Breast augmentation / mastopexy

When the breasts are small or deflated and also show a significant amount of drooping, a procedure combining both the placement of implants and repositioning the breast tissue may be required.  This combined procedure is technically more demanding than either procedure performed alone but can give a great result in a single operation.

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Best candidates

Patients who have this procedure performed most often are those that have had deflation of their breasts due to pregnancy or the aging process.  When possible, we try to correct borderline patients with placement of a breast implant alone, as this is a more straightforward procedure.  However, for some patients implant placement alone is not adequate.  Try this test: if your nipple hangs lower than the fold where the lower part of your breast meets the chest, you will probably require a lift as well as an implant to correct your appearance.

Patients who we see in consultation regarding a breast lift alone are often good candidates for this if they have adequate breast tissue available.  However, the addition of a small to moderate size implant to a lift can help maintain the long term result of the lift, particularly in keeping fullness in the upper pole.

 Types of Implants we use

  • Silicone – For the majority of our patients, we utilize round, smooth walled silicone gel implants.  For most patients we find that the silicone implants have a softer, more natural feel than the saline implants.  The silicone implants now available are superior to those used many years ago that were prone to leakage and rupture, as the gel that fills the implant is thicker and the outer shell is more durable than the early styles.
  • Saline– In the early years of our practice, before silicone implants were available for routine use in cosmetic patients, we had many patients with great results using saline implants.  In terms of appearance, the difference between a saline and silicone implant is seldom visible.  Although they don’t feel quite as soft as a silicone implant, there are some advantages.  In addition to being a less expensive implant, they can generally be placed through a smaller incision as they are filled to their final volume once they are inside the breast.  Minor size adjustments can be made on the operating table to correct asymmetry by putting different amounts of saline (salt water) in each implant.  Although long-term studies have shown they are more prone to leak after many years than a silicone implant, they are easier to replace should a leak occur.
  • Round versus teardrop shaped– We typically use round implants for cosmetic augmentation/mastopexy although we have placed the anatomic (teardrop) shaped implants in the past.  While we had no real problems with the anatomic implants, they were more expensive, somewhat more difficult to place, and we really couldn’t see much difference in the final appearance compared to a round implant.
  • Smooth Versus Textured– For most patients we use smooth walled implants, as we feel textured implants offer no significant advantage.
  • Low, Medium, or High Profile–  The “profile” of an implant essentially refers to how tall it is relative to the size of the base.  A low profile implant has a broad base but is relatively flat compared to a high profile implant.  For most patients, we use a moderate profile implant, but we may suggest a high profile implant if you have a narrow chest but need a lot of volume.

Choosing the right sized implant

The implant size we use during surgery depends on many factors.  We feel there is no magic formula or computer imaging system that can pick your implant for you.  Choosing the right sized implants requires time.  We begin by measuring your breasts and chest wall and assessing the amount of tissue already present.  We’ll talk to you about your desired appearance, your level of physical activity, and other factors.  We then have you try different sizes of implants placed within your bra to see what you think looks full and natural for you.  Based on our measurements and your input, we’ll work with you to choose the right implant that fits you and your lifestyle.

The operation

We perform our breast augmentation/lift procedures at the Lawrence Surgery Center, a fully accredited outpatient surgery facility located in our office building.  The procedure is performed under general anesthesia, and takes about 2-3 hours.  Prior to the operation, we place markings on the breast with the patient in the standing position to serve as landmarks for later in the operation. We typically begin by placing the implants through incisions on the lower part of the breasts. The implants are generally placed under the muscle, as we feel this gives a more natural appearance to the upper part of the breast and better protects the implant.

Once the implants are in place, we evaluate the effects on the breasts while you are in an upright (sitting) position.  Based on our evaluation, we will readjust our preoperative markings as necessary.  The breast tissue is then repositioned, the height and position of the nipple/areolar complex is adjusted, and redundant skin and /or breast tissue is removed.  Before closing your incisions with dissolving sutures, we put a local anesthetic into the pocket around your implants to help decrease your pain after surgery.  Drains are rarely needed.   Finally, you are placed in a special surgical bra to help support your new breasts.

Recovery

After your recovery at the surgery center, you will be sent home with pain medication, which most patients find they need for the first 1-3 days.  We have had patients who never took a single pain pill, while others may find that even a week after surgery they still need an occasional pill, especially at night before going to bed.  We always check our patients in the office the day after surgery to assure that there are no problems with their breasts, medications, bra, etc.

The time before you can return to work and everyday activities varies from patient to patient, but a week is adequate for most patients.  Again, some have returned to work much sooner, others have taken longer, especially those with jobs requiring heavy lifting or strenuous activities.

Scars

While a breast lift inevitably results in longer scars than a straightforward augmentation, we do everything we can to both minimize the length of the scars and help them fade as well as possible.  The length of the scars depends on the amount of lift required and the amount of redundant, loose skin that must be removed.  Common incision scar patterns include:

Periareolar–  When a minimal lift is required, the scar may encircle the areola only, leaving no other scars on the breast.  Silicone gel pads utilized postoperatively will help minimize and fade these scars.

Circumvertical (Lollipop)–  Patients requiring a moderate amount of lift will typically have a scar that goes around the areola then extends down the lower half of the breast.  We place our scars on the lower part of the breast as this keeps them from being visible in clothing and swimsuits and this area is most favorable for scarring.

Inverted T or Anchor–  When there is a fairly significant amount of excess skin we may need to extend the incision scars in a horizontal fashion in the fold where the breast meets the chest.  This type of incision is often needed when there is significant skin redundancy such as after massive weight loss.

Whatever the incision pattern used, our goal is to give you the best possible breast shape while minimizing the scar length.

Combination procedures

Augmentation/mastopexy can often be performed at the same time as other procedures on the breast, body, and face.  We have frequently combined this operation with:

While combining procedures can save you a second trip to the operating room and recovery time, we will sometimes suggest NOT combining procedures if we feel it would compromise your chances for a good result or would significantly increase your risk.

5 Reasons why you should have your augmentation/mastopexy performed at Lawrence Plastic Surgery:

  • Experience– We have hundreds of happy patients and great results after performing this procedure for over 20 years.  We were investigators in both the Allergen and Mentor Silicone Breast Implant Adjunct studies, which were conducted before silicone implants were made available for general use by other surgeons.
  • Accredited facilities–  We only perform this operation at Lawrence Memorial Hospital or the Lawrence Surgery Center.
  • Choices– We offer a wide variety of implant types, sizes, and incisions to suit your individual needs.  We don’t take a “one size fits all” approach.
  • Surgeon certified by the American Board of Plastic Surgery
  • Personal attention– We spend the time it really takes to help chose the implant and the procedure that will give you the natural, fuller look you desire.

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