Breast Lift With Implants: Why I Staple Before I Cut

When patients think about a breast lift with implants, they often imagine that I make all of my measurements before surgery, follow those markings in the operating room, remove the excess skin, and close everything up.

In reality, there is much more real-time decision-making involved.

Preoperative markings give me an important roadmap, but they don't tell me exactly how the breast tissue will behave once a new implant is in place. That's why, when I perform a breast lift with implants or an implant exchange with a breast lift, I often use a technique called tailor tacking.

Tailor tacking allows me to temporarily simulate the breast lift before I actually remove the excess skin. In other words, I can preview the new breast shape, evaluate it from multiple angles, and make adjustments before committing to the final skin removal.

What Happens During a Breast Lift With Implants?

A breast lift with implants, also called an augmentation mastopexy, combines two procedures that accomplish different things. In fact, for a long time, plastic surgeons only performed one of those procedures at at time and would come back later to do the other procedure.

The implant adds or restores breast volume, while the breast lift reshapes the breast, removes excess skin, and repositions the nipple and areola when needed.

When these procedures are performed together, the relationship between the implant and the patient's existing breast tissue is extremely important. I don't simply put an implant underneath the breast and then tighten the skin around it.

Instead, I want to create an attractive breast shape using both the implant and the patient's own tissue.

First, I Place the New Breast Implants

Whether I'm performing a first-time breast augmentation with a lift or exchanging existing implants, I first need to establish the volume and position of the new implant. This may involve placing a new implant for the first time or replacing an old implant and possibly tightening or loosening the pocket to fit the new implant.

Once the implant is in place, I can see how the patient's natural breast tissue actually interacts with it.

This is important because changing the size, projection, or position of an implant can change how much loose skin remains and how the breast tissue needs to be redistributed.

That means the markings we made before surgery are a starting point, not necessarily the final answer.

Then I Redrape the Breast Tissue Around the Implant

Once the implant is in position, I bring the nipple and areola into their planned new position and begin reshaping the breast tissue.

I often describe this to patients as wrapping a present. We want a nice snug and fitted wrapping of breast tissue around our new implant.

The implant provides the underlying volume, and I redrape the patient's own breast tissue and skin around that new volume to create the breast shape.

But there's an important question I still need to answer:

Exactly how much skin should I remove?

Removing too little skin may leave the breast looser than intended. Removing too much can create excessive tension and potentially distort the breast shape or cause the incisions to break down during healing.

And once skin has been removed, I can't put it back.

That's where tailor tacking becomes particularly useful.

What Is Tailor Tacking in Breast Lift Surgery?

Tailor tacking is a technique that allows me to temporarily simulate the breast lift before permanently removing the excess skin.

I first mark the areas where I anticipate removing skin. Instead of immediately cutting along those markings and excising the skin, I temporarily bring the skin together with surgical staples.

Essentially, I'm creating a temporary version of the breast lift.,

The term makes sense if you think about what a tailor does when fitting clothing. Fabric can be temporarily pinned or tacked into position so the tailor can evaluate the fit and make adjustments before permanently cutting and sewing it.

I'm doing something similar with the breast.

Why Do I Use Staples During a Breast Lift?

The staples allow me to essentially "test drive" the breast lift.

With the implant in place and the skin temporarily stapled together, I can sit the patient up on the operating table and evaluate the breast as a whole.

I can look at several things:

• Overall breast shape and contour
• Nipple and areola position
• The amount of skin being removed
• Tension on the planned closure
• How the natural breast tissue is draping around the implant
• The relationship between the two breasts
• Breast symmetry

If I don't like something, I can change it.

I can remove staples, adjust my markings, change how much skin I'm planning to remove, and then tailor tack the breast again.

Only once I'm satisfied with the shape do I commit to the final skin removal.

Why Not Just Follow the Breast Lift Markings Made Before Surgery?

Preoperative markings are extremely important, but the breast I examine while a patient is standing in the preoperative area isn't exactly the same situation I encounter once we're in surgery.

During surgery, I can see what happens after the old implant is removed, if applicable, and after the new implant is actually in position. I can also directly manipulate and reshape the breast tissue.

Every breast behaves a little differently.

Skin elasticity, existing breast tissue, previous surgery, implant size, implant position, asymmetry, and the degree of breast sagging can all affect how the tissues ultimately come together.

For me, the preoperative markings serve as a roadmap. Tailor tacking then gives me an opportunity to refine that plan based on what I'm actually seeing in the operating room.

What Happens After I'm Happy With the Shape?

Once I've tailor tacked the breast and I'm happy with the shape, nipple position, symmetry, and tension, I can finalize my markings.

The temporary staples are removed.

I then remove the excess skin and breast tissue according to the finalized pattern, complete any additional breast tissue shaping that is necessary, and carefully close the incisions.

So, to answer a question patients sometimes have when they see operative photos or videos: No, those staples do not stay in your breasts.

They're simply a temporary tool I use during the operation to help plan and refine the lift before the final closure.

Does Every Plastic Surgeon Use Tailor Tacking?

No.

Not every surgeon uses tailor tacking for breast lift surgery, although many plastic surgeons do. Surgeons develop different techniques based on their training, experience, and preferred approach to breast surgery.

Tailor tacking is a technique I personally like because it gives me another opportunity to evaluate the result before making an irreversible decision about how much skin and breast tissue to remove.

It is not a substitute for careful preoperative planning. Rather, it adds another layer of evaluation after the implant is in place and while I can actually see how the patient's tissues are behaving.

Breast Lift Surgery Involves More Than Following a Pattern

Breast lift surgery can sometimes look very formulaic when you see diagrams showing the markings and resulting scars. But human anatomy doesn't behave like a diagram.

Two patients can have similar measurements and still require very different approaches to achieve an attractive breast shape.

That's especially true when combining a breast lift with breast implants or performing a breast lift during implant exchange or breast revision surgery.

There is careful planning before surgery, but there is also a significant amount of evaluation, judgment, and refinement happening in the operating room.

Tailor tacking is one of the tools I use to do that. It allows me to temporarily create the lift, assess the result, and make adjustments before I permanently remove the excess skin and breast tissue.

For me, that's the value of being able to staple before I cut.

-Dr. Victoria Aimé