The Surgeon Minute

Adding Implants to a Breast Lift – Yes or No?

Adding Implants to a Breast Lift – Yes or No?

It’s common knowledge that anyone with sagging breasts would benefit from a breast lift. Less understood is the answer to the question, “Which of those women would also benefit from the addition of implants at the time of the lift?”

According to leading breast surgeon Dr. Richard Zienowicz, the answer is almost everyone. “In my practice, about 95% of patients have the addition of an implant at the time of mastopexy,” shares Zienowicz.

Why Do Breasts Sag?

The basic equation applied everywhere else on the aging body takes its toll on the chest as well:

Gravity + Aging Skin + Volume Loss = Sagging

Skin declines in quality from its previously youthful, firm and elastic self. No longer able to resist the strong and steady downward pull of gravity, the breasts change. Large breasts, once full and round, now hang heavy and low on the chest. Small breasts, once perky and tight, lay flat against the chest.

Pregnancy and weight fluctuations magnify the normal effects of aging on the breast. During pregnancy, the glandular tissue in the breast swells. As a result, the breast skin stretches to accommodate the enlarged breast. When the breast deflates following pregnancy, the skin may not shrink back to a tight position, leaving loose skin and sagging breasts.

Breasts are not composed only of glands. In fact, the main component of a breast is fat. Weight gain and loss can have a similar effect to pregnancy on the breast.

Nipple position also changes as breasts age. In a youthful breast, the nipple is located close to the center of the breast, with fullness both above and below the nipple. In an aging breast, the nipple may sink to a lower position on the breast, with most of the fullness or weight of the breast sitting below the nipple.

Breast lift - ptosis.

Breast Lift Basics

A breast lift, also known as mastopexy, is a surgical procedure that involves the removal of skin and/or tissue of the breast. The result is a tighter, firmer breast.

Breast Lift Incision Techniques

  • Circumareolar, or Donut Incision
  • Wise Pattern, or Anchor Incision
  • Circumvertical, or Lollipop Incision

Incision placement during a breast lift depends on both the surgeon’s preference and the anatomy of the patient. Repositioning the nipple requires a circular incision around the breast. If a patient has very little loose skin, the surgeon may be able to remove just enough skin from a donut incision around the nipple, also known as a circumareolar incision. In some women this allows for both the repositioning the nipple and tightening the skin through one round incision.

The majority of women who desire a breast lift will require more lift than a donut incision can provide. “Most techniques, even today by a lot of prominent surgeons, involve what’s called a Wise pattern scar,” explains Zienowicz. “The nipple areola complex has a circular scar, there’s a vertical scar that goes down to the inframammary fold, and then it includes a full inframammary fold scar as well.”

Breast lift - Wise Pattern scar.

Zienowicz opts for a technique that allows him to provide maximum lift with minimal scarring. During a circumvertical lift, also called a lollipop lift, he places a circular scar around the nipple and a vertical scar from the nipple to the fold. By avoiding the anchor incision in the fold under the breast, Zienowicz is able to provide lift without adding the risk of raised or “hypertrophic” scars that would potentially rub against the underwire of a typical bra.

Breast Lift Limitations

Do your breasts feel heavy at the bottom but flat at the top? Many women love the idea of repositioning their current breast tissue to provide a boost “up top,” the way a push up bra pushes the breast upwards.  

While a breast lift is able to tighten up the existing breast, it is not effective in rounding out the upper part of the breast. If a patient is looking for a rounder shape to their breast and fullness restored to a flattened upper chest, Zienowicz recommends adding an implant at the time of the lift. “Most plastic surgeons feel that the addition of an implant improves their results,” says Zienowicz. “You are creating a round shape immediately by conferring a device inside that by its very nature confers a round shape.”

Breast lift with implants.

Another benefit to adding an implant at the time of a breast lift is that less skin needs to be removed. When less skin is removed, an incision can be shorter and the scars that result are smaller in size. Expert surgeons are able to provide patients with an optimal lift, improved breast shape and fullness in the upper portion of the chest, all without requiring a long “anchor” scar in the fold of the breast that can be difficult to disguise in swim-wear or a bra.

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