Breast Lift and Augmentation

Conveniently located to serve the areas of Beverly Hills and Los Angeles

Description

The two most popular types of breast surgery procedures are breast augmentations (enlargement) and breast lifts.  While both operations treat the same part of the body, they have very specific purposes and results. A breast augmentation achieves an increase in breast volume, size, and fullness with the surgical insertion of a breast implant (saline or silicone). Breast lift surgery corrects the aesthetic breast problems resulting from ptosis—sagging, droopy, or flat breasts that have lost their youthful, round shape and appearance.  The primary causes of ptosis include: age, genetics, childbearing / breast feeding, and weight fluctuations; a breast lift (mastopexy) can rectify these issues.  Very mild cases of breast ptosis can be improved by breast augmentation alone. However, beyond a certain point, breast augmentation does not address the problem of ptosis, and similarly, a breast lift will not increase the overall size or shape of your breasts (nor will it fill out the center or the upper concavity of your breasts). If your surgical goals include an increase in breast size, as well as the correction of sagging breasts, you can undergo a breast augmentation procedure in conjunction with your breast lift surgery (augmentation-mastopexy). At Gabbay Plastic Surgery, Dr. Joubin Gabbay M.D., has years of experience performing breast augmentation-mastopexy surgery, and will safely and effectively enable you to lift and enlarge your breasts in the context of a single surgery.

Options

Augmentation-mastopexy surgery involves a number of surgical options and choices, including:

  • Type of breast lift surgery (crescent lift, Benelli lift, vertical mastopexy, full mastopexy)
  • Type of breast implant (silicone vs saline)
  • Nipple placement
  • Size of implant
  • Augmentation incision (inframammary, periareolar, transaxillary, tramsumbilical)
  • Implant placement (submuscular vs submammary)

During your initial consultation, Dr. Gabbay conduct a thorough evaluation, and will determine the appropriate options for your breast augmentation with a lift surgery, based on your surgical objectives, medical history, and the degree of your ptosis.

There are many benefits to performing a breast augmentation in conjunction with a breast lift, and when performed by a capable and skillful plastic surgeon such as Dr. Gabbay, you can safely achieve beautiful, natural-looking results.

Advantage of having an augmentation-mastopexy include:

  • Safety and convenience of a single dose of anesthesia,
  • Decreased risk of surgical complications
  • Only one post-operative recovery period
  • Cost-effective
  • Ability to see final results after only one procedure

Dr. Gabbay customizes each augmentation-mastopexy to fulfill your specific goals and expectations, and prioritizes the health and safety of all of his patients.  In some cases, the augmentation mastopexy can be performed as a staged procedure, if indicated. If you would like more information about augmentation-mastopexy, please call Gabbay Plastic Surgery today. We are happy to answer all of your questions and concerns, and to schedule an initial, complimentary consultation with Dr. Gabbay.

Degrees of Breast Ptosis (sagging)

Changes in the appearance of breast tissue take place as a result of aging, weight fluctuations, pregnancy, breastfeeding, or genetics.  There are varying degrees of breast ptosis (sagging), and one of the primary ways to gauge the level of ptosis is to examine the relationship between the nipple and the fold beneath the breast (inframammary fold—IMF).

The severity of breast ptosis is measures according to the following scale:

  • Normal Breast: when the nipple and parenchyma (the functional tissue or cells of an organ or gland distinguished from supporting or connective tissue) of the breast sit above the inframammary fold of the breast
  • Grade 1 Ptosis (mild)—when the central point of the nipple sits slightly above the inframammary crease
  • Mild Ptosis with Asymmetry—when the breasts sit too low on your chest wall or the areola has stretched out causing mild to moderate ptosis
  • Grade 2 Ptosis (moderate): when the nipple rests 1-3 cm below the top of the inframammary fold
  • Grade 3 Ptosis (severe): when the areola descends more than three cm below the breast crease and at the most dependent part of the parenchyma
  • Pseudoptosis: occurs when the nipple is above the inframammary crease, but the breast still appears to sag due to the presence of breast skin and hanging tissue descending below the level of the fold

Anatomy Of The Breast Shape

Breasts are made up mostly of fat and breast tissue, along with nerves, veins, arteries, and connective tissue.  Breast tissue is a complex system of small round sacs that produce milk (lobules) and tubes that carry milk from the lobules to the nipple opening known as ducts.

Breast anatomy includes the following components:

  • Cooper’s Ligament—The connective tissue that attaches the breast to the overlying skin
  • Pectoralis Major—The larger chest muscle
  • Pectoralis Minor—The smaller chest muscle
  • Subcutaneous Fat—Under-the-skin fat
  • Inframammary Crease—The fold or crease under the breast where the breast meets the upper abdomen
  • Ducts—Thin tubes in the breast that carry milk from the breast lobules to the nipple
  • Nipple—The bulge of the mammary gland that contains the openings of the milk ducts
  • Lobules—The part of the breast where milk is produced
  • Lobes—Lobules gather into lobes and there are as many as 20 lobes per breast
  • Breast Envelope—The skin that surrounds the structure of the breast

Indications

There are many breast enhancement options to choose from. A woman with adequate breast tissue and droopy breasts may only require a breast lift; however, when breasts simultaneously lose volume and begin to sag, a breast augmentation with a lift is the best option.

A breast augmentation with lift is appropriate for women who:

  • Have small breasts that are beginning to sag
  • Have breasts that have lost volume and are stretched out from pregnancy or weight fluctuations
  • Have breasts that are elongated or pendulous
  • Have breasts that are asymmetrical
  • Have breasts that have lost their shape and contour
  • Have breasts that sag and have lost volume

Women who have had children make excellent candidates for a combination breast augmentation with a full lift, because the breasts stretch and lose both shape and volume after pregnancy and breastfeeding.  If you are in good overall health, do not smoke, have finished childbearing, and have a realistic expectation of what your results will be, you may be an excellent candidate for a breast augmentation with a lift.  By combining the two procedures, your breasts will typically remain full and “perky” for years to come.

Evaluation

If you are interested in enhancing the size and shape of your breasts, the next step is to call Gabbay Plastic Surgery and let us schedule your initial consultation with Dr. Gabbay.  As a professional surgeon with vast experience and training, Dr. Gabbay will discuss your goals and recommend a customized treatment plan that is designed specifically for your individual needs.

During your consultation, you will be asked about your desired breast size and shape, as well as any other breast-related concerns you have.  Dr. Gabbay will examine your breasts and evaluate the quality of your skin and anatomy, in order to determine what breast procedure is best for your frame and body type.  If you are a good candidate for a breast augmentation with a lift, Dr. Gabbay will discuss the type of implant, incision location, placement options, and breast lift surgery details with you. If you smoke, you will be required to stop at least six weeks before and after your procedure, as smoking can cause surgical complications.

Breast lift surgery (mastopexy) and breast augmentations can be approached as a “staged” procedure, where one surgery is performed alone and the results are assessed before the second surgery is performed 3-6 months later. However, in most cases where a breast augmentation and breast lift are desired, Dr. Gabbay will combine the surgeries as a single operation so his patients only have to undergo one procedure.

Options

Some of the surgical techniques utilized during breast augmentations with a lift include:

Periareolar Breast Lift With Augmentation: this surgical option is designed for women who need more volume but only minimal elevation of the nipple and breast. The periareolar lift with implants involves an incision encircling the areola (making it almost invisible) and the removal of a doughnut-shaped piece of skin from around the areola before inserting the implant into the breast through the incision.  To reduce the size of the areola, extra skin is removed and the areola is repositioned before the skin is sutured closed. During the periareolar lift, the areola is trimmed and lifted: not removed and sutured back on as in other procedures.

Vertical Breast Lift With Augmentation: this surgical option is ideal for women suffering from inadequate breast size and mild to moderate breast ptosis.  This procedure involves removing excess skin from the bottom of the breast and the insertion of a breast implant through the lower part of the incision.  The deep layer of the breast tissue is sutured together to shape the breast before the areola is moved into a higher position. This procedure has also been referred to as a “lollipop” lift, because the appearance of the scar around the areola and straight down the center of the breast resembles a lollipop.  Normally, a vertical lift with implants does not cause puckering of the skin around the areola, although it does leave the breast implants high and the bases of the breasts tight and flat.  A few weeks after surgery, the implants will drop and the breasts will soften.

Inverted T-Lift with Augmentation: this surgical option is best suited for women with minimal breast volume, and moderate to severe breast ptosis, with excess skin at the base of the breast.  During this procedure, much of the lower and central breast skin is removed before an implant is inserted through a deeper incision at the base of the breast.  In addition to skin removal and tightening, the deep layer of breast tissue is sutured together to shape the breast before the areola is placed into a higher position and the skin is closed around the areola, down the center of the breast, and across the bottom of the breast fold.  The resulting scar is similar to an upside down “T,” and this procedure is the most extensive lift, involving more incisions due to the amount of skin removed.

Types of Breast Implant

There are two options for your breast implants:

  • Silicone: Silicone implants are filled with a cohesive gel that holds together in a semisolid mass resembling human fatty tissue, giving the breasts a more natural look.
  • Saline: Saline breast implants consist of a shell filled with saline (salt water)

There are pros and cons to both saline and silicone implants, which will be discussed during your consultation with Dr. Gabbay.  Implants also vary in terms of size, shape, texture, and projection. Prior to your surgery, Dr. Gabbay will thoroughly review all of your implant options in order to determine the ideal implant to fulfill your aesthetic goals.

Procedure Details

A breast augmentation with lift is typically performed under general anesthesia on an outpatient basis (meaning that you will be able to go home the same day) and the procedure can last from 1-3 hours contingent on the extent of your surgery. After you are anesthetized and prepped, Dr. Gabbay will make incisions in the marked areas, and will sculpt the skin and breast tissue before repositioning the nipple to give the breast a lifted and youthful contour.

Once the desired position has been achieved, he will use the same incision to create a pocket to insert silicone or saline breast implants.  After the implants have been inserted and positioned beneath the nipples, the incisions are stitched closed, then taped and bandaged.  A surgical bra will be applies and patients will be discharged from the recovery room after 1-2 hours of observation (you will be released to a family member or friend who must drive you home as you cannot operate a motor vehicle due to the after-effects of anesthesia and pain medications).

Recovery

You will receive detailed instructions on how to ensure a successful recovery period following your breast augmentation with a lift surgery.  Mild discomfort is controllable with oral pain medication and any swelling or bruising typically begins to subside in 3-4 days.  You will be required to wear a support bra 24 hours a day for at least three weeks, and you will see Dr. Gabbay on a regular basis to make sure you are healing properly.  Most patients are able to resume light activities after 7-10 days, and normal activity three weeks after surgery (with some restrictions).  Depending on your progress, you may return to work after two weeks, and the final results of your surgery will be evident after your breasts have completely settled into their new shape and position, which can take up to six months. You will have scars after your breast surgery, but they are usually in well-concealed areas and they typically fade after several months.

Potential (although rare) complications after breast augmentation with a lift surgery include: bleeding, infection, capsular contracture, adverse reaction to anesthesia, changes in skin sensation, skin discoloration, breast asymmetry, nipple asymmetry, and nerve damage.

Frequently Asked Questions (FAQs)

What is a Breast Augmentation with Lift?

Breast augmentation may be combined with a breast lift to achieve rejuvenated, full breasts with a tighter, lifted skin envelope, and more aesthetically pleasing nipple position.  Breast augmentation with lift may also help treat congenital breast asymmetry, and Dr. Gabbay uses saline or silicone breast implants, depending on your personal anatomy and individual preferences.

Who is a good candidate for a breast augmentation with lift?

Good candidates for a breast augmentation with lift are women in good health, who have breasts that have lost their fullness and shape, as well as congenital breast ptosis or sagging.  During your consultation, Dr. Gabbay will evaluate what you would like to improve about your breasts, so he can understand your expectations, and determine how to best achieve the desired results.  Dr. Gabbay always designs a customized treatment plan for each of his patients, to meet their individual desires and needs.

Who benefits the most from a breast augmentation with lift?

A combination breast lift and implants is a way to restore breasts to their firm shape, while simultaneously increasing their volume and cup size. It is an excellent option for women who have flat, sagging breasts from pregnancy and breastfeeding, or when extreme weight loss has left breasts deflated and droopy.  Patients whose breasts have lost volume and dropped simply because of gravity and aging will also benefit from both procedures.

Why is a breast augmentation with lift better than having the surgeries separately?

Breast augmentation and breast lift surgeries performed separately only address one aspect of the breast’s appearance. If you desire larger breasts, but you are happy with their position, a breast augmentation is usually sufficient; but if you want to address your breast position and volume, the combination of the two procedures is more appropriate.  If you are unhappy with the level of fullness in the top of your breasts (cleavage), the combination of the two procedures will address this issue as well.

What kind of breast implants will I choose from?

There are two options for your breast implants: silicone and saline.  Saline breast implants consist of a shell filled with saline (salt water) and they give your breasts a rounded look, with more cleavage.  Silicone implants are made from a silicone gel that resembles human fatty tissue in texture, giving your breasts a more natural look, and both types will be discussed in detail during your consultation at Gabbay Plastic Surgery, to help you select the one that is most appropriate for the goals you have in mind.

How do I prepare for a breast augmentation with lift?

Any pre-surgery instructions will be provided and discussed prior to your breast augmentation. With lift surgery lab tests will be necessary to ensure that you are in good health.  If you smoke, you will be required to stop all nicotine products at least six weeks before your surgery, and depending on the supplements and medications you take, you will be told to stop taking any blood-thinning medications or herbal supplements, two weeks prior to your scheduled surgery to prevent complications and risks.

How is a breast augmentation with lift performed?

You will be prepped for surgery and given anesthesia before Dr. Gabbay makes the incision discussed with you during your consultation.  The incision is generally made around the areola and/or along the horizontal line of the breast crease, where he will create a pocket for the implant.  Breast tissue will be lifted (along with the nipple and the areola) and excess skin will be reshaped and/or removed.  During your breast augmentation with lift, Dr. Gabbay can also decrease the size of your areola by removing a portion of the outer rim. Once the breasts are in their new position, and the implants are secured, sutures will be placed to help the breasts hold their new location.  The incisions will be closed before you are taken to the recovery room and monitored, until the anesthesia wears off.

Will I be able to drive myself home after my breast augmentation with lift?

You will need to arrange to have someone drive you home after your procedure due to the anesthesia and pain medication you received during your breast augmentation with lift surgery.

What is the recovery like after a breast augmentation with lift surgery?

Upon completion of your breast augmentation with lift surgery, dressings will cover your incision sites, and you will have a surgical bra or other compression garment in place to help keep any swelling down.  You will need to continue wearing the support garment for several weeks, and there may be some increasing swelling, bruising, or discomfort in the few days following your surgery.  If necessary, Dr. Gabbay will prescribe medication to help with any tenderness, and the swelling should subside after three days.  You should arrange for help the first week after surgery; and you should avoid bending over, lifting things, or wearing clothing that you have to pull over your head.  Most patients return to work within two weeks, although you will need to avoid strenuous physical activity for at least 4-6 weeks.

When will I see my final results from my breast augmentation with lift?

The results of a breast augmentation and lift are immediately apparent after the surgery, but your final results will become more obvious after the swelling subsides and the breast tissues settle into their new position, which can take several months.

How long will my results last?

The new look of your breasts should last for several years, however, breast implants are not lifetime medical devices and they may need to be replaced eventually.  The larger your implants, the more they affect your breast lift, and over time breasts will begin to lose some of that lift, which is a natural part of the aging process.

What are the risks involved with a breast augmentation with lift procedure?

As with any surgery, a breast augmentation with lift has risks that may include:

  • Bleeding
  • Infection
  • Reaction to anesthesia
  • Changes in skin sensation
  • Skin discoloration
  • Nipple and breast asymmetry
  • Nerve damage
  • Capsular contracture

In some cases, patients also experience dissatisfaction with the results, and this can be avoided by choosing a qualified surgeon who will perform the procedure with meticulous attention to every detail, such as Dr. Gabbay.  Pre and post-operative complications can also be avoided if you follow the instructions provided by Gabbay Plastic Surgery.

What causes breast ptosis (sagging)?

There are varying degrees of breast ptosis and it may occur as a result of advancing age, pregnancy and/or breastfeeding, genetics, and extreme weight fluctuations.

When will I be able to exercise or swim after my breast augmentation with lift?

Your recovery depends on your healing capacity and most patients can resume exercise 3-4 weeks after surgery, when your wounds are completely healed.  You will be allowed to do cardio and lower body exercise, but push and pull exercises should be restricted for up to six weeks.

Will I be able to breastfeed after a breast augmentation with lift?

Your ability to breastfeed will be determined by the surgery procedure you had performed, however; it is typically recommended that women not have a breast augmentation with lift until they have completed childbearing.