The breast lift that lasts without implants or mesh [Austin Hayes, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. How many variations of breast lift surgery are there out there? Now, what are the traditional names for those breast lifts? And then could you talk about how yours is different from those?

Dr. Hayes (00:15):
The typical breast lift, there's three slang terms for a breast lift, and essentially what they're referring to is the incision pattern. So many people will make an inquiry to our office and talk about a donut, a lollipop, or an anchor. And they're referring to the scar pattern. So a donut, no surprise, has a scar that only goes around the areola, and then a lollipop has that scar plus a vertical scar. And then an anchor has, of course, the addition of a scar within the crease. Every surgeon has their own opinion. I don't like the donut at all. The donut essentially uses two concentric circles. It takes a larger circle and shrinks it down into a smaller circle. And the way that it does that is with typically a permanent suture and it can flat in the breast, it can lead to aerial spreading. It just has a complication profile that I don't like, and it's not powerful enough to accomplish anything that I'm trying to accomplish.

(01:12):
The lollipop, it's not that they don't look beautiful, they do. It's just a more totic looking breast to me. It's not a breast shape that I'm ... Essentially in breast lift, I think you're always trying to create the tightest and perkiest look you can because things might settle over time. So I want to start with that kind of ultra tight envelope. And the way I accomplish that is through the anchor incision. And so that extra incision in the scar is for me where all my magic isn't the right word, but all of the structural support is coming from. Securing the fold with a stitch, finding the layers of tissue, creating the two additional hammocks. So all of that is occurring through the anchor.

Eva Sheie (01:55):
Does this technique result in results that last longer?

Dr. Hayes (01:59):
The mesh, typically a mesh called Galaflex. Now there are other meshes and there's new meshes coming to market all the time, but the most common, at least that I've seen is using a mesh called Galaflex. That lasts about three years, but when it absorbs away, it leaves behind a stronger layer of tissue. Does that tissue soften and weaken over time? That I don't know. So I would imagine that mesh though lasts a good amount of time. I think the issue that I see when using mesh is that there's three components of a beautiful breast. There's a plastic surgeon in Europe who wrote a paper filiblondeal. And he wrote a paper about how you ... Essentially a way of thinking about the breast, having a strong footprint, having even fill consistency, and having a tight skin envelope. The issue with mesh is that mesh supports the volume, it supports the breast tissue.

(02:52):
What you still don't have is the tight skin envelope because as surgeons pull the skin many, again, I can't speak for all surgeons. As you pull the skin down and you're trying to make this very tight envelope, what you're doing is placing too much load on the fold. You're placing too much load on the tissue that's below the incision, essentially the upper abdomen, and you pull that up. And so that construct is not strong. And so mesh kind of solves the volume distribution issue of creating the ideal breast. It doesn't solve the perimeter problem and it doesn't solve the tight skin envelope. Whereas what I created solves all of them. First bra, second bra, third bra, all address different versions of that, but perimeter, volume distribution and tight envelope are all idealized in my opinion. And you can see it. One of the things that's really interesting is when I came up with the second one, one of the things that I was finding is that because it secured the skin envelope so tightly that the lateral breast sweep, so essentially the side boob that ... Say it as my patients know it.

(04:03):
The side boob shape, breast lifts tend to look boxy or they can look boxy. Mine look curved and it's because it pulls so strongly, it creates this sweep. And once patients know to look for it or that it's essentially a component of a beautiful breast, they start seeing it and they pick up on it and that's from the second layer.

Eva Sheie (04:27):
The traditional techniques for breast lift specifically, it sounds to me like, and you'll have to tell me if I'm right or wrong here. You could get a breast lift with a traditional technique. Your breast is going to fall again and you might have to do it again later.

Dr. Hayes (04:43):
People are generally very happy with their breast lift. I think because a breast lift, even a traditional breast lift is so transformative, the nipple has moved so much, the extra skin at the bottom has been removed. It's overall tighter and more lifted. So people are generally really happy. They look at their results early on, so let's just call it the first month and they see a shape that just completely blows their mind. Now, as they continue to heal and their breast tissue now falls against the crease that hasn't been supported, it completely changes. So the nipple's still in a great spot, but the volume is falling out. So they're losing volume at the top and they're losing cleavage. Now, most patients probably think that's a part of it. What it is. That's what a breast lift does. I think my patients have a look at a week and yes, that changes a little bit, but a little bit because they don't fall anymore.

(05:35):
They just sit. And so when you look on ... Usually patients are finding me on Instagram or that's where they're going to look at photos. You can see how braless the bottom of that breast is, and that stays. My patients can't hold a pencil under their breast. No way. It's totally braless. And it's the ability to make it stay is what's unique. But I think that patients who have a breast lift, a traditional one are still going to be very happy because it was so transformative for them. My patient population, I'm not saying everybody needs my breast lift. They don't. People who need my breast lift are the people who are looking for the most braless, the most round, the most what I think idealized breast shape after a look. I'll see consults sometime and patients aren't seeking that. And there's probably not a reason to have me do their surgery if they're not looking for kind of what I specialize in.

Eva Sheie (06:30):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.