Breast Augmentation & Mastopexy (breast lift) and the role of tissue stretch
In my breast augmentation practice, a large portion of my patients are mothers who wish to restore lost volume to their breasts, or attain a volume that they wished they had previously. Many of these women have ptosis, or drooping, of their breasts. There are two types of ptosis: true ptosis and false ptosis, also known as pseudoptosis. True ptosis relates to the position of the nipple with respect to the lower breast crease, also known as the inframammary fold. False ptosis describes the position of the glandular tissue with respect to the inframammary fold. The degree of ptosis and pseudoptosis can vary independently with respect to one another. Except for those women with very little breast tissue to start with, most all of these women have a combination of both types of ptosis.
The issue to be addressed is the following: Assuming the woman is going to undergo a breast augmentation, does she also require a lift (also known as a mastopexy)? I frequently see women who have been told by other plastic surgeons that they require a lift in addition to the breast augmentation surgery. Many of these women do not in fact require a breast lift. Using some of the latest advances and refinements in breast pocket dissection, coupled with proper implant size and shape selection, the implant can be fitted into the breast pocket so as to restore lost fill volume to the breast, thus advancing the nipple forward and rotating it upward. In these cases a lift is not necessary.
This cannot be achieved in every case, however, after a thorough analysis of the breast and careful measurements, the need for a mastopexy (breast lift) can be usually determined prior to surgery during the initial consultation. In other cases, such as when the nipples are at the lowest point on the breast when standing or if the nipples point straight downward, a lift is often unavoidable. In borderline cases, I have found it very helpful to perform the augmentation first, and allow the implants to settle into place. Six months later, if a lift is required, this can be performed, but with much greater precision as the breast mound has already settled. Sometimes the lift can be performed with a simpler procedure with less scarring. In my experience with these types of cases, a breast lift is almost never required or desired by the patient six months later.
Patients are concerned as to whether or not adding a simulataneous breast lift (mastopexy) increases the downtime and duration of recovery. In my patients, I am not seeing much difference between breast augmentation alone and augmentation with mastopexy (lift) in terms of recovery time. Even though a breast lift performed at the same time as a breast augmentation requires longer incisions in total, the incisions only go down to the superficial tissues of the breast which heal quickly and with little discomfort. However, it is important to your recovery that you ambulate frequently during that time. I use a specialized “Recipe for Recovery” to hasten your recovery. After the procedure, it is often possible to return to work within a few days.
Strenuous physical activity should be avoided for at least the first three weeks following surgery.
Patient Information: 32 year old female show pre-operatively, 2 days after submuscular placement of 339 cc round silicone gel filled implants placed via a Dual Plane III technique, and 5 months later. Note how the volume of the implant redistributes with time to the lower portion of the breast, rotating the nipple upward. Also, the excessive upper breast fullness corrects as well. Without a dual plane approach, this degree of correction with time could not be achieved. NO LIFT WAS REQUIRED!
Patient Information: 40 year old female show pre-operatively, 2 days after submuscular placement of 400 cc round silicone gel filled implants placed via a Dual Plane III technique, and 4 months later. Preoperatively, these breasts are severely “deflated”, or demonstrate marked volume loss with relative skin excess. After surgery, note how the volume of the implant redistributes with time to the lower portion and especially the anterior portion of the breast, moving the nipple forward and rotating it upward. Note how the excessive upper breast fullness resolves. Without a dual plane approach, there would be a severe “Snoopy dog” deformity of the breasts, where the breast tissue would hang off the front of the implant. Again, NO LIFT WAS REQUIRED!
How your breasts will look and feel after a breast lift with implants
Breast implants will add to the overall results of the breast lift procedure by lifting the breast and increasing your bust size in a single step. Some discoloration and swelling may occur initially after the procedure, but this will disappear quickly.
After recovery, many women equate the feel of their breasts implants to that of a teenage girl with young, healthy, firm breasts. And when you undergo the breast augmentation combined with a breast lift, your breasts will typically remain full and perky for longer. It is important to understand that no surgery will change the quality of your breast tissue, so you will be feeling the breast tissue on top of the implant. The more natural tissue that you have, and the firmer that tissue is, the less you will be able to feel the implant itself. As today's silicone gel implants are designed to mimic the feel of natural breast tissue, it becomes difficult at times to even feel the implant at all in some cases.
risks and complications associated with a breast lift with implants
All the risks applicable to a breast augmentation exist as well when augmentation is combined with implants. The main additional risks are that when the procedures are combined together, it may be difficult, if not impossible, to accurately predict where on the breast (at what height) the nipple will be positioned at after the breasts heal and the new shape stabilizes. This is due to the fact that tissue stretches after surgery and neither surgeon nor patient can either predict or control the amount of stretch that will occur. The reality is that the vast majority of such surgeries have excellent results with very happy patients (and surgeon!), but the patient still needs to understand this risk. Another consideration is that there often will be some loss of correction of sagging, again due to tissue stretching (under the influence of gravity on the breast and implant) after surgery. Sometimes, I find that placing a piece of absorbable surgical mesh (Seri, Galaflex) on the lower part of the breast helps to reduce this problem.
scarring after a breast lift with implants
Scars are a part of the breast augmentation and mastopexy process. Fortunately, breast augmentation and mastopexy scars, regardless of where they are located, tend to heal extremely well. Scars following breast augmentation are usually small and inconspicuous, and Dr. Epstein will make sure the scar is as unnoticeable as possible. A mastopexy does add additional scars such as around the areola, and usually a vertical scar from the bottom of the areola down towards the lower breast crease. In some occasions, an incision is made in this crease, as well.
BREAST FEEDING AFTER A BREAST LIFT WITH IMPLANTS
You will most likely be able to breastfeed after the breast lift with implants procedure, but it may depend on the kind of surgery you had and the type of incisions required.
recovery AFTER A BREAST LIFT WITH IMPLANTS
In my experience, the downtime is little to no more than if only one procedure alone was performed.