 Breast lift surgery, or mastopexy, is performed on women who have sagging breasts. This is commonly performed after completing child bearing. The breast becomes engorged during pregnancy and then involutes after breast-feeding is completed. Like an overblown balloon that eventually loses air, the breast skin "stretches out" and often loses its elasticity, and the breast volume shrinks. It can also happen with fluctuations in weight as well as with aging that results in weakness in skin elasticity.
There are three general skin design patterns for mastopexy. These are based upon the amount of skin that needs to be removed, the distance the nipple areola complex needs to be lifted to place it in an aesthetically pleasing position, the amount of breast tissue that needs to be removed or repositioned, and finally the volume, if any, that needs to be restored with a breast implant (see the breast augmentation section).
The three more common skin patterns include:
- Wise Pattern breast lift - which looks like an inverted –“T” or an anchor after final closure.
- Vertical breast lift - which looks like a “lollipop” incision.
- Circumareolar breast lift - (sometimes referred to as a Benelli breast lift) which ends up with an incision along the border of the areola.
So to summarize, the Wise pattern places incisions along the inframammary border of the breast, a vertical incision from the fold up to the areola, and an incision around the border of the areola. The vertical lift eliminates the inframammary incision, and the circumareola breast lift eliminates both the vertical and inframammary incision. Dr. Wallach will commonly employ a vertical lift technique (a modified LeJour technique) that minimizes the amount of scarring on the breast using a "lollipop-type" pattern that encompasses a circular incision around the areola with a lower breast vertical incision. This eliminates the use of a transverse incision along the lower breast fold that is placed as part of a more traditional "anchor type" procedure. The circumareola breast lift only employs an incision around the areola. This procedure is for a very limited patient population that does not require the nipple areola complex to move too much.
The tissue that supports the blood supply to the nipple areola complex can usually be brought on a leash of tissue commonly referred to as a pedicle from superiorly, inferiorly, medially, or laterally. This technique is usually reserved for patients with moderate breast ptosis (droop) and reasonably good skin elasticity. For this reason, most massive weight loss patients would not be good candidates for this technique because of the poor skin quality. But, for the majority of breast lift patients, this technique is an excellent choice. For patients with poor skin quality and with significant breast ptosis, a Wise pattern skin incision would probably be most beneficial to achieve the desired result. Dr. Wallach will combine breast augmentation with a breast lift for those patients that desire an increase in volume as well as a lift. In many cases, Dr. Wallach will limit the incision from this procedure by using either a "lollipop-type" pattern or a pattern designed only around the areola (circumareola), further limiting the incisions. For massive weight loss patients, Dr. Wallach has used all three types of skin incision designs to achieve nice results for his patients. Sometimes a breast augmentation alone can be performed to lift the breast for minor sagging.
The surgical procedure usually takes between 2-4 hours with a recuperation time of 1-2 weeks. Patients wear a support bra without an under-wire or a sports type bra for about 3-6 weeks before they can go back to using an under-wire bra. Dr. Wallach recommends that patients avoid aerobic type exercise for at least 3 weeks and strenuous exercise for at least 6 weeks after surgery. Dr. Wallach has presented his findings on limited access surgery combining breast augmentation with minor breast sagging in several peer-reviewed journals. He has also presented talks to other plastic surgeons on his preferred techniques for breast lift surgery.
Dr. Wallach has also given an instructional course to fellow plastic surgeons on his preferred techniques at the American Society of Aesthetic Plastic Surgery (ASAPS) national meeting.
If you would like more information about Dr. Wallach and his success with New York City Breast Lift procedures, we hope that you will not hesitate to contact our Manhattan offices at (212) 861-6400, by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028, or using our contact form to request additional details.
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 Patients with very large breasts may suffer from back pain, neck pain, or bra strap grooving and could benefit from breast reduction surgery. This surgery can remove excess breast tissue as well as lift the breast to provide a better shape and size while also improving the underlying symptoms. Many times Dr. Wallach can use limited incision approaches to minimize the amount of scarring around the breast. There are two common skin design patterns for breast reduction. These are based upon the amount of skin that needs to be removed, the distance the nipple areola complex needs to be lifted to place it in an aesthetically pleasing position, and the amount of breast tissue that needs to be removed or repositioned. The tissue that supports the blood supply to the nipple areola complex can usually be brought on a leash of tissue commonly referred to as a pedicle from superiorly, inferiorly, centrally, medially, or laterally.
The two most common skin patterns include:
- Wise Pattern breast reduction - which looks like an inverted –“T” or an anchor after final closure.
- Vertical breast reduction- which looks like a “lollipop” incision.
The Wise pattern places incisions along the inframammary border of the breast, a vertical incision from the fold up to the areola, and an incision around the border of the areola. This pattern is usually employed for patients with very large breasts that require more than 750 grams (just over 1.5 pounds) of tissue to be removed from each breast. In addition, this technique is used when the patient has poor skin quality and the breast is very loose, or when the nipple-areola complex has to be moved a long distance.
The vertical breast reduction eliminates the inframammary incision. Dr. Wallach will commonly employ a vertical breast reduction technique (a modified LeJour technique) that minimizes the amount of scarring on the breast using a "lollipop-type" pattern that encompasses a circular incision around the areola with a lower breast vertical incision. This eliminates the use of a transverse incision along the lower breast fold that is placed as part of a more traditional "anchor type" procedure. This technique is often used when a reduction of less than 750 grams (just over 1.5 pounds) is required to be removed, when the patient’s skin quality is good, and the nipple areola complex does not have to move a long distance.
Most massive weight loss patients would not be good candidates for a vertical breast reduction technique because of their usual poor skin quality. For patients with poor skin quality and with significant breast ptosis, a Wise pattern skin incision would probably be most beneficial to achieve the desired result. For massive weight loss patients, Dr. Wallach has used both types of skin incision designs to achieve nice results for his patients.
Some plastic surgeons perform breast reductions using liposuction alone. This limits the use of breast incisions. However, in the majority of patients, it will not adequately “lift” the breast or reduce the skin envelope that will potentially be looser after the procedure. It is certainly good to take care of the burden of the excess breast weight, but this technique will usually not consistently improve the aesthetic appearance of the breast.
In general, breast reduction surgery takes between 2-4 hours to complete with a recuperation time of 1-2 weeks. Often patients will have a drain in each breast that is commonly removed a few days after surgery. Patients wear a support bra without an under-wire or a sports type bra for about 3-6 weeks before they can go back into an under-wire bra. Dr. Wallach recommends that patients avoid aerobic type exercise for at least 3 weeks and strenuous exercise for at least 6 weeks after surgery. The surgical procedure usually takes between 2-4 hours with a recuperation time of 1-2 weeks. Dr. Wallach has presented and published papers on breast reduction and has presented his experience and techniques to other plastic surgeons. Dr. Wallach has also given an instructional course to fellow plastic surgeons on his preferred techniques at the American Society of Aesthetic Plastic Surgery (ASAPS) national meeting.
If you would like more information about Dr. Wallach and his success with New York City Breast Reduction procedures, we hope that you will not hesitate to contact our Manhattan offices at (212) 861-6400, by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028, or using our contact form to request additional details.
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 Gynecomastia is the treatment of the prominent male chest that is commonly due to excess fatty deposits and sometimes even from actual breast tissue development. Patients will have variable amounts of excess skin and have to be assessed for individualized treatment.
Sometimes patients can be treated by liposuction alone or liposuction can be combined with direct excision of the underlying tissue. Patients with good skin quality and moderate amounts of fatty tissue may only require liposuction.
If there is a component of breast tissue that is not amenable to liposuction alone, then direct excision of the tissue may be necessary. For many patients that require direct excision of tissue, this can be performed through a small incision along the areola-skin border on the chest. Dr. Wallach will often use dissolvable sutures to close the incisions.
For patients that have had excessive weight loss (i.e. post-bariatric surgery patients) or just have very poor skin quality, excision techniques that include removing skin and subcutaneous fatty tissue are sometimes performed. Dr. Wallach will try to limit the amount of incisions used on the male chest. For those patients with excess skin and fatty tissue, incisions sometimes can be limited to the lower fold of the male chest and around the areolar skin. If a patient requires skin and fatty tissue excision then the chest will most likely have a drain that is commonly removed a few days after surgery. The surgical procedure usually takes between 1-3 hours with a recuperation time of 1-2 weeks. Dr. Wallach recommends that patients avoid aerobic type exercise for at least 3 weeks and strenuous exercise for at least 6 weeks after surgery. For those patients that have liposuction, then the recuperation time is shorter, drains are not used, and a liposuction garment is worn for about 2-3 weeks.
If you would like more information about Dr. Wallach and his success with New York City Gynecomastia procedures, we hope that you will not hesitate to contact our Manhattan offices at (212) 861-6400, by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028, or using our contact form to request additional details.
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