Breast Augmentation & Mastopexy (breast lift) and the role of tissue stretch ... Continued
Now let’s consider the case of a breast lift. In this operation, excess breast skin is removed, the nipple is raised and sometimes the glandular tissue is re-shaped and/or elevated as well. This procedure will address the low nipple position, the excess skin and re-shape the breast by elevating the glandular tissue as well. What variables can I control? I can control the amount of skin I remove, how I re-suture and re-shape the glandular tissue, how far up I move the nipple. Sounds like I have total control over the result. Well, not really. When tissue that is compromised (stretched out) is tightened it will slowly lose some of that tightness (partial loss of correction) as healing occurs. This is similar to stretching the elastic band on a pair of underwear. If the elastic is overstretched, there will be loss of its elasticity and the elastic band will not return to its initial length after it has been stretched. As the breast skin envelope relaxes, the glandular tissue will fall into it and there will be some bottoming out, or drooping of the lower part of the breast. Not nearly as much as there was initially, but the breast won't be as "perky" as it initially was after surgery, either. As this process happens, the nipple position may change (usually elevate) as well. The diameter of the areola (the pigmented skin around the nipple) may increase due to stretching of tissue. Again, in most cases when planning a breast lift, based upon experience, I can take the tissues into consideration and plan an operation that will have a nice, aesthetically pleasing result.
What about combining a breast augmentation and a breast lift together? There are now so many uncontrollable variables present at the same time that it makes it very hard, even with a fair amount of experience to accurately produce a predictable result. My approach in these cases is as follows:
- If I think that there is a fair chance that a lift will not be necessary but I am not sure, I suggest proceeding with the augmentation only and reassessing in six months regarding a breast lift. Again, in my experience with these types of cases, a breast lift has almost always NOT been necessary.
- If I am pretty well convinced that I believe that a breast lift will be necessary, then I have a discussion with my patient and offer them the option to perform the procedure in one stage or two stages. If the latter, I prefer the augmentation first, followed by the lift six months later. Most women still prefer to have both procedures at the same time, but at least I have educated them and given them the option to make a decision based upon their needs.
The advantages of the one stage option are:
a. Less cost - only one trip to the operating room
b. Convenience - only one operation to recover from
The disadvantages of the one stage option are:
a. Less control over the predictability of the result
b. Potentially poorer quality scars
c. Sometimes difficult positioning the nipple at the ideal height.
The advantages of the two stage option are:
a. Greater control of the final result - the shape of the breast, the position of the nipple, possibly eliminating the need for a vertical scar on the lower breast.
b. Possibly better quality scars as there will be less tension on the breast lift because the tissues have already relaxed after the previously performed augmentation.
The disadvantages of the two stage option are:
a. Greater cost
b. Having to undergo two separate procedures with two different recoveries
Only when equipped with the appropriate amount of knowledge can a patient make an informed decision as to which type of approach is best for their needs.