Background: The breast is subject to many changes from the influences of time, gravity, pregnancy and fluctuation in weight. But whatever the cause the changes are very typical, loss of breast volume and sagging. Efforts to reverse these negative shape changes are also very consistent through the addition of volume and lifting and tightening the breast skin.
Breast implants can have a lifting effect but it is not as significant as many patients hope. The lifting effect of an implant works best when the breast sag is no greater than the nipple being ideally above the lower breast fold or even just at the fold level. Because one of the effects of implant expansion on the breasts is to fill out the lower pole and even lower the level of the fold to accommodate the additional volume, the nipple and the breast mound will seem to be lifted. This change is partly illusionary but there is some real lift involved also.
Significant breast sagging, however, requires some type of breast lift even when implants are used. The two types of breast lifts that have real lifting power are the vertical (lollipop) and combined vertical-horizontal (anchor style) techniques. Combining implants and lift in a single breast reshaping operation is challenging as the two operations work against each other, one expanding the breast volume and the other lifting and tightening the breast mound. Getting the right balance between the two that can meet the patient’s expectations often requires more than one operation.
Case Study: This 32year-old female wanted to reshape her deflated and sagging breasts after having several children and losing weight. She had loose stretched out breast skin as well as asymmetry with the left breast sagging lower than the right.
Under general anesthesia, she had vertical breast lifts which moved her nipple-areolar complex upward by 6cms on the right and 7cms on the left. Concurrently 500cc high profile silicone breast implants were placed in the submuscular position
Her three month after surgery results show good implant positions, adequately lifted breast mounds up on the implants and good symmetry. Her breast scars remain red as expected at this point after surgery and will take another six months to lose the red color.
This combination breast implant and lift surgery had about as good a result as could be expected for this type of body contouring operation. Whether she will ever need a revision will now depend on how the scars mature and appear later. But many such breast reshaping operations will not do as well nor should patients expect them to do so. There are many variables in this operation that make for less than perfect results. The national average for the need for a revision in combination breast implant and lift surgery is over 30%. The most common reason is that the breast tissue remains inadequately lifted and tightened around the augmented breast mounds…or has dropped off of them a bit as the tissues have relaxed in the healing process.
1) Breasts that have lost volume and sag usually need a combination of implant volume and a lift.
2) The breast reshaping combination of breast implants and a lift is a challenging procedure to achieve good symmetric results in a single operation.
3) The revision rates in combination implant and lift breast operations is high and averages over 30%.
Dr. Barry Eppley