In the last installment of my on-going blog about the “Mommy-Make-Over”, I discussed facial treatments for melasma, stretch marks, and tummy tucks. In this segment, I would like to address breast procedures that are often part of a “Mommy-Make-Over” package.
Before I start, let’s kill some myths. Myth #1, while nursing is good for your baby it is bad for your breasts. If all breasts behaved the same with every pregnancy, this may have some truth to it but the fact is that every woman’s breasts behave uniquely with each and every pregnancy. For some women, after completely nursing their babies, their breasts “snap” right back into place with very little changes. For others, their breasts will undergo changes such as shrinkage, drooping, or they may even get larger. There is just no set pattern as what changes will occur with nursing. From what I have been told by lactation nurses, the one thing every nursing mother should do to give her breasts the best chance of “surviving” nursing is to make sure she wears a well-fitted nursing bra and make sure she has more than one bra. From what they say, too many new mothers buy one or two nursing bras and use them over and over until every bit of support is worn out of them. Yes, they are not the most fashionable bras and they do cost more than most regular bras but think of them as an investment according to the lactation nurses. What happens if you chose not to nurse? Will this prevent any changes from occurring to your breasts? NO! Just the hormonal influences of pregnancy and the engorgement around delivery can result in some of the same changes to a woman’s breasts blamed on nursing. So it appears that nursing gets a bad rap. Again, the nurses also state that wearing a well-fitted maternity bra is important and of course, the same rules apply about not wearing the maternity bra over and over again until it has no left in it.
Another of my favorite myths is that your breasts will behave the same way with each and every pregnancy. If that were true then each pregnancy would be the same. No; each and every pregnancy is different for the breasts. Past history is exactly that-past history.
Then there is the myth that one sex is worst for your breasts than the other. I have heard it both ways, that boys are worst than girls and vice-versa. How this one got started, I have no clue but it has no validity.
Ok, so what are the most common changes that occur to the breasts after pregnancy? The most common changes are shrinkage-a process called involution by doctors, drooping-called ptosis by doctors, nipple-areola enlargement, and breast enlargement. There are other problems that can also arise but these are less common than the above concerns. So what can be done to correct these breast changes and when should you seek to make these corrections? As far as timing of any procedure, you do need to have completed nursing and the breasts should have a period of recovery allowing them to return to their new baseline before any procedure can be performed. For most women, this usually is around three months after they stop nursing but the exact timing is highly variable. In rare cases, the breasts continue to lactate long after the woman has stopped nursing and may require a visit to her OB-GYN for possible medications to assist with “drying up” the breasts but this is very infrequent.
Once the breasts have receded from being enlarged and engorged with pregnancy and possibly nursing, then it is possible to consider procedures to rejuvenate the breasts. Some patients ask if they should complete all childbearing before they have a breast rejuvenation procedure but that really is a case-by-case situation. If she is planning to have more children soon after her last delivery, then she may be advised to consider waiting until she has completed all expected childbearing before proceeding. On the other hand, if she expects not to have more children for a number of years, then she can consider a breast rejuvenation procedure. After all, why should she have to live breasts that she is unhappy with for many years just because she wants to have more children at sometime in the future? I am aware that these things-(pregnancy)-can not always be planned but given the medical options available today, women have far more control as to the timing of their childbearing than they ever have had in the past.
Let’s assume the woman is now ready to proceed with breast rejuvenation: how does she start the process of determining which treatment is right for her? First, she should obtain a consultation with a doctor board-certified in plastic surgery by the American Board of Plastic Surgery. All four of the plastic surgeons at St. Louis Cosmetic Surgery are Board-Certified Plastic Surgeons and members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. During her consultation, she and her plastic surgeon will determine which breast procedures may be correct for her and what options are available for her to consider. For many women with breast tissue shrinkage-(involution)-a breast augmentation using a saline-filled, a silicone-gel filled, or a “cohesive”-gel filled implant will be the treatment of choice. Which type of breast implant is the best implant for each patient is highly variable and has to be individualized by the plastic surgeon and the patient. There simply is no “best” type of breast implant as each type of implant has some advantages and also some disadvantages. The plastic surgeon and the patient need to work together to decide which advantages they want and which disadvantages they are willing to tolerate to have these advantages. (This really is a subject for a whole number of blog pages-maybe soon.) There is also a myth that if a woman’s breast have sagged that by just adding a big enough breast implant, the breasts will “rise up” eliminating the need for a breast lift. Sadly, this is not true for most women. After all, breast implants are not filled with hydrogen or helium so they are not lighter than air. Breast implants have weight and the concept of trying to make breasts rise up by adding even more weight after they have sagged because the stress of too much weight really seems illogical. Yes, if the breasts have slight or mild sagging after pregnancy, then a breast implant alone may correct the problem but if the there is more to the drooping than described above, a breast lift-called a mastopexy-may be the best choice.
What exactly is a “breast lift?” The formal name for a breast lift is mastopexy. A mastopexy is a surgical procedure that is designed to lift the nipple-areola complex back up onto the breast mound and remove and tighten the loose skin and tissues of the breast. There are many variations of mastopexy/breast lift procedures and that is because there are many variations of how women’s breasts droop and sag with childbearing and maturing. Some of my patients come to my practice thinking that one style of breast lift will work for all shapes and sizes but just as every woman’s breasts are unique and different, so too must be the procedures to correct the issues associated with drooping and sagging. Of course, the goal is to use the most minimally invasive technique that is correct for each patient but what works for one woman will not work for another. The incisions for a mastopexy/breast lift can vary with some being as small as a short incision just above the areola to some going around the areola and then downward under the breast in an upside down “T” shape. There are many variations of incision shapes and sizes between these two extremes. Which one is right for you will depend on your goals and what you and your plastic surgeon feel is best for you to regain your desired breast shape. One word about the incisions: they are placed in locations that usually hide very well even when you are undressed but just as with a tummy-tuck, the incisions will fade and blend in with time. You, as a patient should not let your fear about the incisions get in the way of obtaining a much more natural and aesthetic breast appearance.
Can you have a breast lift and a breast augmentation at the same time? Again, there is no clear answer to this question. It varies from patient to patient and from plastic surgeon to plastic surgeon. Some plastic surgeons feel they have more control and less risk over the final result of a breast lift and breast augmentation if they separate the two procedures into two separate surgeries. This, of course, requires two separate operations with two separate anesthesias with two separate recoveries. Many patients are unhappy with this concept and they are also sometimes confused as to why one plastic surgeon will do both procedures at the same time and another will not. It is often a matter of the comfort level of the plastic surgeon. If the plastic surgeon feels they can accomplish both the breast lift and the breast augmentation safely in one procedure, then they will probably do so since it is more convenient and cost-effective for the patient. However, if in the opinion of the plastic surgeon it is safer or a better result can be achieved by performing the breast lift and breast augmentation in two stages, then that is what they will recommend. Again, the treatment has to fit each patient uniquely.
I know this was a lot of material about breast lifts and breast augmentation after childbearing but each “Mommy-Make-Over” has to be designed specifically for each patient since just like those little babies, no two are the same.
Herluf Lund MD