Your Questions

Q:  Dr. Eppley, I am a 32 year old female that is considering a breast lift. I actually have fairly large breasts being a 36D and with a bra on they look great. But when the bra comes off they look gross. They hang down like two old ladies. I had one Is It A Good Bad Sign If U See Ur Ex For The Past Week At The Same Time child ten years ago and nursed him and this appears to have put the whammy on their once nice shape. What I want is a more uplifted and better shape. I do not want them any smaller or larger They are the ideal size for my body shape in my opinion. Will a breast lift do what I want and is there bad scarring as a result?

A: Many women suffer from age and child-bearing a skin-breast tissue mismatch. As a result they have good size to their breasts but the stretched out skin gives them a low sagging appearance. While some breast sag is aesthetically acceptable, when the nipple sits below the lower breast fold it is rarely pleasing to anyone. This is exactly the condition where breast lifts work the best, removing excess skin and reshaping the breast so the nipple and the entire breast sits higher on the chest wall…many times back where it used to be. While there are some minimal incision breast lift procedures, they are only effective for the most minimal amounts of breast sagging. Most really effective breast lifts requires longer scars, much of which lies in the lower breast crease. Whether the part of the scar that goes around the nipple and vertically downward toward the lower crease is acceptable will vary amongst different patients. Seeing pictures of breast lift results with close inspection of the scars is critical for you to determine your level of scar tolerance.

Dr. Barry Eppley

Indianapolis, Indiana

Is It A Good Bad Sign If U See Ur Ex For The Past Week At The Same Time

Q:  Dr. Eppley, I had a breast augmentation done in November last year. Initially I was very satisfied with the results but now they are starting to sag and I need a breast lift. I remember that I had a discussion with my plastic surgeon before the surgery about doing a lift at the same time as my implants but I decided against it because of the scars that would result. Now that I am ready for a breast lift will I have to have the implants removed, have the breast lift performed, and come back at a later date for new implants? Or can the lift be done with the breast implants in place that I have now?

A: Many times modestly sagging breasts get by initially with implants alone. But when the breast tissues relax after being pushed outward, they slide off the implant creating ptosis off of the edge of the implant. If you are happy with the size of your implants and they are in good position, I see no reason why you can’t proceed forward with the lift with the implants you already have in place. Most likely, you will need a vertical breast lift to get the breast tissues up in proper position over the implants. While it is never a pleasing revelation that you will need  a second surgery to get the breast result you want, take solace in the fact that a breast lift is much easier to go through than the initial breast augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am in need of some breast help! I have had three children, all whom I have nursed. I have also lost 45 lbs over the past year through diet and exercise. This has left my breasts saggy. I know that I need a breast, that is without question. The only question I really have is whether I can get by with out breast implants.Do you think that’s possible with how my breasts look? I’m happy with the size of my breasts when I wear a good bra (currently 40D) but unhappy with how deflated and saggy they are without a bra.

A: Breast lifts do an excellent job of lifting and tightening the shape of the breast mound. By keeping the same amount of breast tissue and lifting and tightening the ‘bag’ which contains them, this does create a less saggy and more round breast. This is particularly true in the bottom pole of the breast and less so in the upper pole of the breast. In the beginning right after breast lift surgery, the upper pole of the breast is quite round and full.  But as the tissues relax and settle, much of the upper pole fullness will be lost.  If one doesn’t ming some rebound flattening of the upper breast pole, then I think you would be fine with a breast lift alone. However, if your goal is to have a rounder and more full upper breast pole long-term, then a small implant will be needed to accomplish that breast shape goal.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am 22 years old and my breasts are more saggy than I would like. I have not even had kids yet and they sag. I have a good breast size but much of it just hangs low. I have read about the crescent and Benelli types of breast lifts and was wondering if these would work for me. I have attached a front and side view of my breasts so you can see what they look like.

A: The decision to undergo a breast lift is an aesthetic choice between breast sagging and better shaped breasts that have scars. For some patients with very saggy breasts this can be a relatively easy choice. For other patients with more minimal sagging, such as yourself, that choice is a more difficult one. You have asked about the Benelli (donut) and the crescent lifts because they have the least amount of scarring of all the breast lifts. In reality, they are not breast lifts at all but really nipple-areolar repositioning techniques. They do nothing for lifting or reshaping the breast mound. They work best in cases where an implant is needed to restore breast volume and a slightly higher nipple-areolar position is beneficial. In your case they would provide no breast lifting benefit. More substantial breast lifting techniques are needed to really lift your breasts and that would involve vertical and maybe even horizontal breast crease scars as well. Given the amount of sagging that your breasts have and your young age, the trade-offs for a breast lift are very questionable. Iwould not recommend this procedure at your age. Wait until after you have had children when the need will be greater and the scar trade-off will be more convincing.

Dr. Barry Eppley

Indianapolis, Indiana

Q:    Dr. Eppley I’m a 30 year old single mother of two and I need a breast lift badly to improve my self-esteem.  I got pregnant with my first child at 19 and I gained over a hundred pounds.  I’m now back down to 150 and still need to lose more but I’ve lost 56 lbs.  My body just isn’t the same after two children and I just need some self esteem back. I already have a very nice size to my breast and am just looking to put them back where they belong.  Could you please give me information on what needs to be done to get my breasts back in shape and looking good again. Thank you for your help.

A: Between children and your significant weight loss, your breasts have undoubtably take a turn to the south. Breast sagging, known as ptosis, is defined by how low the nipples sit relative to the lower breast fold. When a large amount of weight has been lost (greater than 50 lbs), breast ptosis is usually severe and the amount of skin exceeds how much breast tissue exists to fill it. This usually requires a full breast lift which will result in the typical anchor scar pattern that is more commonly seen in a breast reduction procedure. This will move the nipple up to the center of the breast mound and will tighten the skin on the bottom side of the breast. While this lifts the breast, it will not usually result in permanent fullness of the upper pole of the breast. This is why a small implant may needed with the lift to get the fuller breast shape that many women desire from a breast reshaping operation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am looking to have what I think is called a Mommy Makeover. I have it on TV shows and read about it on the internet. For the breast implants, I am looking to have saline implants done.  I would like them placed behind the muscle if possible.  I am not sure what my ‘true’ cup size is.  I know it is between an A and B.  I would like to be a full C to a small D.  I do need a slight lift but I am concerned about scarring. I would like the incisions to be as discreet as possible. As for the tummy tuck, I think I only need a mini-tuck.  I have a little bit of fat in my lower stomach that stays and I cannot get rid of it.  I also have a little bit of stretched skin that needs to be removed.  I am looking to have the problem fat suctioned out and the muscles to be sutured back together and the little bit of stretched out belly skin removed.  After looking at pictures and watching animated videos on tummy tuck; I realize that my tummy problem is quite small compared to majority of the pictures I have viewed.  I am a small frame as it is.  I am about 5’2” and weight about 115 pounds.

The issues I have may not seem like anything to someone else; but they are BIG to me.  I look at myself each day and do not see a young beautiful woman.  I wonder each day how in the world is my husband still attracted to me.  I am wanting to do this for my self.  I would love to love myself again! Does this sound like it can be all done in a single operation?

A: Mommy makeovers are typically a combination of breast and abdominal reshaping. Improving the very problems that being a mommy has created. Saline breast implants can be placed from a remote incision high up in the armpit that will never be seen. The most limited incision breast lift is that of the superior crescent mastopexy, also known as a nipple lift. It puts a fine line scar at the top of the nipple only right at the junction of the areola and skin. Given your body frame size, you are describing perfectly what a limited or mini-tummy tuck accomplishes.

Both breast augmentation with a lift and a mini-tummy tuck can be done in a single outpatient procedures. The combination of the two truly makes for a new body for Mommy!

Dr. Barry Eppley

Indianapolis Indiana

Q: I came across your website, while doing research on cosmetic surgery.  I currently have depression.  After three pregnancies, I feel like my body is mangled.  I know that my self-image is what brings on most of my depression.  I know that depression alone is not a reason to have surgery. I have been treated for depression for about three years now.  I have thought about cosmetic surgery just as long.  After the pregnancies and losing weight, gaining weight, and losing weight, my belly definitely needs a tuck.  I breastfed all of my children.  I breastfed only for about 2 months with the first child but about a year with the last child.  With breastfeeding and losing weight; I barely have any breasts at all.

I am only 28 years old.  I want to feel young and beautiful again!  I know I deserve to and my husband deserves to have a wife who feels good about herself again.  My kids deserve a mother that feels comfortable enough to take them swimming. I would love to be able to eventually wear a bikini.

I know that some people may get depressed after they have surgery; whose to know how I will be after surgery.  Seeing that a lot of the causes of my depression are due to the way I feel about myself or view my body. I know surgery could not make my depression worse; if anything it will help improve the way I see myself and think about my body.  The only way surgery would worsen my depression is if I had surgery by a surgeon who did a lousy job.

I am not interested in looking fake.  I just want to look normal again. I would like to either be a full C or small D regarding my breast.

I suppose a ‘Mommy Makeover’ is what I am really looking for. What are your thoughts?

A: Of your situation and feelings, I understand completely and could not be more emphatic. Pregnancies can definitely take a toll on your body, and between the skin stretching and shrinking and the inevitable breast involution (loss of breast tissue), some women can not even recognize  the current skin and body that they now have.

As you have correctly pointed out, surgery is not a cure for depression. But at least it can improve one recognizeable and understandable cause of it…the way one looks. The body problems can definitely be improved and, hopefully with that, one’s self-image elevates. In my experience with women and these type of popular ‘Mommy Makeovers’, patient do report a dramatic improvement in their self-confidence and clothing options.

The classic ‘Mommy Makeover’ is some form of combined abdominal and breast rehaping plastic surgery procedures. This is usually a tummy tuck with or without liposuction and breast implants with or without a lift. In about a four hour surgery (or less), a dramatic body transformation can occur.

Dr. Barry Eppley

Indianapolis Indiana

Q : I am trying to research plastic surgery on nipples but am having trouble. What I am looking for is a remedy for droopy nipples. I am 49 and breast fed my son for 3 and 1/2 years when I was about 30. As he fell asleep he tended to grit his teeth. Because of this and some some loss of size of my breasts there seems to be extra skin around the nipple area and my nipples lay down rather than remain perky (unless it is quite cold). Also, if I raise my arms, they can look like the skin around an elephants ankle. Is there a surgery for this. If so, what is it called. I would like to research it before jumping into things.

A: The extra skin around your nipples is the result of pregnancy and breast feeding. (the gritting of your baby’s teeth had nothing to do with it) Both conditions result is loose breast skin which is most noticeable around the center area of the breast mound where the nipple happens to be located. Depending upon the amount of loose breast skin, there are a variety of breast lift or breast tightening procedures to consider.

If the breast is not too saggy (the nipple still lies at or above the lower breast skin), a periareolar mastopexy may be all that is needed. Sometimes called a ‘donut mastopexy’, a ring of skin taken from around the nipple and the breast skin circumferentially tightened back up against the nipple. This results in a fine line scar around the outside of the nipple.

If the breast is very saggy (nipple lies below the lower breast skin), then  breast lifting techniques are needed to remove and tighten skin that will leave scars that run down from the nipple and into the lower breast crease.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I want to have a breast lift, liposuction on my stomach,thighs,buttocks,under the arms,between my chin and lower neck line, an eyebrow lift, and some under the eye work. (dark and somewhat deep and little wrinkles) I am a mother that is curious of amount of the cost. I’m not even sure that I can afford this but I truly have self esteem issues. My weight topped out at 202 lbs but I i am now down to 178 lbs. I have always been one to want to look and feel good about myself and I do not feel that way at 35 yrs old. I am too young to feel this bad about myself!

A: How we feel about ourselves is one of the most important characteristics of a person. While inner beauty and well-being is all that really counts, there is no doubt that how we look on the outside affects how we feel on the inside. Your plastic surgery wish list is comprehensive and, affordability aside, all of that could and probably should not be done in  a single surgery. Therefore, it is important to prioritize this face and body plastic surgery wish list. The best way to approach that, and is what I discuss with all my patients who want an extreme body makeover, is to ask yourself this question. If I could only do one plastic surgery operation and could never return to the operating room, what procedures would you do on this list? I say pick just three and even put those in order of importance to you. Whether you would ever get to phase 2 or not is unknown, but if you don’t, then you will have accomplished the most important changes anyway.

Looking at your list, I can divide it into body and face work. While I am not you, most likely the body work is of greatest importance to you because you have listed/described it that way. It appears that a breast lift (with or without implants) and some abdominal and waistline contouring are your prime targets for change. It may also be possible to do so thigh and arm liposuction at the same time if your budget allows for it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am very interested in breast augmentation.  I have been pregnant four times and between weight gain and loss my breasts are in need of some repair.  Do you think I will need a breast lift also?

A: The anatomic determination of whether any breast needs lifting is based on where the nipple is sitting relative to where the lower breast crease or fold is. If the nipple is at or above the lower fold, one will not need a lift in combination with breast implants. If the nipple sits below the fold, whether it be a little or down so far the nipple points to the floor, then a combination implant and lift will be needed to get a well shaped breast that has the nipple centrally positioned on the mound and pointing forward.

When a women has had more than two pregnancies, it is almost a certainty that a breast lift will be needed. I do not recall ever seeing in my Indianapolis plastic surgery practice a patient with three or four pregnancies who has not needed one. When you combine the number of pregnancies with up and down body weight, there has undoubtably been a lot of stress and strain on the breast skin. This translates into breast skin that is loose, deflated and has a low nipple position. This will happen to most breasts whether one has breastfed or not.

A breast implant will add volume to the mound but will not significantly lift a downturned or low nipple position. That is exactly what a breast lift does…get the nipple back up to where it once was or close to it. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: How come with breast augmentation the work seems flawless with no scarring at all. But with a breast lift, there appear to be scarring and are not always even. Your augmentation is beautiful, the best i’ve seen so far. I dont think I need an implant because I am already a DD.

A: Breast augmentation is virtually scarless because the small incisions that are used to pass the implants through are placed in very unnoticeable areas. Whether it be in the lower breast crease, around the nipple, or in the armpit, they are undetectable except on the very closest of inspections.  Breast implants do all the work of making the breast, including its new shape, and this makes it almost scarless.

Conversely, breast lifts must create their reshaping effect by removing skin. Because all aspects of the breast skin are in view in a well shaped breast mound, the scars are much more visible. In a typical breast lift, the scars will run around the nipple and vertically down to the lower breast crease. In more extensive breast lifts, the scar may also run along in the lower breast crease.

Unlike breast implants, which are symmetric in shape to start with and can be equal in volume, breast lifts are much more artistic in execution. They require a lot of judgment in how and where to cut the skin and, as a result, can not be expected to be as perfect in shape and symmetry as many breast augmentation results. 

Dr. Barry Eppley

Indianapolis, Indiana

Q:  My breasts are in terrible shape after having had 4 children and nursing them all. They are saggy and disgusting. I think they need a total breast overall. They look so bad I don’t even know if they can be helped. I have read about breast implants, breast lifts, and breast reductions and I think I need all three. Is it possible to have all three of the procedures I am asking for done at the same time?

A: The combination of a breast lift (skin reduction and tightening) with an implant is a very common procedure for the breast that is small in volume but has an excess amount of skin that sags over the lower breast crease. With the breast in this kind of shape, all three procedures are needed simultaneously to give a more pleasing and uplifted breast shape. This is the most difficult of all cosmetic breast procedures and is best thought of a breast reconstruction rather than a simple breast reshaping.

Unlike breast implants alone, this more extensive form of breast reshaping will result in scars on the breast. The scars will be similar to that of a breast reduction. Because of the difficulty of the procedure, secondary revisional surgery is not rare to get the best shape and symmetry between breasts that often start off not only badly shaped but different.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  I am a 31yr old mother of two kids. I got out of a five year relationship where I got too comfortable and gained a lot of weight. About six months ago I started working out and lost over 30lbs along with a strict diet. I still have about 25lbs to go to reach my goal weight but I know that dieting alone will not give me the final results I want. I am interested in a tummy tuck, a monsplasty, and breast augmentation. I was born with one breast about 1 cup size bigger. I would like them to be equal in size along with a lift. Can all of these procedures be done in a single operation?

A: Congratulations on the results you have obtained so far. It is always surprising what effort and discipline can do for one’s weight. You should be proud that you have gotten this far. In pursuit of your goal weight, think of the plastic surgery as an incentive to get there.

The first step in body contouring is weight loss but this alone is often not enough to get the shape that one wants. There is no better combination than a combined breast and abdominal procedure to change a woman’s appearance between the shoulders and the waistline. In a few hours of surgery, some dramatic changes can be obtained. Putting these two operations together is very common and I have done it many times in my Indianapolis plastic surgery practice.  Breast enhancement and tummy tucks together can still be done as  an outpatient procedure.

Many larger tummy tucks require reduction of a large mons at the same time. It is done as part of the tummy tuck by modifying the location and orientation of the lower incision. Complete mons reduction may still require a secondary liposuction procedure for optimal flattening. Breast enhancement in most significant weight loss patients requires a combined lift with an implant, known as an augmentation mastopexy.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I have breast implants originally placed in 2002. I got pregnant shortly afterwards and once I delivered my breasts changed afterwards and I developed some drooping. So I went back and had new implants placed in 2007 that were bigger and helped to fill out some loose and droopy skin. After having these implants for a while, I have decided that I want to go back to my original augmentation size. But I fear in doing so that I will get saggy breasts again. What do you recommend?

A: Going up in breast implant size is always easy because loose skin is expanded and filled out. While breast implants alone are often not the sole solution to a really saggy breast, they do help tremendously and are very forgiving of less than ideal breast skin.

Going down in breast implant size, however, is not so forgiving. Even the smallest amount of loose or droopy breast skin will get much worse as the ‘balloon deflates’ so to speak. As a result, some form of breast lift is often needed in many breast implant downsizings. What makes this aesthetically difficult is that this will involve creating breast scars which is another form of a cosmetic breast deformity.

If the nipple is fairly centered on the breast mound, a smaller implant replacement may not involve any type of lift or only a very small one such as a nipple or circumareolar type lift. If the nipple is off-center  or points any amount downward, then a more significant lift with breast skin scars may be necessary when the breast implants are down-sized.

Dr. Barry Eppley

Indianapolis, Indiana

Q : I would like perky and fuller breasts. I have had three children and my breasts have just lost everything. They are so saggy and droopy they are disgusting. I am so embarrassed about them I won’t even let my husband see them. My right breast is also different than the left. It is bigger and more saggy and the nipple is much bigger. I know I want implants but I think I may some sort of lift too. Can you tell me how bad the scars will be?

A: The need for a lift with the use of breast implants can be determined by one simple anatomic measurement…where does the nipple sit relative to the lower breast fold. (inframammary crease) If the nipple is above this level, an implant alone will give the breast a good shape with the nipple reasonably centered on the new larger mound. If the nipple sits at or below the fold, then an implant will make the breast bigger but the nipple will be on the ‘southside’ of the mound. (i.e., pointing downward)

There are essentially four types of breast lifts based on how much the nipple needs to move upward. They are with their resultant scars; type 1 superior nipple lift (scar on top part of nipple), type 2 circumareolar lift (scar 360 degrees around the nipple), type 3 vertical breast lift (scar around the nipple and vertically down to the fold) and type 4 full breast lift. (around the nipple and vertically down into the fold and then horizontally along the fold, an anchor scar pattern)

In general, breast lift scars usually turn out pretty well. The scars around the nipple and along the inframammary fold do the best. If a vertical breast scar is needed between the nipple and the fold, this is the one that has the most potential to widen due to the constant pulling by the weight of the breast against the scar. Most breast lift scars revisions involve that scar if needed.

Dr. Barry Eppley

Q: I have one breast that is quite a bit larger than the other one. I am way too embarrassed to wear a bathing suit or even go out with men for more than a couple of weeks. (I don’t let my relationships, go to the next level so to speak, in fear that the guy will totally freak out and embarrass me even more if that is possible because I already feel pretty bad about myself!) Anyway I was wondering if you could enlarge just one of my breasts?

A: While few women have breasts that are perfectly symmetric, congenital or developmental breast asymmetry is another matter. In this condition, one breast is significantly larger than the other often by several cup sizes. In its most severe form, there is a medical condition known as Poland’s syndrome where the breast and the underlying chest muscles on one side fail to develop much at all.

All forms of breast asymmetry can be significantly improved through modern breast surgery methods. In some cases, the smaller breast may be merely enlarged by the placement of a breast implant. In other cases, differential enlargement of the breasts will different implants sizes may be better.

Often times, however, the differences between the breasts is more than just that of volume. The larger or more normal breast will have more skin and a different size and position of the nipple on the breast mound. Optimal correction may require adjustment of the more normal breast as well through a lift or nipple elevation.

 Dr. Barry Eppley

Q: I am interested in getting breast implants. I am 34 years old, have had three children and my breasts are just not what they used to be. They are smaller and now droop. They are disgusting to look at and are nothing like they used to be when they were nice C cups and round. I want to get implants so my breasts can look like they did before. Is this possible?

A: The concept of looking like you did before is an understandable one but may not always be possible. The reason is that the breast skin and breast tissue you now have is different than what it used to be.

Women considering breast augmentation almost always fall into two main types; those who have always had little breast tissue whether they have ever been pregnant or not (type 1)…and those  women who have lost their natural breasts and have developed droopy smaller breasts due to childbearing and nursing. (type 2) The results of placing a breast implant will be different for each type of patient. Type 1 patients will do fine with a breast implant alone and will often get the more ideal breast shape result. Type 2 patients may need a breast lift in addition to an implant to get a better shape with a good nipple position. It is this consideration of a lift and breast mound scarring that will often catch the Type 2 patient by surprise.

It is important to appreciate what a breast implant can and can not do. Implants do a superb job of making the breast mound bigger. But they have very little ‘lifting’ ability. The only lift effect that can occur is from inflation of the breast mound and this will move the nipple up a little. The operative word here is…a little. Significant movement upward of the nipple for most breast ptosis patients is a matter of at least several centimeters, not millimiters.

Dr. Barry Eppley