Having been since ancient times an outstanding symbol for femininity and fertility the female breast has always been a central part of the visual image of any woman, and despite the many historical changes that image underwent during the last centuries, there was at any given cultural period a quite well defined image of the ideal breast which inspired artists, fashion and society.When we take in consideration western society’s actual idea of an ideal breast, we experience the recreation of a more female look and style. A full breast is considered as sensual and beautiful and fashion and media are competing to visualize this image day by day.

Therefore, breast augmentation is more and more sought after, especially by young women, to approach their individual image of the perfect breast. But something which is not covered in most features covering aesthetic surgery of the breast is the fact that there are even more women suffering from very big or very saggy breasts who are searching for the possibility to get a smaller and beautiful shaped breast.

This misinformation about the possibilities of modern plastic surgery combined sometimes with the perception of the unfavourable results of some ancient techniques still keeps many women suffering their whole life from their big breasts; with this article we want to provide this missing information by explaining modern techniques of breast lifting and breast reduction and to offer you solutions to this common problem.

From a plastic surgeons view, there are distinctive measurements which define a perfect breast, but aside from those more academic definitions a woman’s feeling regarding her breast size and shape should always be our individual guideline. A breast which may be perfect for a woman looking for a more female and seductive appearance can be much too large for a small-framed woman who loves to do sports and has a more girl-like image of herself.

So the surgeon will consider your personal feeling regarding the size and the form before talking with you about any reduction or lift. After this has been thoroughly discussed the surgeon can evaluate if the adequate technique is a lift which removes only excess skin to achieve a firm and uplifted breast or if a removal of glandular tissue is necessary to meet the patient’s expectations.

A breast lift, sometimes also called a mastopexy, is a procedure which consists of removing excess skin without any removal of glandular tissue to lift up a sagged breast while keeping its original volume. If the sagging and the loose skin are less important the so called Benelli Lifting Technique can be performed removing skin only around the areola. In this case the resulting scar will be only around the areola and is barely perceptible after one year because it is placed exactly on the border of the pigmented areola. If the sagging and consequently the excess of skin are more important, a skin resection of the lower breast pole combined with a resection around the areola is necessary to achieve the desired lift. The result is the circular scar described above and a vertical scar descending to the fold under the breast.

If a patient is suffering not only from an excess of skin but from an excess of glandular breast tissue (Macromastia) the patient’s expectations can mostly only be met by a so called breast reduction procedure. There are multiple factors which can be responsible for Macromastia, in most cases it is a combination of a genetic predisposition together with hormonal changes which can be induced by onset of puberty, pregnancy or menopause. Even without considering the aesthetical aspect, very large breasts are often the origin of serious functional problems like chronic back and neck pain, arthritis of the neck, chronic eczema of the breast fold and others.

Therefore already 2 centuries ago very large breasts represented a serious problem for many women, so the plastic surgeon’s quest for aesthetically and functionally satisfying procedures started in 1882, with the first described breast reduction by the English surgeon Thomas. In the attempt to develop techniques which provide minimal scarring combined with a safe surgical procedure at least 15 different procedures where described during the last century.

Some of those ancient techniques are still frequently used and widely accepted, others have been replaced by more modern procedures, but the basic principle of all breast reduction techniques still remains the same: a circular incision around the areola which allows for skin removal and uplifting of the nipple-areola-complex combined with a vertical incision descending toward the lower breast fold which allows for breast tissue removal in the lower quadrants of the breast. This vertical incision is necessary because any removal of glandular tissue requires a reduction of the skin envelope as well, so by tugging the remaining skin into this vertical oriented scar for suturing the surgeon can rearrange the remaining breast tissue to recreate the natural round breast mound.

Depending on the technique used the scar descending from the areola can have the form of an L, of an inverted T or just be a vertical line. The L or the inverted T shaped vertical scar techniques are the more ancient procedures, but they still have their justification in very large reductions where the single vertical scar technique can not cope with the associated excess of skin.

The more recent technique based on a single vertical scar in combination with the circular scar around the areola was described 1998 by the Belgian surgeon Madeleine Lejour. This surgical approach is based on the ability of the skin to shrink once it has been freed from the glandular breast tissue, so that large amounts of excess skin which would normally need an L or inverted T shaped skin excision can be rearranged in just one vertical scar by using a special purstring suture technique.

Offering the big advantage of minimal scarring, this technique can be used in almost all reductions except for breasts which are extremely big and sagged. Because of the reduced incisions, healing is fast and most patients can get back to normal life activities after 2 weeks. Due to the fact that this technique is based on the postoperative shrinking of the skin, the reduced breasts require 3-6 months after the operation to achieve their final position and the desired aesthetic result; during this early stage the lower half of the breasts will show some small skin folds which will smooth out gradually.

By using all the techniques available after more than hundred years of modern plastic surgery research, the modern breast lift and breast reduction procedures provide excellent aesthetic results combined with an invaluable effect on the functional problems mentioned above resulting in an important improvement of life quality.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

Neck – cheek & eyebrow lift in the temporal area

Dr. Albrecht published in the last issue of Aesthetic Surgery Journal, the magazine of the American Society for Aesthetic Plastic Surgery.

Mrs. V.B. came to my surgery nine months ago following the recommendations of a friend of hers and her hair stylist. She needed a complete face lift including a retouch of her upper and lower eyelids. My state-of-the-art facial rejuvenation technique includes lifting, injections and peeling.

The complete treatment takes 9 hours and it is performed in two days. It is an expensive procedure. Viviane told me that she was willing to spend half the quoted sum so I proposed a simpler strategy that yields very good results.

• The first step of the rejuvenation technique con-sists in lightening to the maximum extent possible the weight of the skin of the jaw line and the neck, allowing it to attach itself back to the subcutaneous muscle.

Through cheek and jaw line liposuction, in combination with the surgical removal of the fat deposited behind the subcutaneous muscle (platisma) of the neck, the weight of the neck skin is eliminated and it adheres back to the jaw.

My face lift theory is based on the ageing of the skin, in other words, the loss of elasticity. What happens when elastic gets old? It fails to go back to its initial position when stretched and it does not bear even the minimum weight. What happens if it is stretched too far? It breaks or does not allow further movement.

The same thing happens with the skin, depending on the elasticity loss degree, which may vary significantly among people of the same age. When it loses elasticity, it fails to bear the weight of the subcutaneous fat and it drops due to the effect of gravity. However, under no circumstances is gravity responsible for the loosening of the skin of the face. If this skin is tightened trough a face lift, the facial expressions will be limited, resulting in a pulled, unnatural look.

In order to avoid this undesired effect, I always focus on the removal of fat from the skin. By removing all this fat (this is a fine surgery procedure that takes from 2 to 4 hours), the skin can go back to its original location and attach to the muscle thanks to the scar-like tissue (fibrosis) resulting from the liposuction. Curiously enough, even thin people have fat in their necks.

This is precisely what I did in the case of Viviane. Through the 3 to 4 cm incision hidden in the first wrinkle under the chin, the neck was “cleaned”. The results are always very good and amazing, taking into consideration that no skin is cut.

• The second step consists in a temporal lift (in the temple area) through a small 3 cm long incision made 2.5 cm from the hair line, slightly to the back and above the eyebrow tail. After removing skin from the lower and upper eyelids, the temporal lift allows to slightly augment the size of the eyes and to elevate the brow naturally (unlike the frontal lift, where the entire brows are lifted, resulting in a permanent look of surprise or fear). Here again there is no skin cut, it is only pulled backwards with internal sutures of the skin to the muscle.

• The third step was an injection of the patient’s own fat in the cheeks and the area around the eyes, particularly in the upper eyelid, to achieve the “full but not loose” effect typical of the youth.

Finally, it can be stated that Mrs. V.B. has achieved a significant and natural rejuvenation with only two small incisions of 3 cm each, under local anesthesia and sedation. You can learn more about this case in her interview in Transform Magazine n° 5.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic