Short expert talk by Robert Whitfield MD explaining how breast lifts are planned during simultaneous explant surgeries. He discusses removing implants and capsular material (to reduce biofilm/cancer risk), assessing nipple-areolar complex position relative to expected breast fold, individualized procedural choices based on skin, volume, and implant size, and recommends a vertical (lollipop) lift when the nipple is significantly low. Provides measurement guidance for nipple position (notch-to-nipple typically 17–20 cm).
Questions this video answers
About one third
Typically between 17 and 20 centimeters
Chapters
Today we're going to talk about breast lifts and how they relate to explant surgeries that we do. We get a lot of questions that ask me, do I actually take the areolar nipple complex actually off and then put it back on? So for everybody listening, I think when we do simultaneous explant lift, fat transfers, any of those combinations, we're really trying to execute a series of steps so that we get really more balance. And so those can be difficult variables because when you're trying to execute basically an explant, you're doing a reduction here instead of breast tissue, reducing the actual breast form by removing the implant, you remove the capsular material as well. We've had a handful of patients have breast cancer, lymphoma. We have about a third of our patients have biofilm. So we want to take all the material out intact each time, if at all possible. It helps protect the patients from biofilm that can be spread throughout the pocket or cancers. Now, when we're trying to reshape the breast, it depends on how much breast tissue each patient has. Or trying to get the areolar nipple complex positioned on the chest so that it's higher. That's done a certain way. So depending on each patient's skin, where the nipple areolar complex sits, how much sag there is, how much volume there is, how big the implant is, we have to discern what combination of procedures will help that patient. If we're taking, for instance, a patient has really low set nipple areolar complex, you want the nipple areolar complex to actually line up to where the breast fold should be. If you can't actually tell where that is because it was arbitrarily lowered during the breast augmentation procedure, you can make measurements and give an estimate, typically between 17 and 20 centimeters, depending on the patient, from the notch to the edge of the ruler complex. This will help give you a guide. If, once again, you can't tell due to the distortion of the anatomy. When that's evaluated, if the nipple complex is significantly lower than that, then a vertical lip that leaves the lollipop scar is typically what we would recommend.
