Breast Augmentation? Breast Lift? Or Both?

If you would like to see examples of augmentation/mastopexy, which can achieve an excellent improvement in contour with acceptable scarring for most individuals, please email or call us at 214-823-1978 for the link to this page.

Many women desire their breasts to be lifted if they have a small amount of "droopiness", referred to medically as "ptosis" (pronounced "toe-sis"). If they don't have a significant amount of droopiness, then a simple breast augmentation will fill out the skin envelope and "lift the breast" by simply restoring volume. However, augmentation alone will not always prove sufficient. It is at times necessary to perform mastopexy (reduction of the skin envelope) in conjunction with augmentation to achieve the desired effect. For instance, if the breast is larger but still too droopy, as often occurs after gross enlargement of the breast and stretching of the skin envelope during pregnancy, breastfeeding, or extreme weight loss, both augmentation (enlargement) and mastopexy (lift) may be necessary to fully restore the breast. This becomes necessary when the skin envelope is larger than the desired breast size. Restoring volume (Breast Augmentation) alone in this case would still result in a droopy breast.

The best analogy for this is to envision a woman who has a breast volume roughly the size of a baseball, whose breasts enlarge to softball size after postpartum breast engorgement and enlargement or extreme weight gain. This obviously varies from woman to woman, but in such cases, after the volume returns to its original state or weight loss occurs there are several things that can happen. 

1. The volume may revert to its original state, and if extremely lucky, the skin may snap back with good elasticity and give a very reasonable, acceptable shape.
    

2. Elasticity is not sufficient for the skin to snap back completely and/or the volume is even smaller than before pregnancy resulting in a larger envelope.
    

3. After weight loss the skin envelope is larger than the volume of the breast and droopiness occurs. 

If you are among the lucky few that fit into the first category you need do nothing.  If you are like the majority of women that fit into the second or third category there are choices to be made and circumstances to be considered before making the decision about which procedure or procedures will achieve the best results for you.

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Choice #1

If the breast envelope is not too large and the patient desires a larger breast than what she had initially, one can simply fill the envelope with a primary breast augmentation, (please click on this link for the details on this procedure). An example of this would be a woman who started with a B breast, engorged to a D, and was left with D skin but B volume. If a D shaped breast is acceptable then it is possible to place a very large breast implant to achieve a final result of a D shaped breast. In this case this would be the simplest solution and would result in the fewest scars.

Choice #2

If the goal is to maintain the same or even smaller size, and the skin envelope is larger than desired, the obvious solution is to reduce the size of the skin envelope through mastopexy or "breast lift". This puts some scars on the breasts that will vary from patient to patient depending on the option chosen, but certainly more scarring than a simple breast augmentation. It does achieve the best shape overall, however, and makes it possible to lift and shape the breast without increasing the overall size.

Choice #3

The most common scenario is somewhere in between these options in that women, after pregnancy or weight loss, lose a small amount of volume and have a little too much skin envelope. Therefore, some type of combination augmentation/mastopexy is carried out. This would result in some additional scarring in reducing the skin envelope and can be done simultaneously with a small implant to restore or increase volume. Any time an implant is placed, the risks and benefits are the same as for a breast augmentation. However, with an augmentation/mastopexy the additional concept of scarring is involved.
In summary, this is one of the most difficult consultations in breast surgery, especially for those who do not want to have extremely large breasts, but want no scarring. Some compromise is inevitable. Careful consultation with each patient keeping their specific needs in mind is essential.

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Fold flaws, Wrinkles, Irregularities, and Asymmetries:

These can occur in any breast augmentation. There can be subtle shifts. There can be irregularities, and it will be pointed out at the time of consultation any irregularities or asymmetries in the patient's breasts pre operatively. It is the rare patient who has perfectly symmetrical breasts. 99% of women have some asymmetries in their breasts, and when breasts are augmented these asymmetries may be more noticeable. There are certain things that can be done to minimize these asymmetries, but natural appearing breasts have some minor asymmetries. However, fold flaws and wrinkles can be noted and they are more common with textured implants and implants that are not slightly over inflated. These are also more common for patients with larger implants and smaller breast pre operatively, as stated above. Once again, the smaller the breast tissue coverage the more likely it is for the implant to be seen, which makes intuitive sense. These cannot be totally avoided in certain patients, but can be minimized greatly by surgical technique of placing the implants under the muscle or over the muscle and by slightly over inflating the implants to avoid fold flaws and wrinkles. We place the majority of patients of primary breast augmentations underneath the muscle. This provides more tissue between the external environment and the implant; thereby maximizing contour and a natural appearance. There will also be slightly less implant masking breast tissue on mammography if placed under the muscle; however, this is a minor consideration. The exception to this rule is that it is occasionally beneficial to place the implant above the muscle in patients who have mild droopiness of their breasts and at least a B breast or greater, i.e., enough breast tissue to cover the implant adequately. If enough breast tissue is present but is droopy, a more direct lift on the breast can be done above the muscle and may save the patient a more extensive lifting procedure (mastopexy).

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Post Operative Course:

There is probably not another plastic surgery procedure in which women compare notes more than breast augmentation. I do not have one way of treating my patients. As you can see from the details above, implants may be placed above the muscle, below the muscle, different sizes, lifts, shapes, etc. I individualize the postoperative treatment care of my patients. If they have droopier breasts, I may place them in a bra post operatively. If they have smaller breasts and larger breast implants, I may want these implants to settle and drop and therefore will not place them in a bra post operatively. If during the operation the patient has been on aspirin or bleeds for whatever the reason, then drainage of any bloody fluid is mandatory to decrease their risk of capsular contracture. Although inconvenient, it is better in the long term, and I do not hesitate to place drains if necessary. However, it is much more convenient not to have drains, and if the condition warrants, the procedure goes well, and the pocket remains dry throughout the case, then drains will not be used. Again, individualization of each specific patient in her operative plan and postoperative care will be carried out. The post operative pain will be handled by oral pain medications and usually the first three days are the most intense, but tolerable with oral pain medications. An overnight stay at Dallas Day Surgery Center is recommended where one can sleep comfortably overnight and then be taken home the following day. After three days the intensity of the procedure diminishes greatly, as does the swelling, and the patient gradually improves so that a return to work at 7-10 days can be accomplished in most patients. Certainly some discomfort with jogging and running and sudden movements can occur for several weeks, but each week it improves to the point where there is a full recovery, usually by 4-6 weeks. Again, the post operative care is individualized, and if the patient is doing extremely well with minimal bruising and no discomfort, a return to light activity at 2-3 weeks is certainly indicated. Three to four weeks is more normal for exercise to begin. Certainly light work with weights on the legs can be carried out earlier than that on the arms, and no bench pressing or use of the pectoralis major for submuscular implantations can be carried out for 6 weeks. Aerobic exercise can begin as early as 2-3 weeks in some patients, but again 3-4 weeks is the norm.

Cost?

We do not feel that it would be appropriate or ethical to post prices for procedures on the internet. We do, however, understand that cost is a factor you must consider. We would be happy to speak with you about this so that you may determine whether the procedure you are considering falls within your budget. Our pricing structure is based on the time, complexity, and surgical costs involved. Please feel free to call our office at 214-823-1978 and speak with either Kurthene or Annette for more details.