Augmentation Mastopexy

Sometimes a breast lift alone reshapes the breast in exactly the way you want.  Sometimes adding volume with an implant is all you need.  In some cases, though, the best result is achieved through combining the two approaches.  Many times this can be done as a single procedure, but occasionally it is recommended to have the correction done in stages due to baseline anatomy, prior surgical history, or desired size.

When the nipple position is lower than the breast crease, placement of implants without a lift is more likely to result in drooping of the breast off the implant, or a “Snoopy” deformity of the breast.  Adding a breast lift to the augmentation results in a more harmonious and youthful appearance of the breast.  In a similar way, when you know you want a lift but the native breast tissue is not adequate to achieve a fuller, rounder shape, adding an implant for upper pole fullness can help you achieve the results you are looking for.

The combination of these two approaches adds complexity to the operation, because while the lift serves to reshape and contour the breast tissues, it usually results in tightening of the skin envelope while the addition of the implant volume tends to stretch the skin or put pressure on the newly shaped skin envelope.  With skill and experience these two opposing forces can be balanced to achieve beautiful results.  However, even in expert hands this combined operation is more likely to result in the need for revision or corrective surgery than either breast augmentation or breast lift alone.  During your consultation, Dr. Owens will review your medical history, listen to your goals, and discuss the trade-offs thoroughly so that together you can decide on the best surgical plan to meet your needs.

Implant Choice

All implants currently available in the United States are silicone shells filled with either saline or silicone gel.

Silicone Filled

Silicone gel has evolved through many generations of cohesiveness over the years, and the current generation of implants is available in structures with less chance of rupture than earlier generations.  These implants are soft in feel and for that reason are more often used in breast reconstruction.  If the shell breaks (‘ruptures”), the gel most often tends to stay within the shell rather than leak out of the shell.  Usually there are no obvious clinical signs of rupture, known as the phenomenon of silent rupture. You may not be able to tell if your silicone implant is ruptured. For that reason, the FDA currently recommends screening with MRI at 3 years post op and every other year thereafter for all patients with silicone gel breast implants, in addition to routine yearly screening mammograms for patients over age 40 with silicone gel breast implants.

Saline Filled

Saline (salt water) implants are filled with the same fluid often used in intravenous fluids.  They are an economical choice and reasonable for those with a moderate amount of native breast tissue to camouflage the implant.  Saline implants can be filled within a range of volumes, which is a useful feature for those patients with minor asymmetry.  If the shell breaks, the saline leaks out and is absorbed safely by the body, causing a deflation that is usually quite obvious.

Structured Saline Filled (Ideal Implant TM)

An implant choice that bridges the gap between silicone and saline, the structured saline implant is constructed of multiple silicone shells filled with saline.  This allows for a softer feel than most standard saline implants but does not require MRI to monitor for rupture.  If the shell breaks, the saline leaks out and is absorbed by the body in the same way as is seen with standard saline filled implants.

Soft Tissue Support

For some patients, due to age, weight loss, or previous surgery, the quality of the breast tissue or skin is not adequate to support the implant and maintain a stable position.  In these cases, Dr. Owens may suggest use of soft tissue support with products such as Strattice or Galaflex.  These implantable slings reinforce your own tissues to help stabilize the implant and minimize later stretching of the skin envelope that can result in sagging or bottoming out.  Not all patients require this added support but Dr. Owens will let you know if she thinks you could benefit from this technique.

Staging Augmentation Mastopexy

If Dr. Owens recommends staging of your procedure, it is most common to plan for breast lift (mastopexy) to be performed first, which allows for correction of any asymmetries and sets the breast shape, so that a more predictable result can be achieved with later placement of implants.  The implant placement is planned no sooner than 3 months after the lift, but may be done at your convenience any time after that.  Because the procedure is tailored to your specific situation, there are occasions when it makes more sense to perform augmentation first, but this is less common.

 Preparing for Augmentation Mastopexy

Please avoid taking Advil, Aleve, aspirin, ibuprofen, Motrin, and Naprosyn for two weeks prior to your surgery. High dose vitamins and herbal medications should also be avoided. Most other medications that you take regularly can be taken before your procedure. It is especially important if you are prescribed blood pressure medication to take that as normal so that your blood pressure remains controlled during surgery.  You will receive prescriptions for your post op meds at your pre-surgical appointment and we recommend you fill those and have available at home for immediately following surgery.

 Your augmentation mastopexy will be performed at one of the outpatient surgery centers where Dr. Owens holds privileges. Be sure to have someone available to drive you home and stay with you for at least the first 24 hours, as you will be drowsy from the anesthesia and may need assistance with personal care in the first day or two after surgery.

The Day of Your Augmentation Mastopexy Surgery

Do not eat or drink after midnight on the night before surgery.  You will arrive at the surgery center and meet the nursing and anesthesia teams.  Dr. Owens will see you to answer any last minute questions and to mark the surgical sites.  Surgery takes about 2 ½ to 3 ½ hours under general anesthesia.  The implants are placed and the skin is reshaped over the implants.  Surgical bra and compression wrap are placed over the dressings.  You will recover and nurses will review instructions to go home with you and your caregiver.  Expect to be sleepy and be sure to arrange for help to stay with you for the first 24-48 hours after surgery.

Recovery from Augmentation Mastopexy

Drains are rarely required, but if they are, these are usually removed in the first day or two.  Dr. Owens will see you for a post op incision check within the first few days.  You should plan not to drive for the first week or two and should plan for about that much time off work.  It is common to feel sore, swollen, and bruised.  Some patients experience nausea after surgery and you should be sure to use your prescribed medicines as needed to treat these symptoms.  In many cases, over the counter medicines like acetaminophen and ibuprofen are adequate for pain management after a few days.  You will be restricted in exertional activity or exercise for several weeks, and should plan to limit your range of motion at the arms to avoid added stress on the incisions.  You will see results of the surgery immediately, but remember that it may be 3-6 months before the final result is appreciated, depending on the extent of your surgery.

Contact Avalon Plastic Surgery to see how augmentation mastopexy can give you a full and youthful profile!