Your Questions

Q: Dr. Eppley, First, do you have a web site I can look at?  And second, knowing you do not have a crystal ball, how long can the average person anticipate a traditional breast lift to last? Thank you.

A: All breast lift results ‘last’ but it is important to realize that they will change or settle over time during the first six months after surgery. This is known as tissue relaxation as seen by changes in the lower pole of the breast. Since the skin has to support the uplifted breast tissue, some stretching or relaxation of the bottom part of the breast will occur in most patients. This is why it is important that the way the operation is done has the breast initially looking a little ‘upside down’. (the top part of the breast looks too full, the bottom part of the breast looks cut off or too short) This factors in the settling that will occur in the first few months after surgery as the mound drops and more round or tear drop breast shape results. In essence, one has to heal into the proper breast shape. But once a breast lift is healed and settled (3 to 6 months after surgery), there should be no major changes thereafter. The nipple position always stays in the new uplifted position, it is just that the breast mound settles around it.

I make these statements assuming that one does not get pregnant after a breast lift, gain or lose a lot of weight, or is having implants placed at the same time as a breast lift. Any of these can modify the aforementioned commentary on the stability of breast lift results.

You may go to my website, www.eppleyplasticsurgery.com/breast-lift/ for more information and patient results on breast lifts.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am finished having children and my body is a wreck. I have tried to get back close to my pre-pregancy body, but it is not happening. I want to have a Mommy Makeover procedure but my husband says I am just not working at it hard enough. When is a good age to have it done?

A: The effects that pregancy has on a woman’s body are largely irreversible by natural efforts for many women. Loose or separated abdominal muscles (rectus diastasis) can not be made to fuse back together by any amount of abdominal situps. Abdominal skin that has been stretched out and partially torn (stretch marks) can not have elasticity restored by situps, creams or weight loss. Breasts that have lost volume and sag can not be lifted up by chest exercises or alleged skin tightening creams. The onething a women can do is lose her pregnancy weight but all other changes require outside help

A so-called Mommy Makeover procedure, which combines breast augmentation with or without a lift and some form of a tummy tuck with or without liposuction, can be done at almost any age. But, by far, the majority of these procedures are done between the ages of 35 to 50. This is an age range where women are done having children and have proven to themselves that diet and exercise just can’t get the body improvement they desire. But age alone is not the only criteria. As long as one is finished breastfeeding, a Mommy Makeover can be done as soon as three to six months after one’s last pregancy.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wanting to find out information about breast augmentation surgery. I used to be a DD and then I have lost weight and gained weight off and on and my breasts have gotten smaller and they sag very bad. I would like to find out how much you charge and if you do any type of financing. Could you please let me know because I really need to figure out how I can get this done because I have such a complex about my body now. It is very bad and I want to try to get this done if at all possible. Thank you.

A: The first thing that I can tell you is that breast implants alone are not the complete solution to your breast concerns. Knowing how big your breasts were at one point (DD cup) and then having lost weight, you undoubtably have a lot of breast sagging. You have described your breasts as so yourself. Contrary to common perception, implants will not lift up sagging breast tissue. This will require some form of a breast lift if implants are done to get a satisfying result. Sending me a few pictures of your breasts will show what type of breast lift you will need with your implants and what the cost of that procedure would be.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a nineteen year old female and since I was 16 I have had saggy breasts. When I was 16 I was a bit overweight. I weighed 180 at 5.5″. By the time I was 18 I had gotten my weight down to 120. I did this by working out and eating healthier. My breast still looked the same however. They are so saggy for my age. I have a small chest too. I’m a 34 B so I’m not sure if I have a medical condition or just bad luck but I want to know if my best option is a breast lift and or going up to a size C with implants.

A: While I have not seen pictures of your breasts, I can make several general statements. Whatever degree of breast shape/sagging you have, it is due to your genetics and the natural way that they developed. Their current shape is not due to a medical condition. While the concept of sagging is a relative one, when someone who is very young like you describes that they have saggy breasts they most likely really do have ptosis (sagging), it is just a matter of the degree of it. But when you combine the issue of a 60 lb weight loss, one can be assured that this is real breast sagging. (low nipple position relative to the lower breast fold) Thus some form of a breast lift is probably needed. Whether an implant is done at the same time to increase breast size as well is an option open for further discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I’m interested in the periareolar breast reduction with lift and wondered if you perform this procedure? Also, I am interested in a tummy tuck at the same time if possible. Does you accept Tricare Prime insurance or Tricare and you a network or nonnetwork provider?

A: Thank you for your inquiry. For the sake of clarification, there is no such thing as a periareolar breast reduction procedure. Limiting the skin removed to the circumareolar area will not only not do any actual breast reduction but is a very poor method of breast lifting for most women with any degree of breast ptosis. (sagging) The only conceivable case in which a periareolar technique may be used successfully is where there is a very minimal amount of breast sagging and liposuction is be used for the removal of some breast tissue. Such a scenario would be most uncommon for most women who seek breast reduction surgery. I would have to see some picture of your breasts to see if this is a possibility for you. The reality about combined breast reduction/lifting is that it requires scars around the areola and downward to the lower breast fold and along the lower breast crease. (anchor scar pattern) This is the only method of breast reduction that actually really works.

It is certainly possible and very common to do any type of abdominal contouring in conjunction with any form of breast reshaping. When done together, these combined operations actually have a name….the Mommy Makeover.

Lastly, I am not a provider in the TriCare insurance program.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is a breast lift without scars possible. I am 38 years old and am done having children. (3)  I have 36 D breasts but they have a lot of sag. I would like to lift them with implants. I want minimal scars and I have read that the implants can be inserted through small incisions in the armpits or areola that leave minimal scars. I don’t want any scar outside of the areolas. I am hoping that the implants can get me enough of a lift, maybe a bigger implant will get me more of a lift. What do you think?

A: Unfortunately the approach you are thinking about for lifting your sagging breasts is an understandably misunderstood one. No woman really wants breast lift scars but the reality is that there is no substitute for them. Basically without scars there will be no real lift. Breast implants can not lift a sagging breast and will actually make it worse if tried alone to lift a saggy one. Once the nipple hangs at or below the lower breast crease, adding implant volume will only drive the nipple even lower…and place a large amount of fullness (implant) above the nipple. Filling out deflated breast skin will only make a nicely shaped breast if the nipple already sits close to the center of the deflated breast mound.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I had lap band 3 years ago and am looking to have excess skin removed, a breast lift and some liposuction in the arms and legs region, just wanting some prices and if my insurance would cover any of it due to being post lap band.
A: To answer your questions, the first thing I need to see is some pictures of what your body looks like. What I am particularly interested in seeing is the size of your abdominal pannus and the degree of breast sagging that you have. But in the interim, let me provide you with some reality about the bariatric surgery patient and and what insurance will or will not do wit the sagging skin that develops afterwards.
1) The only procedure that has any remote chance of being covered would be an abdominal panniculectomy, removal of the abdominal overhang or a simple amputation tummy tuck. But for this to even be considered, a pre-determination letter must be written that describes the medical symptoms the pannus is causing and pictures that show the amount of abdominal overhang. To qualify the pannus must hang over the groin creases and onto the upper thighs and there must be a documented history of treatment for intertrigo. (skin infections under the pannus) Based on this submitted information, it is up to the insurance company to make a decision about coverage.
2) Breast sagging and the breast lift with or without implants is not considered a medical necessary procedure and is not eligible for insurance coverage.
3) It would be extremely unusual for the extreme weight loss patients to benefit by liposuction. The skin quality is often too stretched out to respond well to fat removal alone.
Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I have saggy breasts and I was hoping to avoid a lift so I would’t have scarring. Is it possible with a bigger implant not placed under the muscle that this can be achieved? I did try on 600cc with a bra and a shirt over and decided I wanted bigger. I was thinking of 800cc. I know I’m not the Dr. and this is something you would know more about. So with some of these things I’ve mentioned. Could you tell me if this can be a possibility. Thank you so much for your time.

A: One of the great dilemmas in breast enhancement surgery is that of the sagging breast. It is a common misconception that an implant is going to lift a saggy breast. While that is true for the very smallest amount of breast sag, it will simply not work for what most women perceive as breast sagging. If an implant can not lift a breast, a bigger implant will not do so either. As a matter of fact, the bigger an implant is in breast sagging, the worse the result may appear afterwards if a lift is not done at the same time.

So in what cases will an implant help lift a breast? Check where the position of the nipple is. If the nipple is at or just below the lower breast fold, some form of a lift is going to be needed. The other way is to do the pencil test. If a pencil placed underneath the breast stays, then a breast lift will be needed as too much sag is present.

In reality, implants help re-expand a deflated breast but it will not really lift a sagging one.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Please see the photos I have included regarding my interest for a breast lift and abdominal procedure. I am a fit individual in that I work out 5 days a week, and try to keep a balanced diet. Your advice and expertise would be appreciated.

A: Thank you for sending your pictures. From an abdominal standpoint, I agree that liposuction on the abdomen and around the waistline would be beneficial. Certainly no form of an excisional procedure (tummy tuck) is needed. For the breasts, however, that is a different story. As you have also mentioned, a breast lift is needed. There is simply too much skin for the amount of breast tissue you now have. The type of breast lift needed is most likely a blend of what I call a type III (vertical or lollipop lift) or a Type IV (anchor or inverted T lift) These names relate to the degree of lifting they achieve and the type of scar pattern that occurs as a trade-off. I think you could only get by with a Type III lift if you were doing a simultaneous implant for volume enhancement as well.

Both a breast lift and abdominal and flank liposuction can be done at the same time for your trunk makeover.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I had gastric bypass surgery, and my breasts have flattened out and sag now but so far my actual cup size hasn’t altered all that much. I need a consultation to see what can be done to improve the look and shape of my breast. They have been large my whole life so I definitely do not want larger breasts at all.

A: With your weight loss, you undoubtably have lost some breast tissue volume or they would have not have flattened out and sagged. For a good breast shape, you simply have too much skin for the amount of breast tissue volume that you now have. A full breast lift does not remove any breast tissue but rather only the amount of skin needed to lift and reshape your breasts to a restored position back up on your chest wall. With that the nipple is moved up considerably to a central position on the respositioned breast mound. Interestingly, most breast lifts will actually make the breasts look smaller and never larger. But by your own description, you would not be offended if your breasts do look somewhat smaller. The only negative aspect of a breast lift is that there will be scars. These will be the classic anchor or inverted T scars that are typical of a full breast lift or a traditional breast reduction surgery.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I would like information on breast augmentation. I have breastfed 2 of my children and my breast sag considerably. I compare them to a much older woman. It is very difficult to buy bras that fit well without adding any padding and I am not happy with the way I look shirtless. I would like some info emailed to me so i can think about my options.

A: Based on your own description of ‘ my breast sag considerably’, it sounds like you would need some type of a breast lift if implants were placed. Breast implants have no capability of lifting up a breast and moving the nipple to the center of the breast mound if the starting position of the nipple is below the lower breast fold. Therefore you have to think about the trade-off of scars for fuller and uplifted breasts. You will also have to consider whether you would want saline vs silicone breast implants. I would be happy to look at any pictures that you want to send to me to give you a more exact recommendation. But for now I will assume that you need full breast lifts with implants. I will ask my assistant to send you some cost information for such a procedure for your further education on the matter. If you have any other questions, please let me know.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, Help! I have got the saggest breasts ever. I am only 20 years old and am small at just 5’ 1” and 105 lbs. I have never been pregnant. Despite not having children, I have  very sagging breasts and am not sure the best way to get them lifted. Should I have implants or just have a lift? I am not sure I care either way although I might prefer implants because of the scar issue. How do I go about making the right decision? Thank you.

A: Your question is a common one and often illustrates comfusion about whether a breast implant can create a lifting effect. The asnwer to that question is yes and no. By filling and pushing out the breast skin envelope, the breasts can appear in some patients to be actually lifted. But the key question to this type of ‘scarless breast lifting’ is the location of the nipple before surgery. As long as it is above the level of the lower breast fold, an implant alone will create a lifting effect. But if the nipple is at or below the breast fold, no real lift will happen and the added volume may create the opposite effect of just pushng the existing breast tissue and nipple even further down. Your descriptor of ‘very sagging breasts’ suggests that you do have a low nipple location and a real surgucal breast lift will be needed. Whether that may include an implant for the creation of more volume is an option but the implant alone will not create the desired breast lifting effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting maybe a mommy makeover. I have 2 kids, tubes are tied and I plan to have no more! I have a terrible big flabby stomach and my breasts are saggy :'(  I got pregnant and thought it was a time to indulge. I wanted to have a chubby baby so I ate a lot. Gained almost 100lbs during my pregnancy. In the end my baby wasn’t chubby (weighing only 7lbs 11oz) but I was left with stubborn fat that won’t go nowhere.  I don’t want bigger breasts though, my breasts are big enough, I would honestly maybe even like them a cup or more smaller but as long as they sit right on my chest they may just look better with possibly just a lift.  I want my stomach flat again though. I am a thicker woman. 5’8″ 230lbs. I plan to lose some weight though (I’m working on it) prior to having these operations done. What would this cost? Could I pay like… $4000 then the rest in payments? Is that offered for operations, as these? How much weight do you think I should be before having this done? I don’t smoke or do any drugs, I drink occasionally but overall healthy, just overweight, or obese, I guess I should say… Please help me to feel better about myself again. PLEASE!

A: Thank you for your inquiry. While I will ultimately need to see some pictures of your body or see you in an actual consultation, let me provide you with a few thoughts/recommendations based on the description of your concerns.

From a breast standpoint, you are describing a classic full breast lift. This will leave most of your breast tissue but will significantly tighten and lift your breasts back up on your chest wall and center the nipple on the newly positioned breast mound.

From an abdominal standpoint, you most likely need some version of a full tummy tuck to get rid of any skin overhang and make your stomach flat again. Whether this is what we call a full tummy tuck or an extended tummy tuck awaits my visual assessment of your body.

Putting any form of breast and abdominal reshaping garners the moniker of a Mommy Makeover, changing what has been affected by pregnancy the most…one’s breasts and stomach area.

When it comes to weight loss before a Mommy Makeover, a general rule is that one should be between 15 to 25 lbs of their desired ‘realistic’ weight goal. Notice that I didn’t say your ideal body weight which for some patients is not a truly realistic goal.

I will defer cost estimates to my assistant. But cosmetic surgery is never paid in installments which is more typical in the banking and retail industries. We have no means to reclaim the surgical results if the patient defaults or fails to pay after the work is completed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, After breast feeding, my breasts are less than perfect. My confidence has drastically decreased. I'm in incredible shape but my breasts are just mush. What kind of breast procedure do I need, augmentation or a lift?

A: For many women, the decision between needing an implant or a lift is very straightforward. Breast sagging after childbirth may be improved by implants if there is not too much loose skin and the nipples do not hang below the lower breast fold. If there is significant breast sagging then a combined implant and lift will be needed. It would be very rare to get a breast lift alone unless you already have substantial breast tissue volume. Having breasts described as ‘mush’ indicates a significant loss of breast tissue so some amount of volume through the use of implants is needed. With enough added volume, the loose skin may be adequately filled out and the nipple will sit in a good position. But if there is too much loose skin and the nipple sits even a little bit too low beforehand, the implants will not lift the nipple upward enough and some form of a breast lift will be needed.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am getting quotes and suggestions on liposuction and a breast lift. I already have implants but looking to go smaller and I'm up in the air on replacing them, removing, or keeping the ones I've got. I've have breastfed 4 children and also need a lift and full contouring. What are your prices and are you running any promotions?

A: Unfortunately based on the information that you have given me I can not be of much help to you. It is impossible to give reasonably accurate pricing when you don’t really know what the patient needs. Liposuction can be done on 12 different areas of the body, there are four different types of breast lifts and two types of breast implant options. That leaves a tremendous number of variables to consider all of which take differing amounts of time and effort needed to do the surgery…and that hugely impacts cost. The best way to figure out what you may need  is to either see some pictures of your concerns or give me a very specific set of procedures that you want to do. I suspect you need at least a full breast lift but knowing what to do with your indwelling implants is a very important consideration. Remember that when you do a breast lift, the actual size of the breast gets smaller. Taking out indwelling implants with any degree of sagging will leave you with very flat breasts despite the fact that they may be in much better position higher up on your chest after a lift. When it comes liposuction, I suspect you may be focused on your abdomen and waistline. But whether that would be an effective contouring technique in someone who has had four pregnancies with likely loose skin and stretch marks is an issue yet undecided.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a combined breast lift with implants nearly 5 days ago. My recovery is going well I think, however, the appearance of my breasts concerns me.  I've attached two photos (front & side view).  My concern is that my breasts are oblong with a definite, large “indentation” above the nipple.  In the photos, you see the implant sitting high, then a big indentation above what, I think, is my own breast tissue below.  This seems abnormal to me.  My breast shape looks kind of like an eggplant. Is this a cause for concern? 

A:  When undergoing a combined breast implant and lift for severe breast sagging, the early appearance can be disturbing. This is because the implants often ride early and in conjunction with swelling can push the breast tissue forward and down. This creates the exact appearance that you are seeing. It is important to remember that it is early and many changes will take place. One of those is that the implants will drop. This can be helped by wearing a breast band to encourage the implants to move south into the bottom that has been created for them. Putting gentle sustained pressure on the upper pole of the breasts will help the bottom tissues to expand and allow the implants to drop. It will take 6 to 8 weeks before you have a clear idea as to how much dropping they are going to do. They will definitely drop, it is just a matter of how much. Once that happens the breast tissue in front of them will move up into a better position on the implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am going through a divorce due to domestic violence. I have lost a little over 100 pounds since I left my abusive marriage with our son. I for so many years buried my head into food. Even though I have lost all of this weight I often look in the mirror and cry due to the way I look. I feel empty inside, I want to feel beautiful and content with myself. I want back all of that confidence that he took from me. I have a lot of extra skin from all of the weight I lost. I am only 30 years old but I dress like a 40 or 50 year-old due to my body’s look. I don’t want to feel like I am dying inside anymore, I want to feel alive again, confident, young, and beautiful. These are the goals I want to achieve. Most of all I want to be able to bring my son to a beach in a bikini he is so young I do not want him to miss out on things due to my insecurities, He has suffered so much due to this divorce and domestic Violence. I try to keep a positive outlook on everything. I have attached some pictures so you can see what you have to work with.

A: Thank you for sharing your very personal story and in losing in the weight. This is obviously a transitional period in your life and changing how your body looks would be a complementary component to it. The excess skin and fat represent both physical and emotional baggage. In looking at your pictures, I can see that you would get some good benefit out of the following procedures… a full tummy tuck, liposuction of the lower abdomen (prior to its removal) and flanks with transfer to the buttocks, and a breast lift. Together these would all make a significant improvement in the shape of your body and reverse some of the effects of your prior weight gain.. All those procedures could be done together with the tummy tuck as the foundation procedure which is the one that really involves any significant recovery. Breast lifts are relatively painless and fat injections to the buttocks only as minimal discomfort.

While all four procedures would provide the most benefit in terms of body changes, the most important one is the tummy tuck with flank liposuction. That is the foundational procedure that produces the best benefit out of all the potential body procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I am 24 years old and am needing a breast lift with implants. I am looking for the least amount of breast scarring as possible but also the best results. What type of breast lift do you think is best for me? I have seen scars from the periareolar breast lifts and they look good but will they lift my breasts enough? What should I do? I am very unhappy with my breasts but I do not want to have horrible scars. I don’t want my breasts to look like they have been in an accident.

A: In looking at your pictures, you are in a classic situation that many women are in. They really need some form of a breast lift but understandably don’t want a lot of scars as a trade-off, for they have their own aesthetic liability. What one would consider ‘horrible’ scars is open to interpretation but suffice it to say that breast lift scars will look nothing like ones that occur from being in an accident. Ultimately the breast lift decision comes down to less of a lift with the perirareolar approach (with less scar) vs much more of a lift with the lollipop approach (vertical breast scar) but with more scar. Which choice is the right one for you requires some more research on your part. Spend some time looking at these two different breast scar patterns and results on the internet. I suspect it will not take long before those visual scar images will guide you to the best breast lift choice for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a mastopexy/abdominoplasty (mommy makeover) in future years. So that I have an idea about cost, I would love to know the extend of the incisions that I would need, i.e., anchor incision and full vs crescent incision with partial tummy tuck. I am 5 pounds from my ideal weight and still carry quite a bit of weight in my torso. My ptosis is moderate to severe in my mind, but would love an expert’s opinion. Thanks!

A: There are four basic types of breast lifts that vary based on much lifting is needed and the scars that they produce. Without seeing pictures of your breasts, it is impossible for me to say what exact breast lift operation you need. But since you used the term ‘moderate to severe’ ptosis, and patients almost always underestimate what they really need, I will assume that you need a full breast lift. (anchor scars) Also know that few women actually ever have just a breast lift alone unless they already have substantial volume. Breast lifts in general do not create persistent upper pole fullness which most women want when undergoing any breast enhancement procedure. This is why most breast lifts also incorporate the use of an implant at the same time. (augmentation mastopexy) Even if it is a small implant, it provides that retained upper pole fullness that merely lifting up and resuspending the breast tissue on the chest wall that does not.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been thinking about getting a breast procedure since I was 13. I have 34DD and I’m 5’1 ½. I’m very self conscious about them but my boyfriend thinks they are fine but I do not. They are too big and saggy (gross) I just hate them! If I got a breast reduction how much smaller would my breast’s be and would you recommend having implants put in?

A:  Breast reduction surgery not only reduces the size of one’s breast but also incorporates a lift of the breasts as well. There would be no reason to place implants during a breast reduction, that would partially defeat the purpose of the procedure. The amount of breast reduction that can be achieved in the procedure is different for each patient. There is great variability in how much breast tissue would be removed and takes into account how much or little breast tissue one wants to remove. One could easily go from a saggy DD breasts to an uplifted and more perky full C cup. It is important to remember that the trade-off for that amount of breast shape improvement are permanent scars. You are trading off one breast problem for another, just be sure the scar issue is less of a concern than the way your breasts look now.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to do something about my breast shape but am confused as to what to do. I have a little sag to them after two pregnancies and would love for them to be a little fuller and up higher. So I think that is why I need a breast lift but I really don’t want any scars on my breasts if I don’t have to. On the other hand, I am not opposed to breast implants if it will lift up the breasts and avoid any obvious scars on them. I have attached some pictures of my breasts for you to see. What is your recommendation?

A: Your breast dilemma is a common one in that you are what I call a ‘tweener’. You have some sagging so breast implants will add volume but the breast position will likely stay low.  A larger than desired breast implant may be needed to get the lifting effect you are after. A breast lift alone will changhe the position of the nipple and the breast mound but often the breasts may look smaller afterwards despite the better shape. A lift with an implant will allow you to have a smaller implant and slightly higher positioned breasts but that comes with the trade-off of scars.

Either way you have to accept some disadvantages with either approach and different plastic surgeons will have different preferences for either approach. You must think it through and decide which of the trade-offs is the better choice for you.

In ‘tweener’ patients like you, I wil often choose the middle of the road choice…breast implants with a superior or crescent nipple lift. This provides a slight upward nipple repositoning with minimal scars (no scars on the breast mound)  while relying on the implant to add volume and provide a bit of an upward push.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a recent consultation with another plastic surgeon and that surgeon believes I only need augmentation, no lift necessary. I am somewhat asymmetrical so I need about 50cc more on the right side. I want silicone implants placed under the muscle. I am a paramedic so I have recovery time concerns, but think I will have no problem recovering since I am very fit. The size I had looked at were around 420cc/480cc, but think I might go just a little bit smaller. I am basically a B-cup on the right and a C-cup on the left, but lost size and volume after breast-feeding three children. Fortunately, my nipples are in a good position still and I am not too droopy, just lost my size and fullness. I am 34 years old and weight 145 lbs, but I am an extremely fit size 6. Thanks.

A: The key factor in determining the need for a breast lift is where the nipples are positioned. If they are above the lower breast fold still, then an implant alone will suffice and no lift will be needed. With asymmetrical breast sizes before surgery, placing different implant volumes is common. But be aware that this may improve the asymmetry but it is unlikely they will be perfectly matched after surgery since they are other tissue factors that affect breast size other than just breast tissue volume. (e.g., skin envelope) Most breasts are asymmetric for multiple reasons and a breast implant only addresses one of them.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 28 year-old woman who doesn’t like the shape of her breasts. They are very saggy and not even. One is smaller and hangs lower than the other. In addition, my areolas are huge and way out of proportion to the size of my breasts. I am young and these breasts like old lady breasts. I have attached pictures for you to see. What type of breast reshaping procedure do I need and will there be scars?

A: Thank you for sending your pictures and expressing your interest in breast reshaping/rejuvenation. Breasts like yours pose real challenges in getting uplifted fuller symmetric breasts while minimzing scars. There are two fundamental approaches that can be done. The first would be a periaroelar mastopexy (breast lift) with implants. This approach would make the breasts larger and would have have scars limited to around the smaller areolas. Its downside is that only a minimal lift and an improvement in symmetry would be achieved, so you would have larger breasts that still hang. The second approach would be vertical breast lifts combined with implants. This would be infinitely more effective an uplifting your breasts, improving their symmetry, making the areolas smaller, and providing improved fullness. The one downside is that there would be scars around the smaller areola and then vertically down to the lower breast fold. (and perhaps some scar along the breast fold crease as well)

As you can see, neither approach is perfect and one has to accept either low hanging breasts with minimal scar or uplifted fuller breasts with more scar.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 34 year old woman who has had two children. I am done having children and now want to address the damage done to my breasts by pregnancy and breast feeding. I have lost all of my breast volume and they sag. I want breast implants but I don’t want a breast lift. I don’t want the scars from the lift. I would be ok with small hidden scars but nothing that goes beyond the border of the nipple and the skin. I have attached some pictures of my breasts. Can you tell me if what I am asking is reasonable?

A:  Unfortunately, there is a significant difference between what you need for a good breast result and what you want.  You are not alone in this position as many women need a breast lift but don’t want the scars. You have too much sagging to get a good result using breast implants alone. In fact, implants without a lift is going to make your breasts look worse not better. They will create a mound above the current level of your hanging breast tissue and will merely end up placing your nipple on the bottom half of the implants. This will create a breast appearance that you will likely not find better.  It will just be trading into a different type of breast deformity.

If you are not ready to accept scars as of yet, you can always have breast implants first and let the result prove to you whether that look may be acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am entertaining the thought of a breast lift only. So I am researching a little bit. I am 50 yrs old and have always had nice naturally large breasts but with age they are hanging low but not flat yet. I’m a Size D now. My question is with a lift only does the procedure reduce the size when they are lifted? I’m sure some liposuction etc is needed so that seems to me it would take them down at least one size naturally. Is that correct? I’m thinking it would not be so bad as with age our backs take a toll carrying them around our whole lives, so smaller could be a good thing. Thank you for your time.

A: A breast lift, in its purest form, does not reduce the size of the breast. It lifts it, tightens the skin envelope and moves the nipple position into a more central position on the breast mound, but it removes no breast tissue. This is what separates it from a breast reduction procedure which also removes a significant amount of breast tissue. But variations can be done to a breast lift procedure to provide both a lift and a small amount of breast reduction. It is this procedure that you appear to be seeking by description. This combination breast lift-reduction procedure involves the removal of between 100 to 200 grams of breast tissue which will reduce the size of the breast by a ½ cup or so. Liposuction can also be done on the side of the breast into the back, an area which is outside the direct effect of any breast reshaping procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to change the look of my breasts. I don’t mind having small breasts but I just don’t like the sag. Do you think a  breast lift alone will give me a good result? What are the benefits of implants with a lift? Is the combination better than a lift alone?

A: Your breast sagging and your questions about how to improve them are fairly classic. Your dilemma is not new and it can be hard to figure out what exactly to do. So let me break down into the structural problems. In sagging breasts, there are three elements to them that bother women. First is the lack of upper pole fullness. While a lift may make some immediate improvement, it will not be sustained. This is what implants are used for to create some permanent upper pole fullness. The next issue is the low nipple position that is either pointing forward but low on the breast mound or is pointing downward to the floor. This is what a lift does best, reposition the nipple back up higher and in a more centric position on the breast mound. Lastly, is the bottoming out of the lower breast tissue that hands over the lower breast fold. This also is what a lift helps with by removing skin and tightening the tissues on the lower pole.

This being said, I find in many cases that a breast lift alone can be disappointing particularly in the thin-skinned small breasted patient. It really requires an implant to create sustained upper pole fullness and some upward movement of the breast

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering what are the prices of your procedures I have been looking into mommy makeover for several years, (breast life/augmentation,tummy tuck, and some liposuction of the inner thighs and back flanks. I’m not looking to be a supermodel/size 6, I would be quite happy size 12 – 16. I just want a flatter tummy, non droopy boobs and thighs that don’t rub together. I have attached several pictures, could you please tell me what the cost would be, and if there is anyway to have our insurance company pay. I’m very depressed with the way I look, I just want my outside to reflect the way I feel on inside. I want to be that sexy person for my husband, and confident for myself. I hate trying to find clothes that hide my tire ring for a tummy, and replace pants because they got worn in the thigh area. I would also like to wear shirts without having my breast hang down to my tummy area. I need help, can you help me………..

A: Thank you for sending your pictures. I can not comment on your breasts since the pictures have a bra on but I will assume, for the sake of this discussion, that you need a full breast lift. Otherwise, you would benefit tremendously by having a full abdominoplasty to get rid of the overhanging pannus combined with liposuction of the flanks. This is the one procedure that will provide the greatest overall change. You do not have enough of an abdominal pannus to qualify for insurance coverage based on my experience. From a thigh standpoint, I don’t know that liposuction can ever take you to the point where your thighs don’t rub, that is not a realistic goal. Some improvement can be achieved in their fullness but to say they would not rub together would not be an accurate statement about the achievable result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have previously had breast implants placed below the muscle and donut lift around the nipple. While I thought that would be the best way to get my breasts uplifted and have a batter shape and avoid skin scars, it did not turn out like I thought it would. My breasts are too big and the nipples point slightly downward. I have read that the nipple can die in these more aggressive or full breast lift surgeries. Obviously I don’t want that to happen. What can I do or how should the surgery be done that would afford me the least chance of blood supply problems and loss of the nipple?

A:  When it comes to getting the sagging breast really uplifted, I have rarely found the donut breast lift very satisfactory. So I am not surprised that you have had a similar experience. The one important thing that you can do with any type of breast lift or reduction surgery is to not smoke before or after surgery. If you are not a smoker, great. If you do smoke, you should quite one month before and continue cease smoking for one month after surgery. Fortunately, your breast implants are below the muscle so the blood supply to the nipple has not been previously disrupted. This makes the potential problem with nipple healing after more extensive breast lift surgery unlikely.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dear Dr. Eppley, my breasts are slightly droopy and I want them to be more perky. I thought I needed a lift but one doctor that I consulted with said that I needed more volume in my breast instead of a lift. He said this could be done with an implant or fat injections. The length between my nipple to sternal notch is 22.5 cm. Should I have breast lift or breast augmentation? If augmentation is best, which treatment is better an implant or fat injections?

A: The key to knowing whether a lift or the addition of volume can make the breast look better depends on the position of the nipples. If it sits above the lower breast fold, then volume is the answer. While I do not know exactly what your breasts look like, knowing that the distance from your nipples to the sternal notch is only 22 cms tells me that your nipples are definitely above the inframamammary folds. That is essentially a completely normal or ideal nipple position. (the normal range is 18 to 22 cms depending in the length of one’s torso)

Since more breast volume is the answer, the question of whether it can be done with an implant or fat injections becomes very relevant. The use of fat injections for augmentation of a variety of body areas has become very popular in plastic surgery recently. While it is widely accepted for volume augmentation of the face and buttocks, its use in the breast is currently controversial. This is because there already exists an augmentation method that works well and is very reliable, an implant. For overall breast augmentation, an implant works better, is a one-step procedure, and will cost less. If there is just one area of the breast that needs filled in, then fat injections becomes the preferred treatment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am interested in getting breast augmentation. At 25 years of age with one child I have a height of 5’ 3” and a weight of 137 lbs. What size breast implants do you think I need? I have attached a picture of my breasts to help you decide.

A: In looking at your breasts, your most important decision about breast augmentation is not what size implant should be used. You have a moderate degree of breast sagging, meaning the position of your nipples is at or below your lower breast fold. Contrary to the perception of many, breast implants will not have a breast lifting effect. You are in need of some type of a lift if you are going to get breast implants. With implants alone your sagging breasts will be pushed lower, a look that I doubt you will find as an improvement. All breast lifts result in some scarring, a definite cosmetic liability. Whether larger and more uplifted breasts are worth the scars as a trade-off is what you need to think about first and foremost.

Dr. Barry Eppley

Indianapolis, Indiana