In Fine Form

Created on 18th May 2011

The road to your dream figure doesn't always end once the pounds have been shed as Mr Nicholas Parkhouse, consultant plastic, reconstructive and aesthetic surgeon at the BMI McIndoe Surgical Centre reveals

After months of dieting, exercising or after bariatric (obesity) surgery, you have managed to lose the weight and can now start enjoying your svelte new body, right? Unfortunately not. In many cases, weight loss can result in excess loose skin and skin sagging compounded by the loss of skin elasticity. This frequently results in an unfavourable aesthetic appearance which is responsible for as much self consciousness and loss of confidence as being overweight.

The excess loose skin can affect the whole body from the face to the legs. For women, one area which can be particularly badly affected by substantial weight loss is the bust. After losing a lot of weight, the breasts lose volume and develop ptosis or droopiness. Women who have been used to having a full figure, often find their once voluptuous bosoms reduced to empty sagging skin envelopes. This can be a particular focus of cosmetic concern with a loss of confidence and a sense of disappointment after all the effort they have gone to lose the weight.

It is a common misconception that breast augmentation with implants is the best way of correcting sagging breasts. Where skin has lost elasticity and the degree of dropping is such that the nipples have dropped below the natural inframammary fold, insertion of an implant alone is likely to be disappointing. Where there is significant ptosis (drooping) it may be necessary to perform a mastopexy or breast uplift. This involves the carefully planned removal of excess skin, lifting and reshaping of the breast tissue and tightening of surrounding skin. The nipple is repositioned to a natural level and the overall effect is to restore shape and firmness to the breast.

An uplift invariably involves more scarring on the breast than a breast augmentation. There are a number of patterns that the scarring can take but it usually involves scarring around the nipple and areola and vertically below it with some extension horizontally on the lower part of the breast. For this reason, patients often prefer the idea of a breast augmentation with more limited scarring and have to be carefully advised regarding the likely outcome and advisability of this in their particular situation.

Under certain circumstances, it is possible to combine mastopexy with a breast augmentation. In this situation, the breast skin envelope is being both tightened and stretched in one procedure. Combined breast augmentation and mastopexy is recognised to have a higher incidence of needing some sort of adjustment as a secondary procedure. An alternative is to perform the augmentation and mastopexy as separate procedures, focusing on the primary problem during the initial operation.

The scarring following mastopexy surgery is permanent and though it is always emphasised that it does fade and become paler with time, this does not mean it will disappear altogether. A mastopexy is usually performed under a general anaesthetic as a day case or with a one night stay in hospital. Most patients find a period of seven to ten days off work and resting at home is sufficient time to recover. All patients are advised to avoid strenuous activity and exercise for at least four weeks after surgery. It is important to support the breast with a comfortable, closely fitting bra for a period of three months after the operation, to prevent early reoccurrence of sagging before scarring has matured.

Breast surgery after pregnancy and breastfeeding

One of the most common causes of loss of volume and dropping of the breast is breastfeeding. In cases where sagging and excess skin is minimal, and loss of volume is the primary concern, a breast augmentation is the best way to restore shape and firmness.

Silicone implants are generally used to minimise the risk of rippling associated with saline implants. The implants can be inserted either directly behind breast tissue in the subglandular plane or underneath the pectoralis muscle in the subpectoral plane. In general, a biplanar approach, where the implant is placed partially behind the breast tissue and partially underneath the pectoralis muscle, appears to give the most satisfactory natural appearance minimising the visible curve marking the edge of the implant in the breast. Implants can be inserted via a variety of incisions including under the armpit, or on the areola, the area around the nipple, but I prefer the inframammary incision (underneath the breast in the natural crease) which normally heals well and inconspicuously and provides the best access for optimal positioning. It has been suggested from time to time that implants can be satisfactorily inserted through an incision in the umbilicus (navel) but this is inadvisable.

If you are considering having a breast lift or augmentation, try to ensure you have reached your desired weight as further weight loss after the operation could result in more drooping and excess skin. It is also worth bearing in mind that there is a small risk you may not be able to breastfeed so it might be worth waiting until your family is complete before considering surgery.

It is important to approach cosmetic surgery from a personal viewpoint. What worked for one person is not necessarily going to work for you, as everyone's body is slightly different. It is essential to see a surgeon for a consultation to find out which procedure is going to provide you with the results you desire.
CSMUK