The Surgeon Minute

Breast Augmentation, Breast Lift, or Both?

Breast Augmentation, Breast Lift, or Both?

After pregnancy, women often describe their breasts as having become “deflated.” Not only do they not feel as big, but their breasts are also now starting to sag. These patients come into the plastic surgeon’s office confused about what to do. And rightfully so.

While a breast implant can certainly boost up the volume, it cannot lift a seriously sagging breast. Conversely, a breast lift can place the nipple back in its former, higher position on the chest wall, but it doesn’t increase volume. Deciding whether to get a breast augmentation, breast lift, or both is often a conundrum for many patients. Dr. Anup Patel of Orlando, FL breaks down what each procedure can and cannot do, and discusses whether or not it is safe to have both performed at the same time.

Differences Between Breast Augmentation & Breast Lift

Women will often come into the office complaining that their breasts no longer look the same. They’ve lost volume, feel deflated, and are often sagging. While most of these patients are mothers, significant weight gain/loss and age can also take a toll on your breasts. Thanks to the web and the proliferation of breast augmentation information, most of these women think that a breast implant is the answer, but it’s not always that simple. It is the job of the plastic surgeon to identify whether or not you need a breast augmentation, a breast lift or both.

The first thing to keep in mind is that these are two different procedures with different goals. A breast lift is used to correct sagging breasts. It will literally pull the nipple up to a higher, more youthful position on the chest wall. A breast augmentation, on the other hand, is used to increase volume. With a breast lift, the surgeon removes skin in order to tighten and lift the breasts. But with a breast augmentation, he or she is actually expanding the skin with the implant to increase upper pole fullness.

Breast lift diagram.

Safety is Key

Since these two surgeries almost work against each other, figuring out the best treatment plan can be tricky. There is a lot of literature touting the advantages of performing both of these procedures at the same time. It can be hard, then, to explain to a patient that this may not be feasible. The danger is in compromising the blood supply to the nipple. Dr. Patel uses what’s called “tissue based planning” to decide whether or not the two procedures can be performed as one. It involves taking very precise measurements of your natural breasts and then using these numbers to make an objective decision as to what is the safest course of action for your individual anatomy.

Questions to Consider

When a patient comes in to see Dr. Patel for a breast surgery consultation and they appear to need both a breast augmentation and a breast lift, he always asks: what is more important? Your nipple position or increased upper pole fullness/cleavage? The answer then guides him in developing your treatment plan.

Another important question to consider is how much of a scar are you willing to tolerate? The scar with a breast implant is small and typically hidden in the inframammary fold or crease beneath your breast. The scar for a breast lift, however, is much more visible. It will often go around the nipple and down the front of the breast. If you have a severe degree of ptosis or sagging, that scar will also extend into an anchor incision beneath the breast.

Don’t Let the Scar Scare You Away from a Breast Lift

A scar on the breast, especially one that is as visible as a breast lift scar, is a pretty scary proposition for most patients. Surgeons say don’t let that deter you from getting a breast lift if that is the procedure that will really deliver your desired results. Plastic surgeons pay attention to scars; it’s their business. They use precise surgical techniques to close the skin in a tension free manner. This reduces any “pull” on the incision lines so that the scars on the breast generally heal very well. Oftentimes, a year out, patients no longer even notice their scars. There are also great scar treatments on the market that can soften and diminish any visible incision lines.

Breast lift scars.

How do You Know You Need a Breast Lift?

So, how do you decide if you really need a breast lift? It all comes down to nipple position. If your nipple sits at or below the inframammary fold, which is the crease beneath your breasts, then you are going to need a breast lift. If your breasts do not have a severe degree of sagging or ptosis, then you can probably get away with an implant alone. The implant does provide some lift since it increases the volume of your breast. For patients who are very reticent about a scar on the breast, Dr. Patel will perform the augmentation first. Then, if the patient is happy with the results, great. And if not, she can come back at a latter date for the breast lift.

Breast lift results - Dr. Patel.

The important thing with any breast surgery procedure is that it be individualized to the patient. “No two patients are the same,” explains Dr. Patel. Just because your sister may have needed a breast lift does not mean that you do. Every patient has breast asymmetries. As Dr. Patel likes to say, your breasts, “are sisters, not twins.” It’s important to see a surgeon who will tailor the procedure to your unique anatomy, goals, and lifestyle.

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