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Breast enlargement (augmentation) with breast lift (mastopexy)


   It is a common problem that finishing the breast-feeding the drooping of the breasts begins and usually the volume of the glandular tissue also shrinks after its temporary enlargement during pregnancy and breast-feeding.

We often experience, that patients with drooping breasts which are also smaller than they should be if there were no drooping believe, that a correction with a breast augmentation alone or with a breast lift only could be sufficient. Two delusions are the explication for this: first, that it is only the matter of implant size “to lift” a drooping breast. The other problem is that optically a drooping breast always looks bigger, than the same breast volume without drooping.
 
 

Drooping and non-drooping breasts of same volumes


The answer for the first delusion is that relatively only a very small extent of drooping can be corrected with a breast augmentation alone, with placing implants. If the lower rim of the areola reaches or exceeds the level of the submammary fold, there is no such augmentation method which could give a good result by itself, without a mastopexy.

 

Non-drooping, mildly drooping (not requiring a mastopexy yet), borderline and drooping (requiring a mastopexy) breast shapes - marking their level to the submammary fold.
 

To conclude, if an implant would be placed correctly under the pectoral muscle in such a case, it would form a double contour; the breast would droop below the prominence of the implant. And if the implant would be placed under the glandular tissue of the drooping breast, the breast would become bigger and droop even more, and probably several other complications would come along in addition (capsular contracture, glandular tissue becoming very thin, implant malposition, etc.).

A mastopexy, or to be more exact, its most simple variant – areola positioning - has to be carried out also on candidates for a breast augmentation with areolas looking downwards, where the distance between the lower rim of the areolas and the highly positioned submammary folds is too short, therefore the shape of the breasts is tubular, because the lower part of the glandular tissue is undeveloped compared to the upper part; or if some part of the glandular tissue is bulging through the areolas (tuberous breasts).

 
 

Photos of tubular and tuberous (with bulging areolas) breasts


The patient can be convinced easily about the second delusion (that she thinks the drooping breasts bigger than they really are), when standing before the mirror the areola is brought up to the proper position with a manoeuvre, creating the desired upper fullness by pushing the entire (or most of the) glandular tissue upwards inside the breast. If the patient tells, that she would like to have a breast shape on top exactly like this, it becomes clear that there is nothing (or almost nothing) left of the glandular tissue below, because the volume of the existing glandular tissue is not enough. This is the case where a simultaneous breast augmentation with implants is needed together with the mastopexy.

 
       
A drooping breast optically always seems to be bigger than it really is (Picture 1.). Picture 2. shows the upper fullness, which still forms a concave line, that could be created with a mastopexy only (but this is not worth it in this case). Picture 3. shows the upper fullness that already needs a breast implant, since even this straight contour on the top is created by pushing the complete glandular tissue upwards. The upper fullness that is slightly bulging demonstrated on Picture 4. needs a higher profile breast implant besides the simultaneous mastopexy.


It is important to understand, that the breast augmentation means primarily the correction of the volume, and the mastopexy means the correction of the shape, and these can’t substitute each other! It can result in a great disappointment, in several complications and expensive further operations if the patient wanting to avoid the more visible scars of a mastopexy, looks for such a plastic surgeon anyway, who is not skilled enough, or is not steady enough, and performs the professionally faulty procedure at the “order” of the inexperienced patient. This will surely need further and further corrections.

 

Two cases requiring breast augmentation with mastopexy


With the proper professional experience it can be already told during the first consultation (so it shouldn’t come clear only after the operation), whether a breast lift is needed simultaneously with the breast augmentation. If somebody tells, that this will become clear only during the operation, doesn’t have enough experience and proper planning skills. There are plastic surgeons, which do not perform a simultaneous breast augmentation and mastopexy at all. Undoubtedly this is one of the combined aesthetic procedures requiring the greatest professional experience. I think, that two consecutive operations mean a bigger strain for the patient; furthermore I can achieve a better result with a single operation, by harmonizing all aspects.


   
         
Picture 1. shows the extent of drooping that can't be corrected by a breast augmentation with a good result without a simultaneous mastopexy. Picture 2. demostrates a possible long term result that can be achieved by a mastopexy only, without a breast implant. If the patient desires the upper fullness shown on Picture 3., that needs a breast augmentation besides the mastopexy procedure, because without a breast implant there wouldn't remain enough volume at the lower poles if the upper part became full.


Nowadays there is no need for a mastopexy with the so called inverted “T” scars, meaning scars also in the submammary folds. For a small extent of drooping the periareolar scar only, and for a greater extent of drooping the periareolar plus vertical scars are sufficient. Placing implants through these is also possible in the latter case; and at a small extent of drooping we prefer to place the implants through separate incisions in the armpit, so they do not come in contact with the bacteria which are frequent in the glandular tissue around the areolas, neither must we lift or cut through the entire gland to position them.

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