Breast Augmentation / Mastopexy
What are the Goals of Breast Lifting?
Breast lifting procedures can be very helpful in achieving better symmetry, shape, and fullness of the breast. Communicating your breast surgery goals with your board certified plastic surgeon is one of the most important factors in determining the success of your operation. Bringing photographs of “goal” images, as well as breasts that are too big or too small, proves very helpful in communicating size goals. The use of words such as “natural”, “C cup”, or "fake looking", means different things to different people, and therefore prove unhelpful during consultation. In addition, predetermining the implant size or type desired can result in disappointment later, so it is important to attend a consultation with an open mind. It is difficult to promise or predict final cup size after breast surgery. With breast lifting, there is a change in the position and shape of the breast that may result in a different cup size or fill the cup of a bra in a different way.
What are the different Breast Lifting Options?
There are a variety of different mastopexy procedures that are available depending on the patient's specific needs and goals. A consultation with a well experienced board-certified plastic surgeon will illustrate the best choices for each patient's specific situation. In general, it is often the surgeon's experience and skill level (not the specific mastopexy procedure performed) that is most important in determining the final outcome. In other words, there is no specific mastopexy procedure that has been shown to be “superior” for all patients or avoids all complications. The three most common mastopexy procedures are the circumareolar, lollipop, and full anchor mastopexy.
A circumareolar mastopexy
(Also called Donut or Benelli Breast Lift) can assist in something as simple as moving the nipple areolar complex into a slightly higher position on the breast with a crescent shaped scar. It can also be used for a more dramatic result raising the nipple areolar complex and eliminating a certain amount of excess skin around the nipple, helping with the appearance of sagging (ptosis). This is commonly used after weight gain and loss, as well as after breast feeding. It is preferred for women who need a minimal breast lift or want to achieve greater symmetry with minimal scarring.
A "lollipop” mastopexy
This type of breast lift ncludes the circumareolar scar as well as a vertical scar. The vertical scar traditionally runs from the inferior aspect of the nipple to the inframammary fold, but can be smaller depending on the amount of tissue that needs to be removed. This mastopexy removes more skin and allows for a more dramatic lift than the circumareolar procedure. It raises the nipple areolar complex, increases breast tightness, and helps achieve a rounder shape.
The traditional "anchor” mastopexy
This is the lifting procedure for women who require the greatest degree of breast tissue removal to achieve their size and shape goals. This procedure can also be used for a breast reduction on one side to increase symmetry. An anchor mastopexy, in addition to a circumareolar and vertical scar, has an incision line that runs along the bottom of the breast, along the inframammary fold. The length of this scar also varies depending on the patient's specific needs. This procedure does have the most scarring but can achieve the most dramatic results.
Tailor tacking is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY closure of the skin (for example with temporary skin staples) to help determined the amount of skin to be removed during the procedure. Essentially this technique allows for the surgeon to "double check" the skin excision prior to the actual excision being carried out. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results and tightness the patient is looking for. If too little skin is removed the patient will be left with loose skin and may be dissatisfied with the end result, leading to another surgery for skin excision at a later date. On the other hand, is important not to remove too much skin or it will limit the size of the implant that can be used (if the patient desires an augmentation or re-augmentation) and create too much tension upon closure leading to potential white scars, wide scares, wound healing problems, and/or implant exposure.
Can Breast Lifting and Breast Augmentation be performed at the same time?
1 Stage vs. 2 Stage:
The combination breast augmentation/mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgeries performed separately. The patient has a higher likelihood of needing revisionary surgery with breast augmentation/mastopexy surgery done at the same time, (one stage). If the patient desires a one stage operation despite the increased risk of complications and the potential need for further surgery, the increased risk must be weighed against the practical benefits of a single stage procedure. Conversely, if a patient requires minimal to moderate lifting along with a small to moderate size augmentation, and has good skin quality, a one stage procedure is much safer.
Natural anatomy can be a limiting factor in achieving a patient's goals if it is not understood and discussed during consultation, which can lead to post-operative dissatisfaction. Presenting the patient with a simplified analogy can help illustrate the effects of natural anatomy on the breast augmentation/mastopexy procedure, helping the patient achieve realistic expectations, or lead them to re-evaluate their goals. A frequently used analogy is that of a baseball placed underneath a sheet versus a comforter. The sheet is analogous to a client with very little soft tissue/breast tissue with a thin skin envelope. This patient may experience greater visibility of the implant resulting in a rounder more defined shape, this needs to be taken into consideration when choosing implant type and size. Conversely, a patient with a greater amount of soft tissue/breast tissue and a thicker skin envelope, analogous to a “comforter”, may hide the shape of the implant completely eliminating their ability to achieve a full round look. Once a patient understands this, moving forward in determining their breast augmentation/mastopexy goals with regard to implant size, type, and location is more reliable and effective.
Will I have a scar with Breast Lifting?
There is no good way to do a mastopexy with “little or no scarring”. The patient's primary concern should be obtaining the best results possible (scarring concerns should be secondary). Most patients undergoing this procedure will accept scarring as long as their overall goals in regards to size, shape, contour and symmetry are met.