COSMETIC TOWN JOURNAL



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Breast Augmentation and Mastopexy

Breast Augmentation and Mastopexy

Breast augmentation is a procedure that enlarges the breast and is usually done with an implant and occasionally with just fat.

Mastopexy is a reshaping of the breast that is usually performed by removing some skin, and sometimes some breast tissue and fat, and then moving the nipple into a higher position on the breast. Mastopexy is another term for a breast lift and is a rearranging of the tissues to elevate the breast and make it less droopy.

Augmentation-Mastopexy is a procedure that includes both enlarging the breast while at the same time lifting it to make it less droopy.

 

DIFFERENT TECHNIQUES

Breast augmentation can be done with a silicone implant, a saline implant, fat, or some combination of an implant and fat. The implant can be put in front of, or behind, the pectoralis muscle and be combined with a lift procedure. The lifting procedure can involve repositioning the nipple only or also tightening the skin envelope including sometimes removing some tissue as well.

 

SCARS

There are different scars that may be associated with a breast lift, or mastopexy, with the least scarring happening when the incision is limited to just around the areola. Sometimes the scarring is more extensive than just around the areola with the amount of scar depending on how much the tissue has to be reshaped. In some circumstances the scarring may include a vertical line from the nipple to the inframammary fold. In other cases, the scarring may include a vertical scar plus a scar in the inframammary fold itself. Most of the scar associated with an augmentation-mastopexy is due to the mastopexy because a breast augmentation alone does not usually involve very much scarring.

Breast augmentation scars are usually somewhere around 4 cm to 6 cm in length which is about 1 ½ inches to 2 inches. The scar are usually hidden in the inframammary fold, in the axilla or around the edge of the areola. However, when a lift is added, it usually involves more scarring than just an augmentation alone.

 

IMPLANTS VS FAT TRANSFER

Implants are much more powerful and predictable than fat in terms of enlarging the breast because the volume of the implant placed at the time of surgery is the same as the volume of actual enlargement after the surgery is over, even months or years later.

When fat is used, somewhere between 40% and 80% of the fat disappears after being injected. It is much less effective but what volume is added is the patient’s own tissue. Fat transfer includes removing the fat from somewhere else on the body, processing, and injecting the fat. An augmentation is just making a space for the implant and putting it in. An implant based breast augmentation is probably 30% to 50% faster than one done with fat.

An augmentation with fat alone is usually a three or four hour long operation while an augmentation with an implant alone is more likely an hour to an hour and a half in length .

 

IDEAL CANDIDATES

Augmentation is for women who have small breasts or who have breasts that are smaller than they want. Mastopexy is for women who have droopy breasts or have breasts that are droopier than they want.

Having an implant is an elective decision and the downside of having an implant in terms of scar is the small scar that is required to place it.  The bigger issue with an augmentation with an implant is having an implanted device that may need further surgery or replacement over time. The downside of a mastopexy is that it puts more of a scar in the breast. Some women want to avoid the scar and attempt a correction with an augmentation alone while other women really want to correct the droopiness and readily accept the longer incisions that are required to do so.

 

COMBINING PROCEDURES

A patient can have an implant and a breast lift at the same time but the surgeon has to pay special attention because in some ways these two procedures when combined complicate each other. In other words, when tightening and reshaping the tissues, the surgeon has to be careful to leave enough room to enlarge the breast at the same time.

Tightening too much may not leave enough room for the intended implant. The surgeon has to factor in the implant that is going to be added as part of the size of the breast that is being reshaped. The surgeon has to fit or tailor the breast skin around the bigger breast rather than to the current breast size. Another issue is that the blood supply to the breast, skin, and nipple are compromised to some extent by both operations. When doing a lift procedure, the surgeon must make some incisions around the breast that interferes to some degree with the circulation to the nipple and other breast tissues . When the surgeon does an enlargement or augmentation with an implant, it requires the creation of a space behind the breast which also interferes with the circulation to the nipple and breast tissues but in a different way. When combining a mastopexy with an implant augmentation, special care is thus required  to leave enough blood supply from other sources to all the parts of the breast in order that there are no blood supply issues after surgery.

 

LIMITATIONS

One limitation is that the complications are higher for combining the procedures than doing either operation by itself. In other words, if the complication rate for doing an augmentation is 6% and the complication rate for doing a mastopexy is also 6%, the complication rate for doing the two together is higher than 6%. It is approximately double because there are more moving parts.

This limitation also means that the revision rate for the two operations together is about 20% in the first three to five years. Once again, it is pretty much the sum of the two. If the revision rate for augmentation the first three to five years is 10% and the revision rate for mastopexy in the first three to five years is 10%, the two together is going to be 20%.

 

COMPLICATIONS AND RISKS

When talking about the two procedures, one risk is putting the nipple too high or too low on the breast. A more serious but very rare complication is loss of the nipple as a result of nipple necrosis because of inadequate circulation.  That complication is virtually unheard of in breast augmentation by itself and it is pretty rare in mastopexy. When the two procedures are done together, it rarely happens but it can.

There is also some evidence combining the two procedures increases the risk of capsular contracture and infection as compared to a simple augmentation alone.

 

RECOVERY

The recovery time for the two procedures together is no different than it would be for either a mastopexy or an augmentation alone because they heal simultaneously. Generally speaking, patients need to take it easy for the first three weeks in terms of strenuous activity. They can resume normal activities within a day or two. If a person has a desk job, they can be back at work in a day or two.

 

RESULTS

Both of these operations hold up well over the long run. There are some individuals that need their mastopexy retightened or re-contoured. In general, once the surgery is done, the breast does not go back to where it was but the normal aging process continues. The tissues are permanently fixed and they age from that point but they do not go back to where they were.

The jury is still out on if the procedures interfere with breastfeeding. Whether it is a mastopexy or a breast augmentation, they most likely do not interfere with lactation. However, there is no conclusive t evidence to support that position one way or the other.

 

FINAL THOUGHTS

The combination of the two procedures of breast augmentation and mastopexy is very powerful and creates a major transformation for those women who have small, pendulous, or droopy breasts. They can wind up with attractive, firm, and perky breasts. Patients should consult with an experienced board-certified plastic surgeon to determine if they are an appropriate candidate for the combined procedures or if they are better suited to undergo only one, or neither, of the procedures.

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Scott Spear, MD in Chevy Chase, MD