The Surgeon Minute

Breast Augmentation… and a Lift?

Breast Augmentation… and a Lift?

Have you been told that adding an implant to your aging breasts can give the impression of a lift?  It turns out that while this may be true for a few select women who are starting out with small breasts and have very little loose skin, it doesn’t apply to most women who are in search of a lifted bust line.

How does a surgeon decide if you need a lift at the time of breast augmentation? Board certified plastic surgeon Dr. Jason Cooper of Jupiter, Florida begins every breast augmentation with a series of questions which help him determine the best surgical strategy. Here he breaks down the questions and walks us through the decision making process.

What Size Do You Want to Be?

The first step toward establishing a plan is discovering the size the patient would like to end up at after surgery. You may desire to return to a pre-baby cup size, or you may want to be only slightly fuller than you are now. “A lot of my patients are moms, and they’ve worked out a lot, and they are in great shape,” shares Dr. Cooper. A common consequence of being fit and active is that the volume of the breasts often declines along with body fat. A history of weight fluctuations or pregnancy can also lead to deflation of the breasts. 

A breast lift for upper pole fullness.

What Size Are You Now?

This part of the consultation involves an examination and a series of measurements. Dr. Cooper begins by measuring the distance between the nipple and the fold beneath the breast.  He then examines how much of the breast and nipple complex are sitting below the level of the fold in the lowest portion of the breast.

One measurement in particular, called the “Sternal Notch to Nipple” measurement, is useful in determining who needs a lift. The sternal notch is a large visible dip between your neck and your collar bone, just above your chest. In a woman who is around 5’5” tall, the measurement from sternal notch to each nipple is typically well below 25 centimeters. When the measurement is over 25 centimeters, it is often an indicator that you will need some type of lift at the time of augmentation. A long distance from sternal notch to nipple indicates that the nipple is hanging very low on the chest, often pointing downwards. The best way to address nipple malposition is with a surgical lift.

Do You Have Depletion in the Upper Portion of Your Breast?

“Most women want upper pole fullness,” says Cooper. “They want to feel fuller in the upper portion of their breast, and they want to have more cleavage.” Perhaps you only want to be a little bit bigger than you are now, but you want that volume to sit high on your chest. In order to provide fullness in the upper portion of the breast, the surgeon must re-shape the skin envelope around the implant, otherwise the implant will simply settle low in the breast and the upper portion of the breast will remain flat.

There are downsides to trying to achieve a lift with an implant alone. “One of the important things to distinguish is implant size versus skin envelope,” Dr. Cooper explains. When a surgeon uses an implant that is too large for the patient in order to try to fill out the current skin envelope, the heavy implant will not deliver the youthful, lifted, perky result the patient is after. “It’s very important to remove the skin in those patients,” says Cooper.

Breast lift - before and after.

What Is Your Skin Quality Like?

Wrinkled, sun damaged skin is prone to sagging after an implant has been added to the breasts. While the implant can add youthful volume, ultimately only the lift can reshape the skin and tissue around the implant to provide youthful shape in patients who have poor quality skin.  

Poor skin quality involves:

  • wrinkles
  • sun damage
  • loss of elasticity

“I like doing breast augmentations with a lift on women because I think it achieves the best result for them,” share Cooper. “It enables me to match the skin with the implant and place the volume where it needs to be and then match the skin around it.”

Breast lift with implants - before and after.

What About the Incisions for a Lift?

When your surgeon has established that the best way to accomplish a patient’s goals is a lift, the conversation turns toward the necessary incisions. Dr. Cooper takes the time to demonstrate to each patient where the incisions will be placed to provide the optimal shape and appearance.  Most women are very concerned about scarring associated with a breast lift along with their augmentation,” he explains. “In a perfect world, there would be no scars. But you cannot oftentimes achieve the shape and the overall appearance without the scars.” The great news is that the scars are well concealed and the end result far outweighs the end result of an augmentation alone when it has been determined you are a candidate for a lift.

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