The decision to do a breast augmentation by itself versus a breast augmentation with a breast lift, however, is less based on patient preference and more dictated the saginess, the nipple position, and the ratio between the breast volume and the amount of excess skin that is present.
How ptotic are my breasts?
The gold-standard method of assessing the need for a breast lift is the “pencil test.” Standing in front of a mirror, lift the breast and lay a pencil in the fold under the breast and allow the breast to settle over the pencil. Look at the position of the nipple in relation to the pencil.
The lower the nipples and breast are below the pencil and the more excess skin you have, the greater the chance you will need a breast lift and the more of a breast lift you will need. If your nipple and a majority of your breast are at or above the pencil (Normal), you will likely get a great result from a breast augmentation alone. Larger implants can shift this equation slightly for patients that have borderline ptosis (Grade 1).
What is a breast augmentation?
A breast augmentation (insertion of implants) is often performed to replace volume lost from weight loss, breast-feeding, or age or to increase the size of the breast for aesthetic reasons. It is most appropriate for patients with breasts that don’t sag (normal ptosis).
The implants can be placed over (sub-muscular) or under (sub-glandular) the pectoralis muscle. Advantages to sub-muscular implants include a lower risk of capsular contracture, lower chance of rippling, better coverage in thin women, and perhaps a more natural upper pole contour. Implants placed under the muscle can, however, be influenced by the contraction of the pectoralis muscle – especially in very athletic women.
Implants placed over the muscle, in contrast, are more visible. This results in larger looking augmentation and a sharper transition between the natural breast and the edges of the implant resulting in a more done look. Additionally, in thin women, the folding of the implant in the sub glandular pocket can manifest as rippling of the skin.
There are a variety of implant types, shapes, and styles and the implants are most often inserted through one of two different small incisions. These include 1) an incision around the lower half of the nipple areola (peri-areolar), or 2) an incision in the breast crease between the breast and the chest wall (infra-mammary incision). The choice of incision is based on multiple factors including surgeon preference, patient preference, patient anatomy, and / or type of implant.
What is a breast lift?
A breast lift (mastopexy) is powerful procedure that can lift the nipple, remove excess skin, and reshape the breasts to sit higher on the chest in a more youthful position. A breast lift is appropriate for patients with breasts that are adequately sized but saggy (Grade 1 and greater ptosis); but can also be done in combination with an implant to add volume (breast lift – augmentation), to adjust for asymmetry, or to improve unusually shaped breasts (tuberous breasts).
The trade off with a breast lift is a scar on the breast around the nipple with a possible extension down towards the breast crease creating a lollipop or possibly an inverted “T” pattern. The choice of incision is based on multiple factors including patient anatomy, surgeon preference, and patient preference.
What surgery is right for me?
A detailed examination will help delineate the best surgical treatment. The goal of a breast augmentation or a breast lift is to create an aesthetic breast with the size, shape, and projection that is desired by the patient. The decision the type of surgery and the size, shape, and position of the implants is based on the patient’s anatomy, the type and size of the implant, and patients preferences.
During your consultation, measurements of the breasts are used as a starting point to recommend a surgery and in-office sizing and digital three-dimensional computer simulations are used to help guide your implant choices.
Dr. David Tauber at DeLuca Plastic Surgery tailors the operation to each individual patient.
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