Breast Lift (Mastopexy) Surgery Sydney

BREAST LIFT (MASTOPEXY) WITH OR WITHOUT IMPLANTS

Whether an implant is required or not, there are three types of scar patterns that can be used for breast lift surgery.

Breast Lift (Mastopexy) without Implants

Circumareolar or “doughnut” Technique or Benelli Technique

– this involves a circular incision made around the areola. This technique is a ‘minimally’ invasive procedure that achieves a small degree of lift. It results in a scar around the areolar and is also suitable for reducing the size of the areolar. However, there is a limit to how much the areolar can be reduced as they typically tend to stretch back out again especially when implants are also used. It can also create a very flat looking breast.

Vertical or Lollipop Technique

– this is named a lollipop because of the type of scar it leaves. It results in a scar that extends around the areola and down the midline of the breast to the lower breast fold. Although this procedure is slightly more invasive, it achieves a larger degree of lift with potentially some slight reduction in natural breast tissue volume.

Anchor Technique

– this is the same as a lollipop technique, but also includes a scar along the lower breast fold – hence an ‘anchor’ pattern. This is required in those who require a significant lift and possibly need a reduction in natural breast tissue volume.

Breast Lift (Mastopexy) with Implants

Often extra volume is required as well as a lift of the breast tissue – therefore implants are used.

When performing a Breast Lift with Implants, the basic principle means that the surgeon must use the optimal technique for that patient to ensure that the breast tissue is lifted in such a way that there is a uniform distribution of breast tissue over the implant to create a uniform breast shape.

There are several options available when someone needs a Breast Lift and also desires extra volume. These include:

‘Breast Lift’ achieved with Implants only

– if a mild or borderline sagging problem exists, sometimes a good result can often be achieved with an appropriately planned augmentation alone. In other words, no formal breast lift scar, just a routine augmentation scar. Of course, once things have settled and if the results are not ideal, then you can still proceed with a lift at a later date.

Combined Breast Lift and Implants 

The ideal candidate for this is someone who has minimal breast tissue. However, there are some technical limitations with the implant size that can be used with such an operation. Furthermore, even in the ideal candidate, approximately 20% of patients may benefit from further surgery to “fine tune” the results. However, you would need to wait a minimum of 6 months to allow the results to settle before contemplating and planning this.

It is important to note that a combined breast lift with implants, otherwise known as mastopexy augmentations, is the most difficult cosmetic breast surgical procedures to perform. Therefore, they should only be performed by specialist plastic surgeons that have an expertise in these cases.
However, many plastic surgeons opt to not perform this operation because of the inherent difficulties in doing it.

Two staged Breast Lift (Mastopexy) & Breast Augmentation

This typically means performing a Breast Lift first, and then at a later date performing breast implant surgery. The typical patient who is offered this is someone who has a significant amount of natural breast tissue that has softened and dropped. Trying to do a lift and implants in one operation in these patients generally has a greater risk of complications and a very high chance of requiring further surgery. That is, whilst only one combined Breast Lift and Breast Augmentation surgery is planned, more often than not a second unplanned surgery is required to address problems and improve the results.

Therefore, in these patients a two planned surgeries approach is preferred. The first operation is to perform a lift and create a good breast shape. The second operation, performed a minimum of six months after the first, is to make that new breast shape larger with a carefully planned augmentation. However, many patients don’t proceed with this augmentation as they are just happy to have a better breast shape with the nipples sitting at a better level.

Not to confuse the issue, but some surgeons may opt to do the two-stage approach in reverse – doing an augmentation first, and then performing the lift at a later date and there is nothing wrong with this approach.

Finally, many women who need a lift don’t want to pay the additional costs and/or have the scarring associated with a Breast Lift. Therefore, they only want a Breast Augmentation so that they have the fullness they want in lingerie and clothing. Whilst when naked the breasts will continue to be ptotic, and with the implants the breast tissue will appear to be ‘hanging’ from or ‘falling’ from the implants, this is not a concern to them because they simply state that everyone sees them in clothing and extremely few people see them naked. Of course, if later it does bother them, then they can have a formal lift at that stage.

Learn more about Breast Lift vs Breast Augmentation Surgery

Single or two stage Breast Lift (Mastopexy) Augmentation Surgery

A combined Breast Lift and Breast Augmentation Surgery is the most difficult of all cosmetic breast surgery procedures performed and because of this many plastic surgeons choose not to do them. Whilst some are much easier than others, in general they are extremely challenging.

So, prior to undergoing surgery patients need to be made aware of the complexity of this combination procedure, have realistic expectations, and understand that additional surgery (along with the additional recovery time, time off work, stress, expenses etc) may be necessary in the short or long-term.

A concept that one needs to understand is that a Breast Lift and Breast Augmentation Surgery requires the surgeon to increase the breast size with breast implants, whilst at the same time reducing the breast envelope (that is, removing skin and breast tissue in order to achieve the breast lift). These two potentially counterproductive actions must be balanced as perfectly as possible in order to achieve the desired results.

Ultimately, the surgeon needs to lift the nipple and breast tissue to ensure a uniform and “tight” distribution of the natural breast tissue over the chosen implant to create a uniform appearing and feeling breast mound.

During Breast Lift procedures the nipples remain attached to their blood and nerve supply while they are repositioned. Some of the technical difficulties and limitations of a Breast Lift Surgery is related to ensuring that you surgically don’t completely cut off all the blood supply to the nipple, which would basically mean the nipple would literally die and fall off!

Performing a Breast Lift without an implant allows Dr Dona to apply more surgical ‘manoeuvres’ designed to lift up the breast tissue to maximise the chance of the breast tissue remaining high. Every surgical step involved in a Breast Lift does to some degree cut off part of the blood supply to the nipple. When an implant is added to the equation, many of the steps involved in creating a pocket for the implant, and the pressure effect from the implant, further compromises the blood supply to the nipple. Therefore, Dr Dona often needs to limit the ‘manoeuvres’ required to maximally lift the breast tissue. Dr Dona also needs to reduce the maximal size of the implant that could otherwise be used for a simple Breast Augmentation. These limitations can add to the potential issue of the breast tissue re-sagging early after surgery.

The potential for re-sagging is even greater with breast tissue problems such as:
– Large breast tissue volumes
– Breast tissue that is very soft and lost its elasticity
– Breast tissue that is ‘detached’ from the underlying muscle and slides around
– Skin that is thin and has lost its elasticity

Given that women wanting a Breast Lift typically have one or more of these problems, then you can appreciate that one of the main issues with a Breast Lift with a combined Breast Augmentation is that the breast tissue doesn’t stay where we want it to stay.

Essentially the patient is needing a Breast Lift because they have weak and soft breast tissue quality which has dropped – yet that same breast tissue and skin still exists after surgery, and it’s therefore still wanting to drop. No surgery and no surgeon can change the quality or consistency of the breast tissue and skin – the objective will be to try and reposition and shape the breast tissue.

In addition to breast tissue that doesn’t necessarily stay where it’s meant too, breast implants don’t necessarily stay where we wish they would. Therefore, breast implant related problems such as positioning (too low, lateral slide etc.) can occur and may be a reason for returning to the operating room for further surgery. This is especially the case in those women needing a breast lift because their breast tissue envelope is typically soft without any structural support, so it easily stretches again resulting in a very mobile implant.

In the end, often the look that many women want is simply not achievable due to the persons chest wall shape, breast footprint, and nature of the persons natural breast tissue.

If you need a breast lift and also want implants, then the surgical options Dr Dona will recommend will depend on the state of your pre-existing breasts and the look you’re after. The two possible options include:

• Single combined lift/augmentation operation
• Two separate operations

The rationale for a two staged approach in such women is simple:
– The breast lift alone is designed to create an improved breast shape. Then approximately 6 months later a well-planned breast augmentation is performed as it is ‘easy’ to make what is now an aesthetically improved breast shape larger. However, many patients don’t proceed with this augmentation as they are just happy with the lifted breast shape!

An important aspect of the breast lift alone is that such patients will most likely not achieve a long-lasting upper pole fullness as the breast tissue will settle into a lower position. Hence most of these women do want augments to address this problem.
(Upper pole fullness can also be achieved to a lesser degree with fat transfers but that’s a separate topic)

So basically, you opt to do two well scheduled and well-planned operations – a lift first, then an augmentation later – to have the best chance of achieving a satisfactory long-term result. This is far better than doing one planned operation, a combined lift-augmentation, where you have a high chance of needing further unplanned surgery and you are less likely to get a good long-term outcome.

Finally, with a planned two-stage approach, the surgeon could potentially, and safely, use a larger implant than would otherwise be possible with a combined lift augmentation.

In the end, do your homework, always consider second opinions, and if you want Dr Dona’s opinion, give our office a call to schedule a one-on-one consultation.

Learn more about combining Breast Lift & Breast Augmentation Surgery