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Implants, Lift, or Both?

Breast implant augmentation has become synonymous with cosmetic breast surgery; much like “facelift” has become synonymous with the reversal of the facial aging process. However, a deeper understanding of how specific surgical techniques work to produce a desired result is necessary before heading to the operating room. The real chief risk of cosmetic surgery is a cosmetic deformity after all the healing is done. The best way to avoid this, right from the start, is to develop the correct surgical plan and execute it well.

                In terms of cosmetic breast surgery, breast implants are not necessarily the correct answer for every problem. A commonly held by incorrect belief is that breast implants provide some sort of breast lift. It is much more appropriate to think of breast implants as a source of breast volume. If the breast is lacking in volume, but otherwise has good cosmetic shape, then breast implants alone will serve well to achieve the desired change. However, id considerable breast sag (ptosis) is the problem to be corrected, then breast implant placement alone will only produce a larger saggy breast. That would be a poor operative plan.

                Once breast sag is identified as the real problem, breast lift (mastopexy) is at least part of the correct answer. It is the combination of breast implants and breast lift that has raised controversy among plastic surgeons. Patients must be aware that the performance of these two operations at the same time asks the breast tissue to both stretch and contract at the same time. Standing back and looking at the problem…that does not make a lot of sense. Add to that the fact that most women with breast ptosis are not really aware of just how much volume they already have.

                The best plastic surgeons are able to help patients understand how to get the shape they desire with the best techniques available. Breast practices limit breast augmentation and lift, at the same time, to a group of women with relatively small volume yet still ptotic breast. In this group of patients, the breast implant is clearly going to establish the great majority of breast volume. The native breast tissue and skin can then be tailored to fit reliably around the implant. This should yield a cosmetically reliable result that does not produce the dreaded “snoopy dog” deformity. This deformity can be identified when the patient looks at her breasts in the mirror from the side. It is caused by the patient’s real breast tissue sliding over the implant. The resultant shape looks like “Snoopy’s” nose.

                Mastopexy or breast lift is not a single operative technique. It is a concept. So, there are many different types of mastopexy. In the patient with larger volume breasts and sag, a mastopexy in which the breast tissue itself is reconstructed and reshaped surgically produces routinely excellent results. Nowhere is this better observed than in bariatric surgery patients. These patients can suffer from very distorting sag, but still have good volume. One excellent technique “deconstructs” the breast tissue, elevating the surrounding skin and using suturing technique to create a “living” implant from the patient’s own breasts. It produces a dramatic change. Following this innovative procedure, patients often question whether they really did have implants placed because it looks so good.

                Remember the following points. Proper planning is the key to success. Implants are not the answer to every problem. Saggy breasts probably contain more volume than you realize. The performance of breast lift and implants at the same time should only be applied to ideal patients. All medical/surgical risks considered, the principle risk of cosmetic breast surgery is a cosmetic deformity after all the healing is done. Educate and research before you have your surgery. Whereas, most post-surgical cosmetic problems can be corrected, it is always better to avoid them.