Breast Augmentation with a Lift
With the passage of time, most women experience significant and undesirable changes in the firmness and appearance of their breasts. These changes can be attributed to factors including aging, genetics, gravity, pregnancy, breast feeding, substantial weight fluctuations, diet, smoking, health, sun exposure, tanning booth usage and insufficient breast support on a regular basis. In combination, these factors can cause breasts that were once perky and shapely to appear droopy and deflated.
While breast augmentation can restore lost volume and increase the size of the breasts, implants alone are not able to correct sagging tissues and loose, excess skin. Likewise, a breast lift (mastopexy) can eliminate extra skin, improve contour and raise the breasts to a more natural position on the chest but the procedure will not increase breast volume.
In order to address all of these aesthetic breast issues simultaneously, a breast augmentation with a lift is typically the most effective surgical option. Also known as breast lift with augmentation, breast lift with implants or augmentation-mastopexy, this procedure involves the removal of excess skin, lifting and shaping of breast tissue, resizing and repositioning of the nipples and the placement of implants in order to achieve larger, perkier, firmer and more youthful appearing breasts.
Breast implants are now available in a wide array of types, sizes, shapes, fill material and textures. At his practice, board-certified plastic surgeon Steven H. Turkeltaub, MD offers a large variety of the highly cohesive silicone gel implants including the “gummy bear” type as well as saline implants. The availability of such numerous options allows for the creation of superb outcomes customized for your body.
Selecting the most appropriate implants will depend on a multitude of factors that include your unique needs and goals, tissue characteristics, anatomical indicators and more. At the time of your initial consultation, Dr. Turkeltaub will perform a comprehensive physical examination and discuss all of these considerations in full detail to help you make the proper implant selection.
To learn more about implant options, please visit Dr. Turkeltaub’s page devoted to breast implants.
A breast lift with implants is usually performed as a single-stage procedure (as opposed to performing mastopexy or breast augmentation first and the other at a later date). The surgery consists of the removal of excess skin, contouring and lifting of breast tissues, resizing and repositioning of the nipple-areola complex and the placement of breast implants.
Typically done as an outpatient procedure under general anesthesia, a breast augmentation with mastopexy takes approximately 3 hours to perform. You then spend about an hour and a half to two hours in the recovery room before going home. When combined with abdominoplasty and/or liposuction as part of a “Mommy Makeover,” total operating time will be longer.
The location of the incision for mastopexy-augmentation will depend on several factors including the degree of breast sagging, amount of extra skin, nipple location, skin elasticity, desired breast volume increase and Dr. Turkeltaub’s recommendation. The choices are:
- Periareolar (also called circumareolar, Benelli, donut or purse string) – Involving only an incision around the areola, this approach is most appropriately used when there is only a very minor amount of tissue laxity and breast sagging. Although patients often request this approach due to its relatively inconspicuous location and short length, Dr. Turkeltaub rarely recommends this incision because it most often leads to an abnormal flattening of breast shape rather than facilitating a more natural and youthful appearing conical shape.
- Lollipop – This incision encircles the areola and continues vertically down the breast to the inframammary fold creating a lollipop shape. It may be used in particular situations where there is a mild to moderate amount of excess skin and breast drooping.
- Inverted “T” (anchor-shaped) – By far the most common approach used by Dr. Turkeltaub, this incision extends from around the areola, down to the breast crease and then a variable length along the inframammary fold. It allows for far more flexibility, accuracy, contouring and lifting.
Breast implants can be placed into proper position using each of the incisions or an additional “small” incision. The technique that will best meet your unique needs and goals will be thoroughly discussed during your consultation.
Submammary or Submuscular/Subpectoral Implant Placement
Patients have two options for the placement of breast implants: above the pectoralis major muscle (submammary) or below the pectoralis major muscle (submuscular or subpectoral). With few exceptions, Dr. Turkeltaub generally recommends placing implants in the submuscular position for the reasons outlined below:
- The results of mammogram screenings can be interpreted more easily and accurately
- The risk of capsular contracture (when scar tissue hardens around the implant) is lower
- There is more soft tissue coverage over the implant which helps to limit the potential for visible rippling on the skin’s surface
- This greater soft tissue coverage may provide a more natural feel of the breasts especially in thin individuals
- The better interface created between the chest wall and implant typically leads to a more natural look
- Compared to breast skin alone, the pectoralis major muscle is able to provide superior support for the implant. (In the submammary position, the weight of the implant—particularly larger ones—will accelerate the stretching and thinning of skin over time leading to a greater relative quantity of drooping.)
A contoured, supportive dressing is applied at the end of the surgery and remains in place for a few days. This is replaced with a supportive surgical or sports-type bra that is worn 24 hours a day for at least ten days to two weeks. After this period, it is strongly recommended to wear a supportive bra during waking hours in order to help slow the inevitable progression of breast drooping over time.
There will be some mild to moderate discomfort for the first several days following surgery. Bruising is typically minimal or non-existent. It may take several months for most all of the swelling to subside.
The majority of individuals are able to return to school, office jobs and various other non-strenuous daily activities within five to seven days. To help ensure the breasts heal properly, however, Dr. Turkeltaub advises patients to avoid vigorous exercise, heavy lifting and other strenuous activities for a minimum of three weeks.
The before-and-after images below show the results some of Dr. Turkeltaub’s patients have achieved with augmentation-mastopexy.
*Individual Results May Vary
Q: How apparent is scarring?
A: Breast augmentation and lift scars usually heal fairly well and fade over time. Their final appearance is impacted by a variety of factors that include skin type and color, age, health, use of anti-scarring products, surgical technique, adherence to early activity restrictions, smoking status and more. Regardless of the incision technique utilized, scarring can usually be concealed under most blouse, swimsuit and bra varieties.
Q: I want to correct breast drooping but I don’t want the scars associated with breast lift surgery. Can breast implants provide enough lift on their own?
A: Apart from exceptionally mild cases, implants will not be able to correct breast drooping on their own. Attempting to do so can result in overly large and bizarre appearing breasts.
Q: Will I lose nipple sensation?
A: Some loss of nipple sensation can occur though it is extremely rare for all of the sensation to be lost permanently. In Dr. Turkeltaub’s experience, the vast majority of patients retain most, if not all, of the sensation in their nipples.
Q: Are the results from breast augmentation with a lift permanent?
A: No they are not. Starting even within the first few months after surgery, your breasts will continue to stretch and droop though not in the same manner that they did previously. The nipples will not sag as much but you will likely notice the skin between the lower breast crease and the nipple stretching as the loss of tissue elasticity occurs with time.
Q: Will I have to get new breast implants every ten years?
A: Although breast implants are not permanent devices, there is no ten year rule either. They might last anywhere from 5–30 years, possibly less or more, but at some point in time they will need to be replaced. Fortunately, this can generally be done easily and effectively in a procedure called breast revision surgery.
Q: Is there anything I can do to prevent my breasts from drooping over time?
A: You may not necessarily be able to prevent your breasts from drooping over time but you can certainly help to slow the process. This would include wearing a supportive bra on a regular basis, minimizing significant weight fluctuations and avoiding sun exposure, tanning salons and smoking.
Interested in Scheduling a Consultation?
If you are considering breast augmentation with a lift and would like to schedule a consultation with Dr. Turkeltaub, we encourage you to contact our practice online or by telephone at 480-451-3000 today.