Quick Question

[Envyme]

Hello Dr. Mele,

I am curious if you think I need a lift? I am 5'4" about 113 lbs no kids and I am 24 yrs old.

I have been told by some PS I need a lift and others have said I do not. Can

I have attached pics but it is pretty small (if you click on it the pic will get a bit larger).

I am also wondering if going under the muscle is better for me due to my breast type? Will going under make it less likely to sag?

If you think I need a lift is it better to wait for a few months before having the lift vs right after breast augmentation?
I am trying to go for a Holly Maddison (sp) look.

Thanks so much for your advise.

[Dr. Mele]

Dear Envyme:

Sounds like you are on the borderline for needing a lift. I hope you are not expecting me to break the tie without the benefit of a physical exam. Pictures tend to help when he need is obvious, but not so much with the borderline cases.

In situations were my patients are on the borderline we talk about what we are expecting after surgery. If after the discussion the nipple position is felt to be low (not quite perky enough) then I can usually get away with a "little" lift. (Benelli, roundblock, periareolar type). Lifts in borderline situations tend to be simpler and require smaller scars.

If the nipple is low, but not really an issue for my patient, I will tell them it is low by the textbook, but I am not doing the operation to make the textbook happy. I am doing it to make them happy. We might look at some pictures of similar breast before and after to be certain the point is clear. I also tell them that there is a chance that their opinion may change after surgery. That is, they may decide after the augmentation that they want a lift. If that happens, it can still be done. It means undergoing another separate, usually minor, procedure rather than combining it with the breast augmentation. If you are electing not to have the lift, you may want to discuss the finances of a second surgery with your surgeon beforehand. With the ground rules clear, it can save you and your surgeon some grief later.

Good luck.

[Envyme]

Thank you very much for your advise and assistance. I am aware that without seeing a person infront of you it can not be clear if a lift is necessary to achieve X look

Thank you and I think you are right I need to find out if I decide to do it later then what will the cost be? It may be worth while to get it done upfront.

Can a lift be done under a more local anesthesia (sp)?

Thanks again for your help

[Dr. Mele]

The periareolar lift is fairly localized so yes it can be done with local anesthesia.

It can be performed three ways really.

Under general anesthesia (fully asleep)

Local anesthesia with sedation (twilight anesthesia but not asleep)

And for the properly selected and motivated patient I have performed this lift under local (fully awake).

It takes a bit of skill on the plastic surgeons part and tolerance on the patients part to get through the numbing up part without sedation, but it can be done. Once it's numb, it easy.