Although all body parts age as we grow older, the decline of beauty in the breast region can be sudden and severe. While this type of change is usually due to childbearing, it also can be influenced by weight loss and hormonal change. While most efforts have been directed towards the skin envelope in the past, new data shows that the framework of the breast — the gland and soft tissue — is the scaffold upon which the breast is shaped. The case studies presented show a new approach to breast lifting: restoration of the collagen framework within the soft tissue plus heat mediated soft tissue contraction. With this approach, no skin is excised. Bipolar radiofrequency based energy was applied in the subcutaneous plane of the breast following infusion of tumescent fluid in six patients. Indications included a simple breast lift for grade II ptosis, a scarless breast lift plus subpectoral implants, and reduction of the soft tissue and skin envelope when exchanging large implants for a smaller size. Limitations include the need for post-treatment support for 2–3 months, and a mild to moderate improvement only. If the skin envelope needs to be reduced by more than 25%, a surgical excisional approach would be indicated.

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