Breast lift after sleeve and management

Many patients ask me questions about the breast surgery after weight loss, in particular about breast lifts with or without prostheses. Among these questions is whether or not the procedure is covered by Social Security and mutual insurance companies.

I'll try to summarize the main questions here, in order to provide some answers.

WHY DO BREASTS FALL OFF?

The breast is made up of mammary gland,of grease and skin.

After significant weight loss, the breasts may droop, sag or empty. These consequences follow fat loss. The The drooping of the breasts is called «breast ptosis».».

There are also fluctuations in glandular volume linked to hormonal changes: pregnancy, breastfeeding, menopause...

To correct sagging breasts, the plastic surgeon can practice a « mastopexy »This is the surgical term for a breast lift.

The breast lift consists of subtracting the excess skin to lift the breast thanks to an inverted T scar, also known as a sea anchor scar.

Skin weighs very little, compared to fat or the mammary gland.

In certain special cases, where the breast is only slightly drooping, a single scar can be used. around the areola is possible (round block).

The causes of breast ptosis :

• Congenital ptosis :

Ptosis may appear in young girls. It may be associated with other «malformations», such as asymmetrical breasts and/or tuberous breasts. These anomalies often give rise to severe complexes.

• Breast hypertrophy

It is the most common cause, the consequence of a breast hypertrophy. Excess breast volume cannot be supported by the skin bag. As a result, the breast envelope becomes distended, leading to sagging.

• Pregnancy and breastfeeding

Ptosis may result from one or more pregnancies, with or without breast-feeding. The process is the same as for ptosis caused by breast hypertrophy. There is significant distension of the breast envelope.

• Weight loss

The origins of ptosis can lie in weight loss, which has caused a melting of breast fat. The skin of the breast has not retracted properly over the new, smaller breast volume. As a result, the patient is left with what are colloquially referred to as «ptosis breasts".« washcloth ».

• Age

Age is also one of the causes of breast ptosis. As we age, the skin loses its elasticity and firmness. The breast envelope becomes more fragile, leading to general sagging of the breasts. What's more, with age, fatty infiltration of breast tissue causes the breast to lose its original shape and contour.

BREAST LIFT: COVERAGE?

Social security covers breast reductione, but not the breast lift.

Coverage for breast ptosis alone is exceptional. Indeed, its correction is considered a purely cosmetic surgical procedure. Only ptosis correction associated with clear asymmetry and/or breast reduction involving the removal of more than 300 g of glands per breast can be reimbursed by the French health insurance system.

When a patient undergoes a breast reduction of more than 300 grams per breast combined with a facelift, it is therefore eligible for reimbursement by the French Social Security system. In this case, we speak of breast reduction. These 300 grams can be made up of either fat or gland.

Removing 300 g per breast corresponds roughly to removing between 1 and 2 cups of breast volume. This operation is performed under general anesthesia.

It is quite rare for a patient who has already lost more than 30 kg to still have fat to remove from the breasts.

Even if this is the case, it's still quite rare to reach the famous 300 grams. More often than not, the plastic surgeon may have to fill the lack of breast volume with breast implants. This type of’breast augmentation in Paris is frequently proposed after significant weight loss, when the mammary gland has emptied without the need to remove excess fat.

Other cases of coverage of the breasts are :

- Birth defect with asymmetry ;

- Breast hypoplasia (from birth): no or very small breasts ;

- Thoracic malformation.

In other words, having sagging breasts is not a reason for Social Security reimbursement. This may seem justified by the fact that, diet or not, all women will have sagging breasts one day, due to aging.

In fact, after weight loss by sleeve or bypass, breast surgery is generally the only procedure that is not covered. It is considered to be a plastic surgery to 100 %. There may be exceptions. These are examined on a case-by-case basis.

In the case of a breast lift combined with a breast reduction, only a portion of the costs are covered. reimbursable by the Assurance Maladie. Social security covers part of the surgeon's and anesthetist's fees. Any additional fees, as well as hospital and clinic charges, remain the patient's responsibility.

BREAST LIFT: WHEN SHOULD YOU CONSIDER IT?

It's important to know that a breast lift performed before the patient loses weight again doesn't guarantee that the breasts won't tend to droop again. Removing excess skin through plastic surgery is effective, but does not guarantee results if further weight changes occur.

It is also possible to perform a combined surgery called the mastopexy prosthesis. It consists of a breast lift and a breast augmentation. breast augmentation by breast implants. Depending on the morphology, a mastopexy may also be associated with a breast lipofilling (reinjection of liposuctioned fat into another part of the body) to restore curves.

Breast surgery after weight loss is the exception to the rule for abdominoplasty, breast enlargement and breast augmentation. brachioplasty and cruroplasty. These are generally covered. However, they must meet certain covered by Social Security very precise.

It's important to point out that, after adolescence, there's no such thing as a woman with perfectly symmetrical breasts. Moreover, the larger the breasts, the heavier they are and the more likely they are to fall off.

If you're not sure and would like to know if you're one of the patients for whom a breast lift is an operation to consider, ask your surgeon for advice!