Breast Lift with Implants
Mastopexy and Mastopexy Augmentation
A Mastopexy or breast lift procedure is required when a change in breast shape is required, rather than an increase in size alone. The most common reason for unhappiness with breast shape is breast ptosis or droop. This is usually associated with a low nipple position. Unfortunately there are confusing messages out there about how breast droop and low nipple position can be corrected.
In Dr Stradwick’s experience only very few patients can achieve a “breast lift” with implants. Very occasionally the use of a teardrop implant on its own can create the desired breast shape. Typically these patients have very minor ptosis or breast droop only.
As a general rule breast implants, and particularly round implants, do not change breast shape. They just increase the size of the existing breast. If a patient is unhappy with the existing breast shape then the use of a round implant on its own will not give the desired result. It just creates a big droopy breast. Although some surgeons maintain that a large round implant will “elevate” the nipple Dr Stradwick believes that this approach is just disguising the fact that the nipple is low. An implant sitting low on the chest makes the nipple look higher.
It is therefore critically important to decide whether a change in breast shape and/or nipple elevation is required.
In Dr Stradwick’s opinion the correct approach in cases of significant breast droop is to commit to a breast lift procedure – with or without simultaneous implant placement. The simultaneous lifting of the breast and placement of an implant is known as a mastopexy augmentation (or aug-masto) and is arguably the most difficult cosmetic procedure.
Careful surgeon selection is therefore more important than in any other type of breast surgery. It is always wise to check the qualifications and experience of your surgeon but particularly for this procedure.
Dr Stradwick uses a vertical pattern for breast lifts which results in a “paddle pop” scar. Obviously this is a larger scar than that needed for a breast augmentation and this can be a concern for patients. It is the major trade off when comparing a breast augmentation and any breast lift procedure. Scars do fade with time but an incorrectly placed breast implant in the wrong patient always leads to a poor long-term result.
To summarise the approaches to the drooping breast;
Use of an breast implant alone
Indicated in very few cases where there is minor ptosis. Requires a full projecting teardrop shaped implant. The advantage is the reduced scarring. The disadvantage is the use of an implant entails short and long term implant complications.
Use of a breast lift alone
Sometimes reshaping existing breast tissue gives a satisfactory increase in size without the need for an implant. In such cases the breast tissue is spread over a relatively large area and when this is re-shaped and the excess skin removed the desired breast shape and size is produced. This is an ideal outcome because the patients own tissue has been used for the “augmentation”. The result is long lasting and there is no risk of “implant complications” either short or long term.
Breast lift with late implant placement
This is a two stage procedure where either the breast lift is done first and the implant placed 6 months later when the breast has stabilised, or sometimes vice versa. The advantage of this approach is it gives a more predictable outcome and arguably more stable result. The disadvantage is the need for two operations. It would be uncommon for Dr Stradwick to recommend this approach in primary cases. However in cases where the patient has already had multiple breast procedures a staged approach would almost always be used.
Breast lift with simultaneous implant placement
This is the approach Dr Stradwick would use in most cases of breast droop. The advantage of the single stage approach is that only one operation is required. The disadvantage is that the operation is more difficult. This is because logically the procedure makes no sense. On the one hand the surgeon is trying to elevate the breast and nipple but at the same time is adding weight to the breast. The action of gravity on the extra weight inevitably leads to tissue stretching. It is an unstable situation requiring good judgement. Typically on the operating table the implant looks a little high and the nipples a little low. This is done with the knowledge that the implant will inevitably descend in the early post-op period. It is also much easier to correct a low nipple than the combination of a high nipple and low implant.
For these reasons the best results are achieved in patients with relatively good skin, modest droop and those wanting a modest sized implant.