Background: Many women who present for breast augmentation have varying degrees of breast ptosis or sagging. Some have the belief that a breast implant has the capability to lift the sagging breast and avoid the need for some type of breast lift. Unfortunately this is almost never the case much to the chagrin of the patient.
Burt there are cases where with right size off breast implant and with a breast sag that is not too severe that a breast augmentation procedure by itself can lift up a sagging breast. The key is the type of breast sag. As breast ptosis is defined as the position of the nipple relative to the breast (inframmammary) fold, a breast sag where the nipple is just at the level of the fold is a preoperative sign that an implant alone will suffice.
Case Study: This 38 year-old female presented for breast augmentation. She had small breasts but had lost most of her breast volume after having children.
Under general anesthesia, an inframammary incisional approach was used to place 400cc high profile silicone breast implants in a dual plane position. As judged by her after surgery side view picture comparisons of her elevated nipple position caused by the breast mound enlargement.
Nipple positions at or above the level of the inframmary fold will be elevated from the placement of breast implants. This will occur even when the implant is placed in the submuscular position. The size of the breast implant also plays a role with ‘larger’ implants being more effective than smaller ones. To some degree there is the effect of the ratio of implant to natural breast mound tissue. The greater this ratio the more effective the lift will be.
In some cases when the implant to natural mound tissue is more even, the initially uplifted breast tissue can ‘fall off’ of the implant over time. This is because the weight of the breast tissue is not well supported by the implant size. This is not the case int this example but can be in more marginal patients who are better off having a lift with the implant placement.
Highlights:
- Breast implants do not have a great ability to lift up a sagging breast.
- A good size implant in the properly selected patient can have some breast lifting effect.
- Over time the augmented ‘breast lifted’ patient may have some glandular tissue slide off the implant due to gravity and tissue stretch.
Dr. Barry Eppley
Indianapolis, Indiana