Many women, usually after pregnancy, desire improvement from the resultant change that has occurred in their breasts. Usually the resultant breast involution (shrinking) that occurs after most pregnancies results in sagging or ptosis of the breast. the breasts may appear deflated but the problem is really one of too much skin now for the amount of breast tissue that remains. (yes, you will have less breast tissue after pregnancy)
While breast augmentation and breast reduction are highly successful procedures that achieve the goals of most patients and have acceptable tradeoffs for the benefits (augmentation = use of a synthetic implant, reduction = scars), the breast lift or mastopexy procedure is a different matter.
Most mastopexies of significance result in breast scars but, unlike a breast reduction, the breast lift is a pure cosmetic procedure. Excessive scarring for the cosmetic patient may not be an acceptable tradeoff. Scars are very acceptable in breast reductions because the patient’s goal is primarily relief of back, shoulder, and neck pain. The dilemma in the potential mastopexy patient is a cosmetic one. Which is going to look better…..a saggy breast with no scars or an uplifted breast with scars. While it is true that some small mastopexies involve only a scar around the areola, breasts that require significant lifting involve vertical and vertical-horizontal scars.
Many mastopexy patients, and in about 80 – 90% of my mastopexy patients here in my practice in Indianapolis, are also candidates for an implant with their mastopexy procedure. A breast implant will provide volume and, most importantly, provide fullness in the upper pole of the breast. A breast lift alone will not in most patients result in restoration of fullness to the upper part of the breast. It may do so in the early postoperative period, but this fullness will be lost in the first few months. For this reason, a breast implant (even if small) can be very helpful. I have observed that one of the goals of most potential breast lift patients is a fuller breast as well. A breast lift tightens and lifts a breast but will not make a breast bigger or fuller.
If a patient elects to have a combined mastopexy-implant procedure, the next question is whether they should be done at the same time. I have always done these two procedures together but it can be a very difficult operation to get a symmetric and optimal result. The two procedures actually work against each other, tightening and lifting and increasing the size of the breast…..all at the same time. This can be artistically challenging. For this reason, I advise my patients that there is a very high revision rate with combined mastopexy-implant procedures. Whether it be to adjust the position of the implants, revise the scars, or do some fine-tuning of the breast shapes, the patient will frequently desire a revision. Conversely, however, staging the two procedures guarantees a 100% likelihood of two procedures.
The breast lift (mastopexy) procedure presents several challenging issues; Are breast scars worth the improvement in the breast shape? Do I need an implant with my breast lift? Can I live with the concept that a second surgery may be needed to get the best result?
Dr. Barry Eppley
Indianapolis, Indiana