Breast lift augmentation

This question may have prompted the greatest number and most long winded answers in realself.com history.  Many of the answers are valid and complete, so I will not reiterate.  Just a word of advice, simultaneous breast lift and augmentation is one of the most difficult procedures in plastic surgery.  So, if there is even a remote possibility that you would be happy with the volume of breast tissue that you already have (minus 5-10% for tightening of the skin, 15% seems a little high), do the lift without the aug.  Even though it would require a second surgery, you can always do the aug later AND if your board certified plastic surgeon is any kind of altruistic physician they will sharply discount the subsequent surgery.  Good luck!

When talking with women about breast lifts and the size of the breasts, the most important question is: are you happy with the size of your breasts now?  Sometimes this is a little difficult to figure out if you have a lot of sagging, so the other way to look at this is: are you happy with the size of your breasts when you are in a bra? If this is the case, you do not need breast implants. 

When performing the breast lift, very little volume needs to be removed with the skin removal.  And the amount removed (probably 5% or less in terms of volume) will not have a big difference in the overall size of your breasts.  And, the breast tissue itself can be moved in such way as to consolidate the breast tissue centrally and give better fullness in the upper part of the breast.

So, if you are having a breast lift and you are happy with the size of your breasts, you don't need an implant.  If you breasts are smaller than you would like, then an implant at the time of the lift is a good option.  If you are not sure, and are generally happy with the size of your breasts, then just have the lift.  You can always have an implant placed later if you feel that you need it.

If you like your breast size then don't change it. There are many different types of breast lifts today;

1-skin only circumareolar breast lifts - a bad technique that flattens out the breast. The scars are not acceptable and the position of the nipples is rarely symmetrical. Most importantly, the durability is about 1 year,if you are lucky!

2-An anchor scar skin only lift - not much better than the above. The breasts have a nice shape, but the scars are awful and the sag returns within a year. The better newer techniques change the shape of the breast tissue under the skin and as the tissues moves to it's new position, the skin reshapes around the tissue without much effort - even if you think you have lots of extra skin.

3- The Vertical scar mastopexy (lollipop scar) this comes in many flavors - the two most common are the Hall-findlay and the Lejour. The Lejour is harder to learn and perform by the physician but gives a more natural, perky shape (look at the photos on my website). The Hall-findlay is more common today because of the ease of use, but the scars do not heal as nicely and the breast is not as perky. These techniques require a small a mount of volume reduction, so if you decide to have this type of lift, you must accept the slight loss in volume or get an implant as well.

4- the Goes Circumareolar breast lift is a great technique with a minimal scar around the areola for patients who have less that 5 cm of sag. That is the amount of movement of the nipple from its old position to the desired new position. This technique moves and shapes the breast tissue under the skin. It is a great technique, although not as perky as the Lejour technique. This technique does not have to remove any tissue at all if desired.

5- My Tear Drop Augmentation Mastopexy technque is a fabulous way to lift and augment a breast that is sagging and needs a small to large amount of volume improvement. I have been performing this technique for 11 years with almost no complications and it is designed to eliminate the hollow appearance along the top of the chest wall that so many of the other techniques have. The key is to only use the implant that gives you the size that you need. If you hear a doctor telling you that you need to go bigger than you want to fill out a sagging breast - then run.

6- My newest lift The IBM technique (inframammary breast medialization) is designed for patients wanting to move there nipples, areal and breast tissue toward the center of their chest. This is especially designed for those with a wide space between their breasts. Fron a 3 cm incision under the breasts, I can place the implants under the muscle and move the breasts toward the middle. The procedure is new, so durability is to be determined, but the patients that have had it are ecstatic. Good Luck.

In our office we help many patients with that same decision, along with several others.  You are right to have questions.

First, I would suggest that you may lose very little of your current volume if you choose breast lift (mastopexy) alone.  It should improve breast contour and projection.  It may also enhance breast firmness.  Patients frequently report they change bra size a little (up or down) because the reshaped breast fits in a bra differently.

Second, I suggest you make the decision about implants based on whether you are happy with your current size or want to be fuller.  If you do, and the surgeon thinks it can be done safely, implants can be a good choice.

Patients do generally get a different shape when implants are added during mastopexy.  Implants give more fullness to the upper pole of the breast than lift alone.  They can also give more projection for some patients.  If you want those effects, you may choose to add implants.

Combining mastopexy and implants can increase the chance of complications, depending on the patient and type of mastopexy procedure (there are several, tailored to your needs).  For most patients, they can be done together safely. 

However, planning a two-step method may be excellent: an initial mastopexy to give you the best lift, followed months later be an implant augmentation to your desired size.  This allows you to decide about the size, and get the tightest lift.

An increasingly attractive and popular option for breast enhancement, particularly in women who have been through pregnancy and lactation, is the combination of a vertical mastopexy (breast lift) with breast augmentation. This is the ideal breast surgery procedure for women seeking breast enhancement who have experienced breast volume 'deflation' following pregnancy and lactation (and for those with 'deflated' appearing breasts who have never been pregnant), and who have the desire for a fuller breast profile.

For some patients with a significant amount of existing breast tissue, a breast lift alone may produce an acceptable breast appearance. However, it is difficult to achieve fullness in the upper poles (the cleavage area) of the breasts by means of a breast lift alone. In consultations I ask patients how important it is for them to have the appearance of some fullness in the upper part of the breasts, and thereby achieve a significantly more youthful breast profile. For patients that indicate that this is important to them, I recommend a breast augmentation mastopexy.

On the morning of surgery breast implant patients are marked for breast augmentation mastopexy in the standing position. In the operating room, the breast implants are placed first, as the addition of volume to the breasts by means of breast implant placement reduces the requirement for skin excision. The size of the implants to be placed is determined in the same manner as is described in the section on breast augmentation. Once the implants have been placed, the patient is again placed in the upright sitting position and adjustments are made to the preoperative marking for the mastopexy. The mastopexy involves not only removing breast skin, but also creating an internal support for the breast implants so that breast fullness is maintained long-term (and 'bottoming out' is avoided).

This breast augmentation surgery has become increasingly popular in my practice, especially among moms who are looking to get some aspects of their 'pre-baby' body back. A breast implant of modest size can produce a very dramatic enhancement in overall breast appearance when combined with the vertical mastopexy, producing a result that is not possible by means of breast augmentation mastopexy alone.

Michael Law MD

Board Certified Plastic Surgeon

Raleigh,  North Carolina

If you are happy with your breast size but just want a lift after loss of shape following pregnancy or weight loss a breast lift may be just the right decision for you. This can be done with no real size loss but doesn't give quite the projection you could gain with a lift with a breast augmentation. Your decision to have either a lift alone or a lift with a breast implant is an important decision and requires a in depth consultation with your Board Certified Plastic Surgeon. While I perform both of these procedures on a daily basis, they require a great deal of experience. I would encourage you to see several Plastic Surgeons and check them out for your self. See photos of their surgeries including both lift with and with out breast augmentation. See many photos and find out how many they have done and what their results have been. Both are great operations to restore the size and shape of your breasts but must be done by some one with a great deal of experience.

It all depends on how much breast tisue you have as well as the placement of the breasts on your chest.  If you have lost the fullness on the upper part of the breasts and they are sagging with small amount of breast tissue present, then you will need the lift along with the implant placement.  However if you have moderate breast volume with just the nipples slightly lower than they should be, the lift may do well without having to place an implant. 

It is true that you will loose some volume with the lifting and tightening of the skin.  yo also have to look at what you desire.  in other owrds do you want to do go larger since you are having the incisions nd the post operative down time.

Think about what will make you happy as your final result. Together with an assessment of your normal anatomy, a plastic surgeon can determine what is required to achieve your result. In general, a breast lift or mastopexy by itself removes very little volume but can compress the remaining volume as it firms the consistency of the breast. THis will lead to a smaller volume and size. The shape of the breast will change  and different types of lifts can restore volume in the upper portion of the breast to varying degress. If you feel you require more fullness, then an  implant will be necessary. If the shape is less important and you just want the breast lifted, you may be happy without an implant.

In general, implants can be placed at the same time as a lift but it is dependent on the comfort of the surgeon, the technique of the lift, and the size and position of the implant.  Some surgeons do not feel comfortable doing a simultaneous augmentation-mastopexy because of a theoretical increase risk of complications. Address these issues openly and thoroughly with your surgeon.

A good breast lift moves up your breasts and your nipples INTERNALLY and a little bit of skin is removed. At most, you should lose no more than 5% of your breast size with a lift.  And the breasts look bigger anyway because they are higher on your chest.  So this is not a good reason to get implants.

If you have "empty" or "deflated" breasts, on the other hand, then a combination lift-augmentation can be a good choice. Many women fall into this category after having children.

Breast Lift (Mastopexy) involves tailoring the excess skin of the breast and re-packaging the existing breast tissue into a smaller skin envelope.  At the same time, the nipple is lifted higher on the mound of the breast, and the areola diameter is reduced.

It is inevitable that some small amount of breast volume will be lost during the process of reducing the skin envelope of the breast.  Whether this lost volume will be significant cannot often be determined in advance.

It is not generally necessary that Breast Augmentation should be done simultaneous with Breast Lift (Mastopexy-Augmentation).  Many women simply do not want breast implants, or don't think they need them.  Under this circumstance, it may be preferable to do the lift first, and live with the results for a few months or more.  If the breasts are ultimately smaller or less plump than desired, a delayed Breast Augmentation can be done to add volume and fullness to the breasts.  Arguably, it is somewhat safer to proceed in this two-staged approach, since there is no compromise between the Breast Lift (which tightens the breast envelope), and the Breast Augmentation (which stretches the envelope), and fewer potential wound healing problems.  The only down-side to the staged approach is that two surgeries are involved, rather than one.

Breast lifts alone require removal of some excess skin and then the breast is molded to improve the shape.  Very little to no breast tissue is removed.  If you want more volume, then implants can be inserted as well.  This really depends upon what you want.

Breast implants certainly can be performed at the time of a lift if you are interested in a larger cup size. However, if your primary goal is to elevate the nipple or reshape the breast, and you're happy with your size, then all you need is a lift.

But your question about an augmentation at the time of a lift increasing the risk of the procedure is a good one. The short answer is that it can increase the risk of complications, the primary one being problems with the incision healing. In most healthy women, the incision heals fine, but I personally will not perform this procedure (called an "Augmentation/mastopexy") in a smoker, as the nicotine will increase the risk of poor wound healing.

Your anatomy and overall health will also play a part in terms of whether or not you have an increase risk of complications. This is why it is really important to trust your procedure to a Board Certified Plastic Surgeon who can review with you in detail your options and the risks and benefits of each option.

I meet many patients who need a lift because of a lowered nipple position relative to the crease below the breast. If they feel that they are large enough in their bra, the lift can be performed without an implant. They will lose the extra skin and therefore some volume, but will look paradoxically bigger than before surgery because of the elevation of the nipple and the conical shaping of the skin tightening. This patient may still want an implant though if they want superior pole fullness which won't come from the lift.

If a patient who needs a lift feels that they are too small in their bra, they will certainly need an implant.

June-

Good question.  With a breast lift, also called a mastopexy, patients lose a small amount of volume during the procedure.  This will make your breasts a bit smaller as they are lifted.  Many patients want to increase fullness along with getting their breasts lifted.  A breast implant with a mastopexy helps give a better shape and size.  In my practice, I find that the happiest patients are those that have had implants with their lift.  This does not usually lead to greater complications, but implants do have their risks. 

Make sure that your surgeon goes over all the risks as well as the benefits of a breast lift with and without implants.  Have them show you pictures of cases they have done.  Hopefully you both want to achieve the same aesthetic result.

Hope this helps.