When does one need a breast lift?
Whether or not you need a breast lift procedure depends on two things; the position of the nipple relative to the breast fold, and the desired appearance. This has to be balanced with the fact that a breast lift procedure always comes with additional scarring. Scars fade over time and may become less noticeable, but nevertheless scars will always be present.
If the nipple position is above the fold then generally one does not require a breast lift, though occasionally if there is a lot of breast tissue sagging below the fold (pseudoptosis) then a breast lift procedure may be required to tighten the lower part of the breast.
If the nipple position is close to the fold or there is pseudoptosis, then the breast implant needs to be positioned lower than normal for a natural appearing breast. This means that the implant cannot be in a submuscular position, and should be partially submuscular (dual-plane) or over the muscle (subglandular (subfascial)).
With our Vectra 3-D Breast Sculptor system we are now able to demonstrate the effect and appearance of a breast lift with or without breast implants.
What type of breast lift is required?
The type of lift that will work depends on the position of the nipple and the width of the lower part of the breast. If the nipple only needs to be moved a small amount, then a crescent lift may work. If the nipple needs to be moved a moderate amount and the lower part of the breast is narrow or tubular, then an areolar (doughnut) lift will often work well. If the lower part of the breast is wider and needs tightening, then a vertical (lollipop) or Wise type (anchor) lift will be needed to tighten the lower part of the breast. If the lower part of the breast is wide or there is excessive skin, an areolar Doughnut) lift will not provide an attractive appearance. Unfortunately I think this concept is not commonly understood, and frequently accounts for the poor results with areolar lifts when used inappropriately.
Adding breast implants to a breast lift.
In 2006, I published an article with Dr. Hilton Becker on combining adjustable saline Mentor Spectrum breast implants with a breast lift procedure. Of the 175 cases reported, approximately 130 were my patients, and since then I have performed at least 200 more of these procedures since then. (Augmentation Mastopexy Using Adjustable Implants With External Injection Domes. Aesthetic Surg J 2006; 26:736-740)
For women who want larger breast augmentation with their lift, we find that this is the safest way to perform the procedure. One of the risks of combining a lift with breast implants is the increased risk of problems with nipple healing. It is even possible to lose the nipple skin with this procedure. By using an adjustable implant, the implant can be deflated at the end of the procedure to make sure there is no pressure on the nipple area immediately after surgery. One week later the implant can be inflated with saline to the full size and after the patient is satisfied with the size and symmetry, the fill tubes can be easily removed with a gentle tug. We have also found that the mastopexy scars appear to heal better with this approach. For a smaller size increase, I often recommend smaller non-adjustable silicone gel implants. Another option is to use fat grafting for a small to moderate augmentation, or if the only objective is to have more fullness in the upper part of the breast. The beauty of fat grafting is that it can be placed exactly where desired, to fill the upper pole and to improve symmetry. For upper pole fullness I find fat grafting to be much more reliable than techniques designed to improve fullness during mastopexy, as the fat tends to stay where placed once the graft takes.
Recent studies have proved that methods to try reposition the underlying breast tissue to obtain more upper breast fullness, do not work in the long term. I believe they also add to the risk of nipple skin loss in combined lift and implant procedures. Fat grafting is also an excellent option to improve the appearance of tubular breasts, without resorting to aggressive release of the breast tissue with open surgery.
At the Bougainvillea Clinique, our Florida area breast surgeon offers all these choices. Our recommendations are based on the type of appearance you desire as well as the actual shape and position of your breasts. For more information on breast augmentation with breast lifts, contact Dr. Hartog for an individualized consultation. He proudly serves all of Central Florida including Orlando and Winter Park, FL.