When performing breast lifts, it is critical to gauge the lower breast pole during breast tissue in-setting. This is because the lower breast pole tissues are very dynamic. Often, they will shift and stretch out even within three to six months. Thus, the typical complaint I observe on social question and answer platform, is why are more nipples pointing upward? This side effect occurs very frequently as the lower breast pole gives out and results in what we call bottoming out. Bottoming out occurs when the weight of the breast pushes on the lower breast skin and makes it stretch out.
The resulting deformity is described by a prominent lower breast pole, poor upper breast pole fullness, and nipples that are pointing up to the sky. In order to counter this, often, the lower breast pole is over tightened during surgery. Over tightening is intentional and ensures that once the breast tissues and skin settle, that breast is aesthetically shaped and not bottomed out. Unfortunately, patients get concerned early in the postoperative period, complaining that their breasts look “Boxy” or square. In summary, I tend to make the lower breast pole slightly tighter than what would be considered ideal on the operating room table.
I do this because I know that the breast tissues will relax and that the lower breast pole will stretch out over the first three to six months. After this initial stretch, the breast tissues become stable and breast dimensions become permanent. Thus, I gauge how much your breasts will stretch prior stabilizing and then adjust your lower breast tissues accordingly. When I am gauging how much I feel your tissue will stretch, I take into consideration both the weight of your breast tissues as well as the quality and laxity of your breast skin. My ultimate goal is to make sure that your breast will round out following a breast lift at you 3 to 6 month time period.
This is because, at 3 to 6 months, the breast shape becomes stable and will be indicative of its shape for years to come. I always advise patients concerned about boxy shape in their early postoperative period, that they should be patient and recognize that this is done on purpose to counter the bottoming out that occurs over the first six months. If you are desiring a breast lift please be forewarned that slight boxiness is welcome in the early postoperative period.
Please enjoy this 49-year-old patient who underwent bilateral breast revision surgery. Her breast lift rounded out at six months following breast lift surgery.