What happens if my breast lift doesn't last? [Austin Hayes, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. Talk to me about revision surgery. How does previous surgery affect the way that you approach a case like that?

Dr. Hayes (00:10):
So when it comes to revisions of implants, I've basically stopped. I basically have three surgeries that I do, breast augmentation, breast lift, tummy tuck. And I'm busy enough with those things that that's where all of my focus is. So when people have breast implants that need revision, I help them find another doctor. For revision of breast lift. So the classic would be I had a breast lift, let's just say five, 10 years ago. There's something that they have something that's bugging them and usually it's that the fold has given away and the breast tissue has fallen and that they don't have the braless look that they had. And so for me, it's all about figuring out one, where is their nipple? And usually, like I said, it's in the correct location. There's nothing to do there. The question is just how do we tighten and reconstruct and strengthen the bottom? And so it ends up being an anchor breast lift minus the circle part. It's the vertical and the horizontal. So it's me redoing that and then adding layers one, two, three to the horizontal. And essentially just retucking and lifting the bottom and driving the breast tissue up. And then maybe I would fat graft them.

Dr. Hayes (01:19):
That's a way to give volume to the cleavage and to the top, but that's the revision breast lift surgery for me. Well, I'll tell you, I don't get a ton of inquiries for it. And I will tell you that I think that's because most people are really happy with a quote unquote good breast lift.

Eva Sheie (01:34):
What about nipple size? If you're just coming for a breast lift, but you also need or would like your nipples to be a little bit smaller, especially if you've had kids, can you do that at the same time?

Dr. Hayes (01:45):
Yeah. So super common question. The answer is always. As you create the anchor scar, part of that is resizing the nipple. So it's always resized. There's a little flexibility there. So people have options and I explain what their choices are as far as size. We just want to make sure it's a nice match to their breast size. But yes, always changed.

Eva Sheie (02:06):
You mentioned fat grafting too. So where are you taking the fat from usually?

Dr. Hayes (02:11):
It really depends. We want to, certainly if someone has a place where they have extra that they don't like, that would be a top spot. But if they don't have or they don't have a specific area they want it to come from, places I look, lower abdomen, inner thigh, inner knee, places that I can get to while they're tummy up. So not having to flip them over, usually I can get enough from those places.

Eva Sheie (02:32):
The fat, it stays. It's not the kind of fat, and I think we hear a lot that some of it is going to disappear. Is that still true or does it stick?

Dr. Hayes (02:42):
So every plastic surgeon would probably quote a different number on this, but yes, some of the fat goes away. I think traditionally that number would be as low as maybe ... Imagine half of it going away, 60% of it going away. Many surgeons would claim that they get met much higher rates of fat sticking around by whatever technique they use. However, there's a product that was introduced to the market a few years ago, which is essentially washing the fat. And by washing the fat with a certain soap, basically, a surfactant, it allows the take rates to go to 80 plus percent. So every time I fat graft, I'm using that. So all fat is washed. And so the take rate should be what the research shows, which is more than 80%.

Eva Sheie (03:27):
Is it possible to just resize the nipple itself?

Dr. Hayes (03:31):
Yeah.

Eva Sheie (03:31):
If that's too big, not usually too small. Usually we're complaining that it's too large, right?

Dr. Hayes (03:37):
Yeah. So the answer is yes. A breast lift always resizes the areola. So the areola, the pigmented part around the breast, I would say that most people are having a breast lift, their areola is larger than they want it to be. Specifically referring to the papule, which is the part of the nipple, the projecting part of the nipple, and that can be resized also. So everybody has a different technique for that. The technique I use is one popularized by a plastic surgeon in Texas. And it's essentially an amputation, basically, determining what part of the nipple you want to keep, of course, what part needs to go away and then transecting that. And one of the reasons that he popularized it or that the Texas doctor was such a fan of it is that it preserves the ducts so someone could still breastfeed and it preserves the sensation because then the nerve endings are all still there.

Dr. Hayes (04:30):
And it takes about two weeks for essentially the scab to heal. And so that's the one I use. And resizing a papule can be done or resizing a nipple can be done during an augmentation, during a lift. Yeah.

Eva Sheie (04:47):
How often does that come up?

Dr. Hayes (04:48):
Not a ton, honestly. Breast anatomy is so different. Everybody has a different nipple size. Some people have basically nipples that are flat and then nipples that are very projecting, but like everything, it's only what bothers the person. So how often does somebody bring it up to me? Maybe twice a year. Pretty rare. It's not something I point out, of course. But sometimes you'll hear somebody's on a second, third, fourth consult with me and they'll say, "I had a bad experience with Dr. So- and-so. They went around and just pointed out, just went through my body and pointed out all the things that they think I should have done." And obviously not a great experience.

Eva Sheie (05:28):
No.

Dr. Hayes (05:28):
No. Something comes through in the audio that I do, the videos that I make that allows people to feel comfortable talking about this. I don't know exactly how I give people that perception, but there's some way that when people come in, they essentially already feel comfortable talking to me about these very sensitive ... I mean, all of this is sensitive.

Eva Sheie (05:52):
Well, there's something really special about you taking that five minutes for that person and just giving ... You're giving them a gift by telling them what you see and what you can do. No one's doing that. I mean, I have to think about how we want to use that information because it's such a huge competitive advantage for you that you're doing that.

Dr. Hayes (06:13):
I know.

Eva Sheie (06:13):
It speaks to who you are as a person and not just a surgeon. Who's the ideal candidate for the triple bra breastlift.

Dr. Hayes (06:21):
The thing that's amazing about breast lifts is when you're a person who wants a breast lift, people come in and see me and typically they all say the same thing. It's, "My breasts are sagging. I don't feel comfortable not wearing a bra. I wear a bra at home." Obviously that depends if they live with somebody and what their comfort level is, but many people still don't feel comfortable not wearing their bra or taking their bra off when they get home. Wearing bathing suits, wearing dresses, summer dresses that backless dresses can't do it, different other circumstances where we're in different positions in our life, wherever that is and not feeling comfortable because their breasts take on a shape they don't like. And so people come in and are looking for being braless, having no bras and no problems.

Eva Sheie (07:12):
If you had to give the name of this surgery a hashtag of its own, what would it be?

Dr. Hayes (07:17):
It would be no bra, no problem. The triple bra breastlift is a new, innovative way of creating the maximum amount of lift, the maximum amount of fullness and bralessness in a breast lift by using the patient's all natural tissue without any implants, without any mesh, and securing the bottom of the breast to make the breast as lifted as possible.

Eva Sheie (07:41):
Is this the same as an auto augmentation or different?

Dr. Hayes (07:44):
I think it's a little bit different. Auto augmentation is using the breast tissue. Many surgeons' technique is they bring the breast tissue up and try to sew it to the chest wall. It's not something I do, so I don't know exactly what each surgeon does. I'm moving the breast tissue up and I'm just securing the bottom by creating hammocks for the breast tissue. So I'm not sewing the breast tissue to your chest. I'm basically making very strong hammocks that hold your breast tissue up. So kind of is like an auto augmentation, but as I mentioned before, an auto augmentation is addressing fill, whereas I'm trying to address making the outline really sharp, making the fill perfect and distributed very high and then tightening the skin envelope. So what I'm doing is solving three problems, not just one.

Eva Sheie (08:32):
If I want a consultation for a triple bra breast lift, what should I do?

Dr. Hayes (08:36):
Go to my website or go to my Instagram. There's a place to schedule a consultation. It allows you to drop in photos. Everything's HIPAA secure, so encrypted and safe. My assistant will talk to you. If you're interested, I can look at your photos, give you an audio telling you what I think. We give you a pricing, so we try to make it easy, and that's before you even come in for your first consult. So I would say check out my website.

Eva Sheie (09:04):
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.