It’s often difficult for women to adjust to changes in breast shape. When sagging or drooping
occurs, many women don’t feel as attractive as they once did. They may wish to alter their
breast size and form simply to feel better about themselves.
In you find yourself in this situation, you may be considering a breast lift. Unlike breast reduction,
which is often a medical necessity, a breast lift if a purely cosmetic procedure.
| After having children, my breasts were like deflated balloons. The sagged to my navel. It was traumatic. I was ashamed. After a breast lift, it was WOW! My breasts were normal again. It changed my life. I feel sexy again. |
| — Karen, 29 |
What is a Breast Lift?
A breast lift, also known as a mastopexy, is a procedure to remove
excess skin and reshape the breast tissue in order to lift and support
drooping breasts. The medical term for the sag or droop in the breasts
is ptosis. The degree of ptosis is classified according to the relationship
between the nipple and the inframammary fold, the crease below the
breast. In the normal breast, the nipple lies above the inframammary
fold and on the mound of the breast. The degrees are ptosis are:
• First degree: minimal droop; the nipple lies at the level of the fold.
• Second degree: moderate droop; the nipple is below the fold
but is still above the lowest part of the breast.
• Third degree: major droop: the nipple lies below the fold and
at the lower part of the breast.
• Pseudoptosis: the nipple is above the inframammary fold, but
the breast tissue falls below it.
Causes of Sagging
Whether breasts are large or small, ptosis is inevitable No one is
immune to the effects of gravity. All females who live beyond adolescence
will experience some degree of sagging during their lifetime.
The degree of ptosis, however, does vary from woman to woman.
A variety of elements contribute to this difference, the most significant
of which is breast size. Because breasts consist of only ligaments, fat,
and connective tissue and do not contain any actual muscle, breasts
begin to droop over time. The ligaments and skin lose their elasticity
and begin to stretch.
Although ptosis is inevitable, the rate at which it occurs also is
affected by genes, diet, aging, and breast size. Pregnancy, breastfeeding,
and menopause contribute to ptosis, as well. Many childless women,
however, also complain of drooping breasts. Ptosis is especially
evident after significant weight loss.
Generally speaking, women with small breasts will not experience
as much sagging as women with larger breasts. Women with smaller
breasts have less breast tissue pulling the breasts down.
Are You a Candidate for a Breast Lift?
Maybe you are pleased with the size of your breasts, but simply
would like to have a shapelier, firmer, more youthful look. Or, maybe
you would even like to increase the size of your breasts or slightly
decrease them just a little. If this is your situation and you are in overall
good health, you are probably a good candidate for a breast lift.
However, if you plan to have children in the future, you may
want to wait until after your last pregnancy before having this
procedure. Another pregnancy could reverse your surgical results, and
further ptosis may occur in the future.
How Is a Breast Lift Performed?
The same basic incision techniques are used for breast lifts
and reductions. Many women, who want only a breast lift with no
reduction, are candidates for the lollipop technique, which will leave
less scaring. The surgeon’s approach will depend, in part, on the
degree of droop in your breasts. In cases involving lesser degrees of
sagging, a circumareolar incision, which is made around the areola, only
may be used. This technique is also called a doughnut mastopexy.
Drainage tubes are not typically utilized during breast lifts that
include augmentation.
In order to shape an attractive breast mound during a breast lift,
the surgeon may also need to remove some breast tissue. The major
difference between a breast reduction and a breast lift is the amount
of tissue removed during surgery. As mentioned earlier, a procedure is considered a breast lift and not a breast reduction if less than 500
grams of fat and breast tissue is removed.
|
Breast Reduction |
| Procedure: Mastopexy / lifts and reshapes breasts Length: 1.5 to 3 hours Anesthesia: General anesthesia or local with sedation In/Out Patient: Out-patient or short-term in-patient Side Effects: Bruising, swelling, soreness, scars. Risks: Infection, asymmetry, loss of nipple sensation Recovery: Initial: 7 to 10 days / Full: several months |
Breast Lift with Augmentation
For some women, a breast lift alone corrects sagging and produces a
shapely breast. However, there are times when removing excess skin
and lifting the breast will not produce a shapely breast. These are cases
in which a woman is lacking sufficient breast tissue to produce an
attractive breast mound. If this is your situation, your plastic surgeon
will likely recommend an implant, or augmentation, along with the
breast lift.
| Ihad little pain after my breast lift. I was sore, but I didn’t need to take the pain medications. My scars healed nicely, too. |
| — Dawn, 29 |
Types of Implants
If you are considering a breast lift with augmentation, you’ll need to
have a dialogue about this with your surgeon. He or she will create an
augmentation plan individually catered to meet your needs. Implants
now come in a variety of shapes, sizes, and textures.
Saline Implants
The vast majority of implants used today are made of a soft silicone
shell, filled with saline, which is salt water. Medical professionals
consider saline to be safe as an implant filler because it consists only
of salt and water—two ingredients that our bodies contain already; as
a result, even if a leak should occur, the saline would easily be
absorbed by the body.
Silicone
Silicon implants are filled with silicone gel. Many surgeons and
women alike find that silicone implants have a more natural feel.
However, FDA restrictions permit the use of silicone-gel implants only
in controlled clinical studies for the purposes of reconstruction after
mastectomy, correction of congenital deformities, or replacement of
ruptured silicone-gel implants that were used for augmentation.
Silicone implants can also be used in women with saline implants who
have either had complications or problems and are unsatisfied.
You may recall hearing about the controversy in the 1990s over
whether silicone implants are safe. Some women, whose implants
ruptured, claimed the silicone made them ill. Leaks in silicone
implants are not as easily detected; however, years of studies have
produced no hard data that connect silicone implants with disease.
Implant Shapes
Implants can be round or anatomical, which is a tear-drop shape.
Most women prefer round implants to anatomical ones because they
give a fuller appearance. Some implants are called high profile
implants—they project farther out from the chest and may be best
suited for women with small chests and narrow frames.
Implant Texture
Implants come in either smooth or textured surfaces. Smooth
implants can move freely in the “pocket” created for them, and many
women report the smooth shell surfaces makes the implant less
detectable to the touch on the breast’s exterior. Some women believe
the textured surface does not feel as natural through the skin as the
round implants. Today, most women choose smooth implants.
Implant Size
Breast implants are measured in cubic centimeters (cc). Most
implants used in general range in size between 125cc and 700cc. In
recent years, women do seem to be choosing larger implants than they
have previously. Surgeons will not typically approve implants that
would yield an unnatural appearance on patients, though. Your body
type, height and weight all must factor in to which size will best meet your needs. You and your surgeon will work together to find the
perfect size for you. He or she may even ask you to experiment with
different sizes by wearing them in your bra or under a tee shirt during
the consultation.
Placement of Implants
During your consultation, you and your surgeon will discuss the
best type of implant for you and exactly where your implants will be
placed. Factors that determine implant placement include your breast
shape and basic anatomy, breast tissue amount, general size of your
body, and your favorite exercise activities.
Submuscular Placement
Most often, surgeons prefer to insert
implants partially under the pectoral muscles.
The advantages to this placement: a more
natural look, edges of the implant are less
likely to be noticed, rippling is less likely, and
there is a lower risk of a complication known
as a capsular contracture. A capsular contracture
occurs when scar tissue forms around the
implants, resulting in what feels like a hard core inside the breasts.
Another important advantage of sub-muscular is that there is no
interference with mammograms Disadvantages are the implants may create more of an upper roundness
in the breasts than you’d like; there is also more post-operative
discomfort. Implants placed under the muscle wall usually cause some
discomfort that can last for 7-10 days after surgery because pectoral
muscles are in the process of stretching over the implants. Usually,
the discomfort is worse for women who have not had children. Why?
Because their breast tissues are usually tighter. This discomfort, however,
often improves somewhat within 48 hours after surgery.
Note that your implants may appear “ride” high within the first
few weeks after surgery. This is common. They should drop to a more
pleasing position after the swelling subsides and the implants settle
into place.
Subglandular Placement
A subglandular placement means the
implant is placed behind the breast tissue
and in front of the pectoral muscle. The
advantages to this placement are: the
implants are easier for the surgeon to insert,
less discomfort and shorter recovery time,
and larger implants can be inserted. The disadvantages
are: ripples in the skin are more
likely and capsular contracture is more likely.
Are You a Candidate for Breast Lift with Augmentation?
As with any breast lift or reduction, you may want to wait until
you have completed your family before committing to a breast lift
with augmentation. Implants have not been proven to interfere with
pregnancy or breastfeeding, but it’s a strong possibility that your
breasts will sag as they did prior to surgery, even with implants, if you
endure another pregnancy later.
Other candidates for breast lifts with augmentation are women
whose breasts are noticeably different sizes. Surgeons insert an implant
only in the smaller breast to create a more balanced appearance.
Basically, if you desire larger, firmer or fuller breasts, a breast lift with
implants may be a desirable choice for you.
If you are considering a breast lift with augmentation, a factor to
consider is that your breasts will not feel as natural with implants as
they do without them. Instead, you will notice that your breasts are
rounder and firmer than they were before, which a lot of women
actually are pleased about. In fact, you may not even need to wear a
bra after having your implants inserted.
Breast Lift with Augmentation Procedure
The surgical procedure of a breast lift with augmentation is similar
to that of the basic breast lift. The incision made for a breast lift with
augmentation is often lollipop-shaped; however, if a woman has
severe sagging, the anchor-shaped incisions may be necessary.
Risks and Complications of Breast Lifts with Augmentation
| Questions for Your Surgeon about Your Breast Lift:
|
As with any surgery, certain risks and complications apply to
breast lifts with augmentation, as well. In addition to the risks
associated with traditional breast lifts, breast lifts that include implant
insertion could potentially cause a condition called capsular contracture.
This situation occurs when the scar or the capsule surrounding the
implant begins to tighten, thus causing the breast to feel hard.
Capsular contracture is rectified either by removing the implant or
operating on the breast’s scar tissue.
Additional complications sometimes associated with breast
augmentation include the formation of calcium deposits and implant
shifting. Some women who’ve undergone silicone implant insertion
do complain of immune system disorder symptoms, such as joint
pain, swelling, fever, fatigue, and pain; however, again, no evidence
has been found to support the hypothesis that implants actually cause
these symptoms. Many studies have shown that women who do experience these symptoms may very well have developed them over
time, even if their surgery were never performed.
Do Implants Affect Mammograms?
Although saline implants are not thought to be dangerous, you need
to be aware that you will need to rely on radiologists who know how to
x-ray patients with breast implants when you have mammograms.
Implants, though not proven to cause breast cancer, appear white on
mammograms and sometimes can block masses behind them. As
mentioned earlier, this is a problem associated with subglandular
implants rather than submuscular implants.
This is not a concern, however, if various angles of your breasts
are x-rayed by a radiologist with applicable experience. Make sure that
you inform the radiologist as well as the technician performing the
study that you have had implants inserted before they complete the
mammogram. If you desire a more sensitive method of breast cancer
screening, you may wish to consider an MRI, which uses magnetic
fields instead of radiation to screen for breast masses.
Paying for a Breast Lift
Insurance companies traditionally pay only for procedures that
are medically necessary. As you realize, breast lifts are cosmetic and
have no substantial medical purpose. So the chances are not good for
getting your insurance company to pay for a breast lift.
Table of Contents
Previous: Chapter 5. Your Breast Reduction Procedure
Next: Chapter 2. Follow-up Care
About the Author: Dr. Edwin Williams
Dr. Edwin Williams is a double board-certified facial plastic surgeon who founded The Williams Center in 1993. He has performed over 10,000 facial plastic surgery procedures and has pioneered the deep plane facelift. He served on the Board of Directors for the American Academy of Facial Plastic Surgery for over a decade, and served as President from 2015-2016. In 2016, 2017, 2018 and 2019, Dr. Williams earned the Castle Connelly Top Doctors award in New York Facial Plastic Surgery.
Dr. Edwin F. Williams III attended Cornell University in Ithaca, New York where he received a Bachelor of Science degree in 1982. He began medical school at the State University of Buffalo School of Medicine and received his Doctor of Medicine in 1986.
Dr. Williams is actively involved in teaching facial plastic and reconstruction surgery to the residents of the Albany Medical Center and is former Chief of the Section of Facial and Plastic Reconstruction Surgery at Albany Medical Center where he received an academic appointment of Clinical Professor, Department of Surgery.