Breast Lift Testimonials

First, let me start by saying I see many women come in for breast implant removal. There are a host of issues for the “why”- they are over it, they want to be smaller, they worry their implants are making them sick (BII- breast implant illness). Many of them ask, “Can’t you just put my fat in there instead?”

This is a study out of Belgium where they are attempting to do just that.

This is an article out of the July 2021 Aesthetic Surgery Journal, “Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation with Power Assisted Liposuction and Lipofilling.”  They even have a catchy name for it “PALLL.”

Study:

They proposed a new technique to remodel the breast after removing the implant by using an internal suture to loop the breast to help it narrow and have more projection. The researchers claim it also helps recruit tissue from the upper abdomen and axilla (armpit) area, which gives more tissue to fill with fat.

• They did 52 consecutive patients, average age 55, and BMI 24.
• 41% were smokers
• Reason for removal – 28% for rupture, 58% for capsular contracture and 14% for pain or migration.
• Average implant volume removed 292cc
• Average lipofilling was 223cc
• Average breast volume by the suture loop 82cc

Technical issues: They did not remove the breast capsule unless it was thickened with severe capsular contracture. To create the double loop, they tunnel using a cannula in the subcutaneous plane lower, going deeper as they go cephalad. They do this loop twice. They use a nonabsorbable Filapeau 2 suture. Then, they do fat transfer where they can, rinsing out any fat that ends up in the old breast implant cavity. Patients wear loose non compressible bras for 2 months after surgery.

They do the fat grafting using power assisted handpiece, which they think the vibration and grafting together helps the fat transfer by preventing coalescence of fat lobules.

They discuss issues with fat grafting to the breast. 1. Fat resorption. 2. Unpredictable movement of injected fat, and you are limited to grafting into the native breast tissue only. 3. It can’t reverse breast droop. 4. It does not give good projection to the breast.

Discussion

Others have tried to improve fat grafting survival in the breast by increasing the space to graft into by BRAVA domes and other expanders. (BRAVA domes are no longer available on the market) They also discuss those who do serial surgeries, grafting more each time .

My thoughts?

Wow. I think I need to address this as a separate blog as I have many thoughts. I think doing a suture loop to lift the breast or shape the breast is fraught with tons of issues. Dr. Khouri did it when I studied with him in Miami. I am a HUGE Dr. Khouri fan, but just like I don’t like threadlifts in the face to do facelifts (and even our literature doesn’t support them), and I feel “threadlifts” for the breast are the same. For true change, you can’t treat tissue like a marionette string.

As for fat grafting to the breast, there are uses for it, but it is tricky. Where the implant used to be is a space with no blood supply. To put fat into that space doesn’t work- it would be like planting a tree into a concrete swimming pool.

This is out of the Aesthetic Surgery Journal March 2019.  “Physical Properties of Silicone Gel Breast Implants.” Yawn.  Not a catchy title, but important things to know.  With the options for silicone gel implants exploding, how do you choose?

There are some things which are not addressed here:

• the width and projection of the implant, which give you the profile of implant (low, medium, high profile)
• the volume of the implant (measured in ccs, which ranges from 120-600)

The study:

• They looked at 4 manufacturers: Sientra, Mentor, Allergan, and Establishment labs
• They did bench testing to look at
  • form stability– does the device retain its dimensions when you move from horizontal (lying down) to vertical (standing up)?  The less it changes, the more they have shape retention.
  • dynamic response to the gel– when you compress it, what is the gel cohesivity, resistance to gel deformation (stiffness), and energy absorption (softness)?
  • Shell thickness, tested in five regions of the implant.
• They tested 3 textured shaped implants, 6 textured round implants, and 8 smooth round implants.  They tested 6 of each type.

Findings:

• Form stability:
  • SHAPED SILICONE GEL BREAST IMPLANTS: Natrelle 410 implants containing Truform 3 gel retained significantly more of their original dimensions than Mentor MemoryShape and Sientra Textured Shaped implants.
  • TEXTURED ROUND SILICONE GEL IMPLANTS: Inspira (Allergan) implants with Truform 3 gel, followed by TruForm 2 gel.
    • Sientra had the lowest form stability in height,
    • Mentor had the lowest form stability in projection
    • Inspira Truform 1 gel had lower form stability in the upper pole.
  • SMOOTH ROUND SILICONE GEL IMPLANTS: Inspira Truform 3 gel was equal to Motiva ProgressiveGel Plus
    • Inspira Truform 2 gel was equal to Motiva ProgressiveGEl Ultima
    • Sientra implants with High Strength Cohesive Plus gel did in the middle
    • Mentor implants Cohesive 1 implants had lowest form stability in each dimension
• Gel Material Properties
  • Allergan Natrelle 410 implants with TruForm 3 had significantly higher gel cohesion, resistance to gel deformation, and lower energy absorption complared to Mentor MemoryShape or Sientra Textured shaped implants
    • Truform 3 had higher retention of all 3 properties than Truform2 or Truform 1
  • In general the gel properties of the implants varied “significantly across devices.” The order of gel cohesion:
    • Natrelle 410 or round with TruForm 3 gel
    • Mentor textured shaped with Cohesive III gel
    • Sientral with High Strength Cohesive gel
    • Motiva with ProgressiveGel Ultima
    • Mentor with Cohesive 1 gel
    • Inspira with TruForm 1 gel
• Shell thickness
  • Allergan shell thickness was consistent in all textured implants regardless of shape
  • Natrelle 410 and Mentor MemoryShape had the same mean shell thickness.
  • Sientra textured were thinner
  • The round textured implants, Inspira implants were thicker than Mentor implants or Sientra implants

So what does this all mean??

In their discussion, the authors talk about these differences may affect performance of the breast implants in clinical settings.  If you have more form stability, you will retain the breast implant shape better.  The more cohesive the gel in the breast implant means more form stability, which determines shape retention.  The shell thickness may also have an effect.

What does this mean to you?

After reading this, or skimming this, or just skipping all of the above and reading my summary here, you may think- aha! I need to do a form stable implant with the highest cohesive gel so my implant retains its shape as much and as long as possible.

Not so fast.

The more cohesive the implant, the firmer the breast feels. I have patients who think their implant has a capsular contracture because the implant feels firm.  They don’t have capsular contracture. They are just feeing the firmness of the high cohesive silicone gel itself.

The higher cohesive gels also keep the upper pole of the breast fuller, which for those who want a more cleavage, augmented look is great.  But for those who want a more subtle, natural look having a really full upper pole looks like they had a breast augmentation- and they don’t want that.

All of the brands have variations in cohesiveness- hence the confusing lingo above with different levels of cohesive gel. It seems that Allergan TruForm 3 gel is the most stable.  (Of note, this study was done by Allergan consultant doctors, and in the critique of the study, it was noted an independent study supporting these findings would be nice.)

When you meet with your doctor, ask to feel the different cohesive gels.  They should have samples of each.  I think it is useful for you to feel it- you will know which you like the best. I use primarily Allergan implants.  I can have you feel and squeeze an implant with TruForm 1, 2, or 3 type gel.

“My experience with Dr. Greenberg has been terrific and very transforming for me, both physically and emotionally.  After having 4 kids in 5 ½ years, I had put my body through a lot.  I had also passed the 40 year mark, and felt I needed to do something now so I could enjoy my body and appearance.  So, I interviewed plastic surgeons, and Dr. Greenberg stood out immediately.  Her ability to relate to my situation (she has young children too) and my concerns with my body, plus her great personality, made me instantly know she was the surgeon for me.  She did an awesome job on giving me my body back; my breasts haven’t looked so good since I was in my early 20s.  She is caring and responsive and I would highly recommend her to anyone.  Her work on helping me fix what the babies did to my body, particularly by breasts, really transformed not just my body but my attitude.  I am so confident now and happy with my body, which I have not been in more years than I can remember.  The results are worth it! ”

E., Breast Lift and Liposuction patient, Atherton CA

After having seen Dr. Greenberg’s surgical results on a friend I decided to pull the trigger and on 5/14/13 I had a breast lift by Dr. Greenberg. I am absolutely thrilled with the results! Dr. G did an excellent job with both the shape and the stitch work (it was my second, so I had something to compare it to (and it turned out better than the first one!)) I give her my highest recommendation!

K.L., Breast Lift patient, Portola Valley, CA

Dr. Greenberg is a fantastic surgeon and I have never had a more positive experience with a doctor. She is caring, kind, and keeps up on the latest information in her field. I went to her after losing 190 pounds and she has done a wonderful job at removing all the wrinkles caused by my weight loss. Within the past year she completed a tummy tuck, breast lift, liposuction, and 2 weeks ago, a face lift. She is honest, direct, and kind. She answers all my questions and has always given me the full information I needed to make the right decisions for my body. She is not someone who encourages more surgery to enrich herself. My phone calls have always been returned within minutes. Best of all, she did a great job with each surgery and I am so happy with how I look now!

M.B., Body Contouring after Major Weight Loss and Face Lift patient, San Jose, CA

I had the most wonderful experience with Dr. Greenberg. I had a breast reduction and a lift and I am so happy with the results. I tell everyone to go to Dr. Greenberg. She is a perfectionist. She puts her patients first and she arrived at the hospital early to make sure that all was in place for my procedure. If you are seeking a compassionate professional that will produce the best results possible, there is no other plastic surgeon to consider. I met with 3 other plastic surgeons before I made the right decision to go with Dr. Greenberg.

S.B., Breast Reduction patient, San Carlos, CA

I found Dr. Greenberg after several months of searching. I was unhappy with the size of my breasts implants and wanted to make a change. After interviewing five or six women surgeons, I made my decision and decided to run with Dr. Greenberg. From the first appointment and initial impression, I knew that Dr. Greenberg and her staff was top notch. Not only did I feel extremely comfortable talking to Dr. Greenberg, my husband felt the exact same way. We both came in numerous times and pestered her with more and more questions about this and that and what if and you know, all the apprehensions related to breast reduction. Every time, Dr. Greenberg answered every question we had in terms that we, non doctors understand and spent considerable amounts of time with us on each visit. She was extremely knowledgeable and patient with us. Came down the day of surgery, she greeted us with a big smile, drew some lines on me, made me feel very relaxed and reassured me that I was going to be a very happy girl when I woke up, sore but still, very happy. Post surgery, she was 100 % correct, I could not have been happier. She created my new look exactly the way I envisioned and I could not be happier with the results. Her work is amazing! Very little down time too, maybe a month and that was it. I was back to the gym and loving my new look. It has been 4 months since the surgery and I have very little scarring or pain. Dr. Greenberg’s expertise and ability to actually create what she told me she would create amazed me. Her work is beautiful and I can honestly say that, my new figure has changed my life and am the happiest I have ever been. I will highly recommend Dr. Greenberg for years to come. Dr. Greenberg does awesome work!

R.M., Breast Implant Removal with Breast Lift, Burlingame, CA

I highly recommend Dr. Greenberg and tell my friends about her when they ask about age defying treatments. Dr. Greenberg reconstructed my breasts 1-1/2 years ago and I could not be more happy about the results. She was very thorough in explaining the results to me and I gave her my full trust and rightly so – she did a beautiful job with both breasts – one that was 35% missing tissue due to breast cancer. She took my “cut up boob” and made it match the other side as best as anyone could. It healed beautifully and 18 months later I am still very happy with the results. I fully trust her for all of my needs – fillers, lipo and anything else that I will need to have done over the years now since I am 50. Dr. Greenberg is honest and trustworthy. I can say this with confidence as I interviewed 6 surgeons around the SF Bay Area and went with my gut – best decision. Thank you Dr. Greenberg for helping me feel more confident and I appreciate your professionalism. Sincerely,

M.M., Breast Cancer Reconstruction, Breast Lift, and Liposuction patient, Saratoga, CA

Dr. Greenberg is an extremely skilled, compassionate surgeon. I had been through 2 breast augmentation and reduction surgeries. One was performed by a well known on TV beverly hills plastic surgeon who is a supposed known expert, who left me disappointed, disfigured and never even saw me after the surgery even though I tried to schedule with him. I have to say since my first appt with Dr. Greenberg, she knew what I had gone through and understood me thoroughly and took the time to understand my needs and she gave me very comprehensive advice. I thought I needed a smaller implant but she suggested I had enough breast tissue to remove implants and she was correct. I have never even in my twenties had perky nice figured breasts. She uses a technique that leaves minimal scarring and s sure to uplift the breast. Now, I take off my bra and have to stare awhile in the mirror because I can’t believe the nice well shaped perky breasts in the mirror are mine. I look at them for the first time admiring them adoringly. Although I have always had a positive outlook and disposition, I cannot explain how Dr. Greenberg’s skillful work has given me my life back. I can wear pretty shirts that close and do not pop open, my breasts have a beautiful uplift and I can exercise and even jog again. Life is definitely better. Dr. Greenberg has studied different techniques and explains why she uses the technique she does and explained to me exaxtly what to expect after. This experience was so vastly different than the other two I had. I would recommend my sister, my mother, a friend to Dr. Greenberg because I trust her fully and know that as a woman she cares about women, their health and has the skill to help women beccome the best they can be. She would never push a procedure on anybody and explains clearly before the outcomes that can be expected. As far as caring for her patients, she took the time on her way home from her vacation for a follow up visit with me after the holidays as my home is 2 hours away from her office. I cannot sing her praises enough. In short, yes, I highly recommend her. From California

R.L., Breast Implant Removal with Breast Lift, Revision, and Capsulectomy, Sacramento CA

Lauren Greenberg is the only board certified plastic surgeon I will let work on me now. Dr. Greenberg takes as much time as you need during consults to ensure that you have all the information you need, and that all questions are answered. I went in wanting a breast reduction and mini face lift, and instead she told me I needed a lift, not a reduction and could do it with a lollypop incision. My other surgeon that I was schedule for the procedure said I had to have an anchor incision and take me down to a C, which is smaller than I wanted. This is a HUGE difference in scarring and size. It’s easier to take off more breast tissue later on if I want them smaller than to have to put an implant in to get the size back. Regarding the request for a mini face lift, she said it wasn’t time and suggested several other options that were non-invasive and much less expensive. (I am 48 years old). I said I’d go the Juvederm route first, and she stayed late to administer it without hesitation. I went back three weeks later for a second round, and the next day coworkers told me how good/rested I looked – vibrant with great skin! Dr. Greenberg does not up sell you, gives you all of the downsides of treatments and surgeries and is honest about complications that past patients have had and how to avoid them. She doesn’t talk down to you, doesn’t use clinical terms that a layman would not understand, and uses analogies to explain how the different options work. She is very busy, and you need to be patient when making appointments because she is so booked…because she is THAT good. I have two more procedures scheduled with her and am no longer afraid to have the surgery. Check out her website – she puts so much time and thought into it to educate her patients and the public. She described the different incisions for breast reductions/lifts including what she favors and how she does it. Don’t have fillers or surgeries done until you have the chance to meet her. You’ve be happy you did.

N.M., Breast Lift and Skin Fillers patient, San Jose, CA