Your Questions

Q: Dr. Eppley, I am having trouble deciding whether I need a breast lift alone or should have implants with it. I am 35 years old, had 2 kids and am a fairly full 34C. I do struggle to keep them in a C bra however. While I am happy with the size of my breasts I am not so with their shape. I just want back my fbreasts back up where they used to be and were nice and perky. I know I need a lift but am uncertain about whether an implant is necessary? I have several plastic surgery consutations and have been given different opinions, one says I definitely need it the other I cn have it or not. Neither doctor seems to be able to explain why in terms that I can understand and, quite frankly, they both seemed a little uncertain themselves. 

A: The breast issue that you have is a common one, once full breasts have fallen even though they have not necessarily gotten smaller. This has happened because of two breast tissue changes, there is now more skin and less internal breast tissue. That combination makes the change from a perky to a saggy breast. While you are happy with your breast size now know that they appear the same size because of the extra skin. When they are lifted, the breasts may appear smaller because a lot of extra skin has been removed. While breast lifts do not remove volume, this is why some women will have the perception that their breasts are a little smaller after a lift. There is also the longer term issue in that most breast lifts will lose the initial upper breast fullness that exists right after surgery as they settle with tissue relaxation. The role that a small breast implant may play for you then is in maintaining upper pole fullness and avoiding the fear that you may look a little smaller after a lift alone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had a lap band for about 5 years and I have lost about 90 pounds and basically kept it off give or take an occasional 5 to 8 pounds. I would very much like to get rid of the remaining skin and fat in my stomach and upper torso area. I am searching for a surgeon who has quite a bit of experience with these procedures. I was planning on a local plastic surgeon do it but he is moving out of state and is booked solid. I only know of one other Dr. in this area who has extensive experience in this procedure on drastic weight loss, however, I do not choose to have him do this for me. I have consulted and been examined by my initial plastic surgeon about one year ago and he approved me for the surgery. I just was not quite ready at the time. I am now.  I am 66 years old. I am very active and always have been and am in very good health.
I would like to know if you are accepting patients from central Illinois, and if this is something that we can talk about the possibilities and the possible concerns of my not living in your area. I will likely have to self-pay, since my insurance company was approached as to if I would be covered for this procedure, and I was denied. They feel that it is cosmetic and not a necessity. Therefore I would also like to be informed of the cost involved. I would also like to have my breasts lifted and was wondering if it is possible to do both surgeries at the same time and the cost of that procedure as well. I think you in advance for your time and consideration.

A: Congratulations are your weight loss and, equally importantly, the ability to have maintained it. With a near 100 lb weight, you undoubtably have many of the typical findings that one would expect with  a resultant abdominal pannus and significant breast sagging. While I would ultimately need to see some pictures  of you to confirm your exact surgical needs, having done a lot of extreme weight loss patients (bariatric plastic surgery) over the years I can envision with some certainty as to your needs… an extended tummy tuck and full (type 4) breast lifts. It is very common to do both of those procedures together and it is safe to do so.

I have patients that come from all over the world for a variety of procedures so we are very familiar with how to handle patients from afar and can accurately foresee their needs and how they must be accomodated from afar. Doing a tummy tuck and a breast lift in a 66 year-old from afar would need to be done as an overnight procedure in our facility. The extent of the procedure (it is surprisingly not that painful) and your age mandates overnight observation for your medical safety. Whether you would then go directly home the next morning or stay just one more night in a local hotel is an issue to be discussed and also based on how you feel. You would go home with abdominal drains (you would have breast drains but those would be removed the next day) and those would need to stay in for 10 days at which time you would come back to have them removed. We follow all of our patients carefully using e-mail, photographs and texting, available 24/7, to handle any questions or needs. Thus you may be far away but are electronically just a click of a button close. All incision are taped so you have to provide no care to them and can shower with 48 hours, getting all tapes wet without any concerns about doing so.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am looking to get breast augmentation and mastoplexy. What do you charge usually? And what type of lifts do you preform?

A: In trying to determine cost of a combined breast implant-lift procedure, there are several variables in that combination that affect cost. One is what type of implant (saline vs silicone) and the other is what type of lift is needed. These two issues significantly affect cost due to a material issue (implant) and the time it takes to perform the procedure. (lift) Thus there are a wide range of price differences (thousands of dollars difference) when these two issues are factored into the cost equation. I would really need to know what type of implant you want and would need to see pictures of your breasts to determine the degree of sagging you have and the type of lift that is needed to improve its shape. There are four basic types of breast lifts which differ based on how much lift they create and how much scar results from doing it. So it is not a question of what type of lift I perform (you have to be able to perform them all) but what type of breast lift you need.

But for the sake of information, I will have my assistant pass along the costs of a combined silicone breast implant and vertical (lollipop) breast lift which is the most common need/request that most women have.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m 38 years old and had 3 children by age 22 that I breastfed. I have small breasts which is cool with me, I just want them a little perkier. My tummy and love handles need to go. I can work on my legs in the gym and they have always been strong. Can my breasts, tummy and love handles all be done at the same time?

A: When you put breast and tummy reshaping together as a single procedure, that has become known as a Mommy Makeover. Most forms of breast reshaping include implants with some type of lift although breast lifting can be done alone. If volume is not an issue then breast lifts by themselves will be just fine. Tummy tucks, mini- or full versions, almost always include liposuction of the flanks. (aka love handles) Most people envision a near circumferential waistline reshaping and tummy tuck scars stop at the hips. So fat reduction beyond that needs to involve liposuction to extend the 180 degree effect of a tummy tuck into more of a 270 degree wrap around waistline effect. It would be very common and would have a more profound body change if what was affected by pregancies is reversed in a single operation. This explains the popularity and the effectiveness of the Mommy Makeover of which you desire.

Dr. Barry Eppley

Indianapolis, Indiana