Background: Breast augmentation remains as one of the most popular body contouring procedures. In simplicity, breast augmentation works by using an implant to expand out the existing breast tissue. Therein lies how the final breast result will look…it will reflect nothing more than a ‘blown-up’ version of the existing breast mound in most cases.
Many women appear for breast augmentation that do not have ideal breast mounds. They have varying degrees of breast sagging and low nipple positions. This is particularly true in older women and those who have had multiple children. They often have the mistaken assumption that breast implants will correct the sagging breast problem. Nothing could be further from the truth. Such patients need to consider some form of a breast lift if they are to get the breast outcome that they desire.
Case Study: This 44 year-old female presented for breast enhancement, which was really revisional breast surgery. She previously had saline breast implants under the muscle by another surgeon. She was aware that her breasts were saggy but thought the placement of implants would provide a lift as well as give more volume. The potential need for a breast lift was never discussed before her original implant procedure.
At the least, her prior surgery proved that implants alone were inadequate for her breast sagging problem. For her revisional surgery, the need for a breast lift was discussed. Since her nipple needed to move at least 2 to 3 inches upward, she required a breast lift that would result in final scars around the nipples and down vertically into the lower breast creases.
During surgery, her saline breast implants were initially replaced with new ones that were larger. (250cc to 325ccs) Then a breast lift was performed to move the breast mound up on top of the implants with a vertical lift technique. The nipple was moved upward and the size of the areolas reduced as well.
Her postoperative recovery was quick and relatively painless. Most of the pain from breast implants comes with the muscle and pocket dissection. This was done with her original surgery. Implant replacement uses the established pocket which makes for no tissue dissection or pain. Breast lifts are not particularly painful since it is just skin and breast tissue manipulation.
At just one month after surgery, her breast size and shape is much improved. Her vertical breast lift scars will take time to mature, but they usually are much better looking than most patients expect. Breast lift patients must be willing to accept scars for a less saggy and better shaped breasts.
Case Highlights:
1) When considering breast augmentation, it is extremely important to consider the amount of breast skin and nipple position. Any sagging of the breasts will not be corrected by implants alone.
2) The decision for any type of a concomitant breast lift with an augmentation must carefully weigh the aesthetics of the scar trade-off for improved breast shape.
3) Vertically oriented breast lifts provide the greatest amount of sagging breast correction and nipple repositioning.
Dr. Barry Eppley
Indianapolis, Indiana