedure is called an Augmentation-Mastopexy

5. If your breast is too big, and causing issues with neck and back pain, or rashes in the folds under the breast:

• You’ll need an operation that will remove the excess breast tissue, and the associated excess breast skin, and leave you with the correct shape, size, and placement of the breast on the chest wall.
• This procedure is called a Breast Reduction, and includes the reshaping of the breast and repositioning (and typically reducing the size of) the nipple-areolar complex.

As can be seen from above, the question of breast lift vs breast reduction is ultimately made depending on whether the patient has an excess of breast tissue or just an excess of breast skin requiring excision and lift.  Both of these operations can potentially be medicare rebatable and covered by Private health insurance in certain situations.  Your Plastic Surgeon is the best person to advise you in this regard.

Scarring

After deciding which procedure is most suitable for their desired outcome, the second most commonly asked question is “What kind of scar do I need to have”.  Broadly speaking, the surgical scars routinely performed for Mastopexy and Breast Reduction procedures are the “Donut”, the “Lollipop” and the “Anchor” Scar.

The “Donut” or peri-areolar scar is where the only skin incision is around the nipple area. It is useful for patients that have a good breast shape, but want to lift the nipple position a small distance (maximum of 2cm).  As it does not allow the removal of much excess skin, it cannot be used in Breast Reduction Surgery patients or those that require a more aggressive type of lift.  If the surgeon attempts to remove too much skin and close the wound with a donut scar, the remaining tissue has a tendency to pull against the nipple, potentially stretching the areolar, and causing a large, “cookie” nipple deformity.

The “Lollipop” or circumvertical scar is similar to the “Donut” in that the scar surrounds the new nipple position, and then extends vertically down onto the chest wall.  This incision type allows for excess skin and breast tissue to be removed in a vertical column on the breast, and for the nipple to be raised several inches on the breast.  It is appropriate for women who may have excess breast width, but no excess breast height, or for women that have tuberous breast deformity with only a small amount of skin between the nipple and the breast fold (where the breast attaches onto the chest wall).

The “Anchor” or Wise pattern scar is similar to the “Lollipop”, but with a transverse scar in the breast fold.  This incision type allows for removal of excess breast skin both vertically and horizontally (which is the majority of breast lift patients), and for the nipple to be raised by up to 20cm on the breast.  It is the most appropriate incision type for breast reduction patients that have excess width, height, and projection of breast tissue, and need large volumes of breast tissue removed.  The only ‘extra’ scar from the Anchor incision is the horizontal scar, which sits directly in the breast fold, and is the one that is never seen by the patient.

Conclusion

There are a variety of different surgical procedures and combinations of procedures available for patients seeking breast surgery.  Within these categories, there are also many ways to tailor these procedures to each patient in order to best achieve their desired result.  Sometimes the names of procedures can be confusing to patients, and the types of scars and incisions required can cloud the decision-making process.  At The Lotus Institute, our Specialist Plastic and Reconstructive Surgeon Dr Widdowson is here to listen to your desired outcomes from breast surgery and work with you to formulate the most appropriate, personalised surgical plan.  If you’re considering any type of breast rejuvenation surgery, come and see us today.