Breast lift surgery refers to the procedures performed for improving the shape of sagging breasts when the aim is not to significantly change the size of the breasts. Various factors can cause sagging of the breast. Factors such as breastfeeding, weight gain, aging, and gravity cause breast sagging over time. Also, loss of skin elasticity results in changes in the breast shape and a continuing sagging process. Breast lift surgery is performed to reduce or eliminate these problems.

Breast ptosis is examined in 3 stages:

In grade I ptosis, the nipple is aligned with the inframammary crease or it is located 1 cm below the crease. In grade II ptosis, the nipple is found at a level 1 to 3 cm below the inframammary crease but it points forward. In the third grade; the nipple is placed lower than 3 cm below the inframammary crease, pointing downward. In another condition called pseudoptosis, the nipple is located above the inframammary crease despite the breast is flaccid and sagged.

A variety of surgical techniques are used during breast lift surgery. Breast lift surgery can be performed through an incision around the nipple or it may sometimes be necessary to perform a straight or a reverse T-shaped incision under the breast. The critical factors affecting the selection of the surgery technique include the degree of skin elasticity, the structure of the breast tissue, and the intended outcomes. Scars may form after breast lift surgery depending on the technique used. The nipple pedicle can be positioned superiorly (upward), inferiorly (downward), laterally (outer), centrally, or medially (inner), again depending on the technique that the surgeon will select to use.

Breast lift surgery alone may sometimes not help achieve proportionally sized breasts. If breast tissue is less than required, a breast implant can be placed during breast lift surgery to achieve the desired outcome. On the contrary, large and heavy breasts (hypertrophic breast) will make it difficult to maintain the outcomes of the surgery. In these cases, breast reduction can be considered in combination with the breast lift surgery. Therefore, potential outcomes of breast lift surgery should be discussed in detail before the operation.

No striking methods that can be performed as alternatives to breast lift surgery have been introduced, yet. An alternative option for breast lift surgery can be wearing a supportive bra. If the breasts are excessively large, it will be useful to maintain the outcomes. Breast lift threads have recently been introduced as an alternative method; however, the outcomes fail to be permanent or the intended outcomes cannot be achieved unless the cases are selected carefully.

The latest trend in LIPOSUCTION (removal of excess body fat): VASER

As it is well known today, liposuction refers to the procedure of removing excess body fat. After inflating the site of operation with special fluids prepared for this purpose, the excess fat tissue and the inflating fluid are removed via small cannulas introduced into the respective body parts. This procedure is not performed to help weight loss or to reduce the size of body parts. The procedure is used for the correction of "contour irregularities". The hips, waist, abdomen, internal parts of knees, thighs, the upper arm area, and the jowl are the areas, where men and women are operated on most frequently. In men, liposuction is a method used for the treatment of pseudogynecomastia (excessive fat accumulation in the male breast). Irregularities in body contour may not only result from fat excess.

In some conditions; such as the presence of asymmetries, dimples or indentations in the breast, not the removal of fat but fat injection may be required. Therefore, some surgeons prefer using the term liposculpture (re-shaping the fat tissue) instead of the term liposuction (removal of excess fat). In these conditions; excess fat is removed from the defined parts of the body, processed in specified ways, and then injected into the parts of the body where the fat amount is considered inadequate.

Liposuction is not associated with a high number of complications and allows the patient to return to work-home life in 1-2 days when it is performed in the right patient properly. It may take a little longer for patients to return to their daily activities of life completely, depending on the fat volume to be removed and the selected type of the removal procedure. Liposuction is a mechanical procedure. During the procedure, small cannulas are inserted into the adipose tissue through the small holes opened in the skin. The surgeon moves these cannulas back and forth during the procedure so that a machine connected to these cannulas sucks out the excess fat. The surgeon will insert several types of cannulas with different calibers, lengths, and tips repeatedly to correct the irregularities at the site of the operation. This procedure may require strenuous efforts by the surgeon and can be very traumatic for the patient. The swelling and bruising occurring in the patients after the surgery results from the trauma of the sucking out process. Pain, swelling, and bruising are the major complaints raised by the patients after the liposuction procedure.

Sometimes these complaints can last for a considerable period of time. Since this type of mechanical trauma caused by the cannulas will not only affect the excess fat tissue but the surrounding tissue (nerves, blood vessels, and connective tissue) as well; such complaints described above will be inevitable, unfortunately.

At this point, VASER liposelection (selective targeting of unwanted fat) comes into play. We are going to call the device used in this procedure VASER in the coming parts of the article. The VASER device utilizes ultrasound waves to break and emulsify (liquefy) fat tissue, while the surrounding tissue (nerves, blood vessels, and the connective tissue) remains intact. This procedure enables an easy and comfortable postoperative period. The severity of pain, swelling, and bruising after the VASER procedure is milder compared to those developing in patients undergoing classical liposuction.

As with classical liposuction, general or local anesthesia or sedation is administered to the patient during the VASER procedure. The following process is no different from classical liposuction, in which special fluids are injected into the sites of the body with excess fat accumulation. Then, the special cannulae of the VASER device are inserted into the adipose tissue to a depth of 3-4 mm through small holes opened in the skin. Since the high-frequency sound waves produced by the device are adjusted considering the density of adipose tissue, breakdown involves only the fat tissue, emulsifying it. Meanwhile, the surrounding tissue will not be affected much. Then; by gently massaging the area of fat emulsification, the emulsified fat tissue is mixed with the specific fluids injected into the area. After this process, the mixture is sucked out by the suction cannulas inserted through the same holes in the skin. As liposuction, the procedure can be performed on any part of the body.

With the sound waves acting on the subcutaneous adipose tissue, also the skin will be stretched during the VASER procedure. This stretching of the skin is also thought to contribute to the favorable outcomes obtained by VASER; however, this has yet to be confirmed by clinical studies.

Although VASER is a method that provides many advantages for both the patient and the surgeon, it requires more experience compared to the classical liposuction. In fact, it is technically more difficult and costly. Furthermore; just like liposuction, it does not improve the appearance of “cellulite” or skin striae. When the procedure is performed by inexperienced people or people not specialists of plastic surgery, dangerous complications like skin burns may be likely. However; as long as it is applied correctly by exercising care against all these risks, the patients will have a very comfortable postoperative period (period after the procedure). This way, the outcomes will be quite satisfactory for both the patient and the surgeon.