Ask 10 plastic surgeons about breast augmentation with a lift and you will get 10 different opinions. Most surgeons will agree this is one of the more difficult procedures that we do. The difficulty comes from the fact that the goals of those two procedures are conflicting. Breast augmentation takes a small or deflated breast and makes it larger and more full. Mastopexy (breast lift) takes a breast that sags and lifts and tightens it. The challenge is to create an operation that achieves both goals.
Who Needs Both?
Breasts come in all shapes, sizes and dimensions. Often after pregnancy, breast feeding or weight loss, we find that the breast has a deflated appearance. As long as the nipple stays in good position or there is not a lot of skin and breast tissue hanging over the natural breast crease, you will probably be fine with implants alone. If you find that the nipple sits below your breast crease or a lot of your breast tissue and skin hangs below that crease, you will probably need a lift as well. A simple test is to place a pencil beneath your breast right in the crease and if the skin holds the pencil in place, you may need a lift.
One Procedure or Two?
The plastic surgery community is divided on this. Some surgeons will never combine a breast augmentation and breast lift into one procedure. They will typically perform the lift first, and then, three months later, perform the augmentation. Other surgeons always combine the procedures into one operation. I tend to combine the procedures into one, as I think I get better results in my patients when I put the implant in to determine the size, and then lift the breast tissue and nipple. However, there are times where patients have so much droop that I will recommend doing the lift first followed by implants three months later.
Another bit of advice I have is to avoid using very large implants when combining the two procedures. Augmentation/Lifts seem to have better, longer lasting results when there is not so much pressure on the lift from a large implant.
Results and Expectations.
Augmentation combined with mastopexy, whether performed in one or two procedures, can have excellent results. I think it is very important to discuss your expectations with your surgeon. Even though the breasts are lifted, more full and youthful, they may not look like some of the pictures on the internet. Often, those pictured on the breast websites show women who have not experienced pregnancy, breast feeding or weight loss.
This procedure is complicated enough that I would recommend seeing a plastic surgeon who specializes in breast surgery. Always research your surgeon to ensure he is board certified. I am a board certified plastic surgeons who focus our practices on cosmetic and reconstructive surgery of the breast, so feel free to call for an appointment.
All the best,