In “standard” breast augmentation surgery saline or silicone implants are used to increase the bust size and/or create more fullness especially in the upper poles or “cleavage.” But to achieve the ideal proportions, some patients need additional procedures such as breast lift.
Breast lift or mastopexy uses incisions around the nipple area to tighten the loose skin, in addition to a vertical scar between the areola and inframammary fold. In severe cases of ptosis or sagging, a horizontal incision within the natural breast crease is also needed for an additional lifting effect.
If the nipple area has sagged below the natural crease, implants alone will not provide a sufficient amount of lift and may in fact aggravate the saggy appearance and lead to more cosmetic-related problems, Los Angeles breast augmentation expert Dr. Tarick Smaili explains.
Dr. Smaili says that breast augmentation and lift are usually performed simultaneously, although some patients may benefit more with a staged procedure, especially if they need “more correction.”
Breast augmentation with lift is primarily performed to simulate the “ideal” breast proportions, which according to a recent study published in the Plastic and Reconstructive Surgery journal is having a ratio of 45:55 in which the nipple area serves as the demarcating line between the upper and lower poles.
Aside from delivering the ideal breast proportions, the Los Angeles breast augmentation surgeon says the “combo” procedure is particularly suitable for small-breasted “older” patients—i.e., 45 years and above—who are prone to tissue laxity.
Tissue laxity also “afflicts” massive weight loss patients who may also complain about the deflated-looking upper breast poles, which can be corrected by implants.
Using implants without correcting the “existing” tissue laxity often leads to a condition called double bubble in which a pair of visible line or indention appears above the breast crease, says Dr. Smaili.
In some severe cases, Dr. Smaili says the nipple area may appear herniated on top of the base of the breast if implants are used without correcting the saggy appearance.
While it is not uncommon to combine breast augmentation and mastopexy in one surgical setting, the renowned plastic surgeon says that sometimes a staged procedure in which breast lift is performed first followed by implant surgery after several months is a better approach.
With staged procedure, the skin has enough time to shrink and the swelling from breast lift to dissipate completely before implants are placed in the “pocket,” explains Dr. Smaili