As we get older, our skin loses its elasticity and becomes lax. These aging changes, along with factors such as pregnancy, breastfeeding, and weight changes, cause the breasts to lose their firmness, shape, and position. If you're interested in repositioning your nipples and addressing the sagginess of your breasts, a breast lift may be the correct procedure.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of cosmetic breast surgery. This includes, Dr. William P. Adams, creator of the Tissue Based Triad Augmentation-Mastopexy technique, dual-plane breast augmentation, and pioneer in the use of biological mesh support in cosmetic breast surgery.
Dr. Couto has also authored book chapters and publications in peer-reviewed journals related to breast implants, breast augmentation, breast cosmetic surgery.
A breast lift, also known as a mastopexy, is a procedure designed to rejuvenate the breasts by restoring their position and form. Furthermore, it also reduces the size and the aesthetic shape of the nipple areola complex. In this procedure, loose skin and soft tissue around the breast and areola are removed and tightened to lift and reshape the breast into a natural and aesthetically pleasing look. A breast lift does not increase the volume of the breasts, since no implant or fat is added. If you are interested in increasing your breast size and/or accentuating your breast cleavage, a breast augmentation with a lift may be indicated.
The consultation is divided into 4 parts:
1) Health and Medical History Evaluation
During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Although this procedure is short and relatively low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks must be essential.
2)Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet our patient’s expectations. We focus on learning whether the patient is interested in just lifting the breast or if she is also interested in adding volume with an implant or fat . We always like to emphasize to the patient that a breast lift does not increase the volume of the breasts, it just strictly lifts and reshapes the breast and nipple-areola complex. If in addition to lifting the breast, the patient is interested in volumizing and enhancing the cleavage, then a combined breast augmentation with a lift (hyperlink) may be required.
3) Breast Analysis & Surgical Recommendations
A comprehensive breast analysis is performed. In this part of the consultation, our goal is to determine whether the patient is a candidate for a breast lift, a breast augmentation, or a combined breast augmentation and lift. We examine the size, shape, and descent of the breasts, identify any existing breast or chest asymmetries, and evaluate the contour and proportion of the breasts in relation to the body. After the examination, Dr. Couto discusses with the patient his recommendation and explains in detail everything involved with the procedure and its recovery. If the patient is also interested in volumizing her breast with an implant, then we use 3D-imaging technology (hyperlink) to determine the correct breast implant. This 3D simulation system enables us to determine the correct breast implant size/shape and show the patient how the breasts could look with the selected implants.
4) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and review the steps involved to book the procedure with us.
Skin Incisions:
A common concern of a patient seeking a breast lift is the location and size of the scar. The principal cause of a droopy breast is the presence of excess lax skin. Therefore, in order to lift the breast and nipple, that loose skin needs to be removed and tightened. That means an incision needs to be made and a scar will be produced. The tradeoff of restoring the shape and position of the breast is having a scar. This scar typically heals properly, is well concealed, and most importantly, outweighs the benefit of a rounder, fuller and younger breasts.
There are three types of skin incision tecniques that Dr. Couto uses to perform a breast lift:
Breast Lift with Mesh Support:
A breast lift with mesh support is a variation of a traditional breast lift, where soft tissue support is added to slow down the aging changes that will naturally occur after surgery.
Following any breast surgery, the skin will continue to age and the breasts will continue to be exposed to gravity. Therefore, with time, the breasts will take their natural course and will descend. An effective way to delay this effect is by adding a soft tissue support to the breast. This is achieved with the use of a biological mesh (Galaflex Ⓡ) that is placed in the breast at the time of surgery, serving as an internal bra. With time the body absorbs this mesh and leaves in place a reinforced layer of collagen.
Patient with:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we thoroughly review the patient preoperative/postoperative instructions and the medication regimen. We also schedule post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products can affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 6-8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We have a detailed postoperative protocol to ensure that the patient has a comfortable and quick recovery. Following surgery, it is common to feel soreness and sensitivity around the surgical site; however, this is easily manageable without the need of narcotic medications. Furthermore, we start all our patients in a scar therapy regimen to optimize the healing process and obtain the best scar results. We recommend our patient to take 5 days of work (less if working from home) and avoid lifting anything heavier than 10 pounds. Patients can resume their aerobic exercise (e.g. running, walking, spinning, biking) 2 weeks after surgery. However, you will be able to begin your gym exercises and full activities 6 weeks after surgery. Although the final results of the breast lift can be seen within 3 months from surgery, the final appearance of your scars will be observed 1 year after surgery.
A breast reduction is indicated for patients experiencing symptoms associated with a heavy breast, such as neck/back pain, skin rash, etc. Consequently, in a breast reduction we remove excess mammary tissue to make it smaller and lighter, but also we lift the breast and nipple/areola to an aesthetic pleasing position.
On the other hand, a breast lift is performed on patients that are strictly bothered by the saggy and droopy appearance of their breast, not the size or weight. In this procedure we are just lifting the breast and nipple and making it perkier. Breast tissue is not removed in a breast lift; therefore, the breast size and weight continues to be the same.
Surgical drains are rarely used for this procedure. If surgical drains are placed, they are usually removed 3-5 days after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly and increase risk of infection. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HgbA1c of less than 7 are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6-8 weeks before surgery.
