Cosmetic breast surgery that combines two or more procedures has become a common routine nowadays. In some situations, this is even a more preferable approach than having two separate surgeries in order to produce more natural results.
Today, the most common “combo” procedures are breast augmentation with lift, and breast reduction with lift, according to the California Surgical Institute website.
Breast augmentation with lift prevents a specific deformity called Snoopy due to its close resemblance to the profile of the classic cartoon dog.
When implants are used in sagging breasts without a simultaneous breast lift, their bottom edge might become visible beneath the lax skin, and thus there will be an appearance of two pairs of submammary fold.
But with a simultaneous breast lift, the implants will not “herniate” as the internal support and the actual breast tissues are reinforced with sutures. In addition, the south-pointing or low-lying nipple area is positioned higher to further achieve a proportionate result.
Breast lift is also commonly incorporated with breast reduction, a procedure that produces a smaller “cup size,” which in turn can provide instant relief from back pain, rounded shoulders, postural problems, and other ill effects of overlarge, heavy breasts.
Large breasts are susceptible to the effects of gravity (i.e., causing their skin to lose their elasticity), thus it always makes sense to incorporate some type of breast lift during the surgery.
Meanwhile, breast lift does not always entail a simultaneous breast reduction unless the patient specifically requests for a smaller cup size as well.
Cosmetic breast surgery involving combination procedures aim to produce a more natural-looking and youthful appearance—i.e., conical shaped, 45:55 breast ratio (i.e., most of the volume should be in the lower pole), proportionate nipple diameter relative to the breast size, and “ample” distance between the areola and the submammary fold.
A slight lateral bulge is also deemed ideal, although all efforts are made to prevent it from becoming excessive and thus giving an illusion that the breasts are too wide apart.
Also, it is ideal to produce a ski-slope appearance in the upper pole. In fact, one study has suggested that the ideal breast profile should have a 45:55 ratio, with the areolar complex serving as the delineating mark between the lower and upper breast poles.
Of course, good symmetry between the left and right breasts must be achieved during cosmetic breast surgery. For this reason, some patients may need different sized implants, or require more tissue removal or additional elevation on one side.
Mommy makeover revision surgery becomes necessary because of three basic reasons: inadvertent pregnancy, significant weight fluctuations, and botched results from the initial procedure.
A mommy makeover surgery is any combination of body contouring procedures that generally focus on improving the appearance of abdomen and breasts, areas that are highly susceptible to the effects of pregnancy.
Leading body contouring expert Dr. Tarick Smiley says all efforts are made to avoid the need for mommy makeover revision, adding that it always starts with proper patient selection—i.e., the patient must be near her ideal weight and is done having children.
Nevertheless, “inadvertent” pregnancy and drastic weight fluctuations do happen, which can change if not reverse the results of tummy tuck, breast augmentation, and breast lift, which are the three most common mommy makeover procedures performed by the celebrity plastic surgeon.
Oftentimes, mommy makeover revision is possible provided that the patient’s weight has been stable for at least six months and/or she has fully recovered from the “trauma” of childbirth (it takes about 6-12 months); however, a longer waiting period is deemed necessary if one chooses to breastfeed.
It is important to note that the hormones that trigger the body to produce milk have some effect on skin elasticity or shrinkage; hence, the patient must wait at least six months after weaning, says Dr. Smiley.
All efforts are made to avoid additional scars in mommy makeover revision, so the surgeon would simply use the previous incision sites. However, some patients may have to accept a longer scar to achieve the optimal breast shape or to preserve the natural curves and contours of their tummy.
For instance, a patient who previously had a mini tummy tuck (its scar is typically 4-6 inches in length) but later gained weight or became pregnant may need her scar extended from hip to hip, which is the standard technique, to achieve a flatter abdomen and a narrower waistline.
Also, a patient who had a modified form of breast lift (less scarring) may have to accept the scars from the standard technique (it uses an anchor-shaped incision for additional lifting effect) if she requires a more extensive revision.
In the event of botched mommy makeover surgery, Dr. Smiley says it is of critical importance to wait at least six months before a revision is attempted. The idea is to wait for the skin to relax and the implants (in the case of breast augmentation surgery) to settle.
Performing revisions too soon is like “hitting a moving target,” hence the results are harder to predict, he explains.
Mastopexy for tuberous breasts is designed to correct the herniated appearance of the nipple area. Oftentimes, it also incorporate the use of breast implants to further improve the overall projection and shape, as suggested by leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Mastopexy, or breast lift in layman’s term, is typically performed to reshape the sagging breasts. However, women with tuberous breast deformity can also benefit from this procedure.
While the exact origin of tuberous breasts remains unclear, its physical manifestations have been widely studied: They are caused by constriction of the connective tissue around and behind the areola, and the weak and thin tissue support that leads to the puffiness and herniation of the nipple area.
Aside from areola puffiness, mastopexy for tuberous breasts also deals with asymmetry in variable degrees (i.e., some are very mild while others are highly obvious) due to differences in shape, nipple size, breast volume, and projection.
Other physical manifestations of tuberous breasts include little soft tissue, enlarged or wide areola complex, and drooping appearance.
Mastopexy for tuberous breasts not just corrects the drooping appearance. Oftentimes, the surgeon must also remove some tissue behind the areola complex to reduce its puffiness. This is achieved by creating incisions around the areola’s edges, which typically fade into imperceptible scars.
The round incisions along the areola’s edges can also allow the surgeon to reduce its size.
While the tuberous breasts could be improved with mastopexy alone (without breast implants), it is important to note that it has its own limits.
With a simultaneous breast implant surgery, the surgeon is able to reduce the wide spacing between the breasts and improve their overall shape and volume.
During mastopexy for tuberous breasts that includes implants, it becomes more important than ever to release the constricting bands of connective tissue. The goal is to allow the prosthetics to settle centrally behind the areola complex, leading to a natural-looking shape.
Mastopexy for tuberous breasts is technically more demanding than a breast lift involving an “average” patient (no significant deformity; only soft tissue laxity due to aging or pregnancy). For this reason, one should be extra strict when choosing a surgeon.
Aside from having appropriate board certifications, the “right” surgeon should also be performing mastopexy, breast augmentation, reduction, and reconstructive breast surgeries on a regular basis. Ideally, he must be able to present hundreds if not thousands of before-and-after photos of his actual patients, which can serve as a proof that he has extensive experience.
Breast reduction for asymmetrical breasts is a highly customized procedure. While it is possible to perform a unilateral procedure—i.e., only operating on the bigger breast—it may not result in optimal shape and good overall appearance.
While almost all women have asymmetric breasts, the difference in size or shape is often insignificant.
Before and after photos of patient who had breast reduction for asymmetrical breasts.
But in severe cases of lopsidedness, breast reduction, breast lift, and/or implant surgery can be of great help. To achieve high patient satisfaction, a prudent surgeon will try to understand the cosmetic goals and personal tastes of his patient.
There are many ways to perform breast reduction for asymmetrical breasts, however, the usual approach is to take more tissue on one side than the other in an attempt to improve the symmetry between the two, according to California Surgical Institute website.
Another possible approach is to reduce the bigger breast and only “lift” the smaller one so that both nipples will be at the same height and/or both “mounds” will almost have similar projection and shape.
Contrary to popular belief, obvious asymmetry is not only caused by a notable size gap. Oftentimes, the lopsided appearance is aggravated by different-sized areolas, one breast drooping or projecting more than other, or one nipple positioned higher than the other side.
Breast lift is a fitting complementary procedure of breast reduction. In this procedure, doctors not just lift the sagging tissue, but also reshape the breast and reposition the areola complex.
Most doctors use some form of internal sutures to support the planned size or shape after breast reduction/lift. Failure to create a strong underlying structure not only leads to short-lived results, but also results in increased risk of scar migration or “thickening.”
While it may sound counterintuitive, sometimes breast reduction is combined with implant surgery. This approach is primarily reserved for patients who want to achieve more upper pole fullness, which breast lift alone cannot achieve.
Because the incisions used in breast lift are confined within the lower poles, as a stand-alone procedure it cannot improve the appearance of deflated-looking upper cleavage, a cosmetic problem that is best addressed by breast implants.
Regardless of the surgical technique, breast reduction (with or without adjunct procedures) is only reserved for normal weight individuals who understand the importance of healthy lifestyle as a long-term weight management solution.
It is important to note that significant weight gain/loss can affect, if not completely reverse, the effects of breast enhancement surgeries.
Breast reduction and lift scars are placed within the natural folds of skin and will usually heal into a fine white line about one year postop. Nevertheless, modalities known to improve scar appearance remain important especially prior to its full maturity, as suggested by experts from the California Surgical Institute.
Breast reduction and lift surgery performed as a combo procedure is ideal for women with overlarge, pendulous breasts. Both techniques use the same scar pattern, so there is additional scarring.
Almost all breast reductions utilize the techniques used in breast lift—i.e., reposition the nipple-areolar complex and/or tighten the deeper tissue with internal sutures—to achieve natural contour and good projection.
On the other hand, patients who need a breast lift to correct the drooping appearance may not require a reduction surgery, particularly if they are already satisfied with their current cup size.
Most patients will need an anchor-shaped scar in which the incisions go around the areola’s border, vertically down the lower pole, and within the breast crease.
The vertical scar between the areola and the crease is the most visible, although over time it will fade significantly and blend in with the skin for most patients.
While time remains the best scar treatment, a simple scar massage remains helpful especially in the first 3-6 months. The idea is to break up the scar tissue with the use of manual manipulation, leading to the appearance of finest scar possible.
Scar creams and lotions that contain silicone and other hydrating agents are also known to help improve the scar appearance.
Raised scars are believed to respond well with silicone sheets or tapes and embrace dressing; both modalities work by reducing the tension on the skin and applying constant pressure to the scar to prevent it from becoming thick and raised.
Breast reduction and lift scars that appear red, meanwhile, are often treated with lasers to help them blend in with the surrounding skin tissue.
To further achieve the finest scar possible, it is crucial to avoid sun exposure for at least six months because they are known to trigger the “injured” skin to produce more melanin, leading to darker, more conspicuous scars. And since some UV rays can pass through fabrics, it still makes sense to apply sunscreen under clothes.
Despite the resulting scars, surveys have suggested that breast reduction and/or lift surgeries provide a high patient satisfaction rate, especially in women seeking relief from symptoms caused by overlarge breasts.