Breast Augmentation / Lift

Breast augmentation lift with mastopexy is a combined surgery designed to both lift the breast and increase the fullness and size.  This is a good procedure in someone that has breast ptosis, or “sagging”, where the nipple position hangs lower than desired, and an implant alone is not able to provide enough lift. Many women with larger breasts have some degree of ptosis, but aging, pregnancy changes, breast feeding, and weight changes can also contribute to sagging over time. Although a breast lift will enhance the appearance of the breast, the tradeoff is that there are scars which are more visible on the breasts compared to just an augmentation because the nipple areolar position is elevated. The goal for this surgery is to achieve lift and volume with an acceptable scar. Every woman has an ideal image of how they would like their breasts to look and this is a very personal decision.

The ideal patient is someone that wants more breast volume and projection, but also has concerns that the breasts droop or sag, with downward-pointing nipples that rest below the breast crease. Most importantly, the patient should have realistic expectations of what this combined surgery can achieve. Most women can undergo both procedures at the same time during a single surgery, but a small group of patients will require two separate surgeries in order to optimize safety and outcome.

When considering breast augmentation mastopexy, there are several factors to think about. These include:

• What type and size of implant is desired for the breast enhancement
• Where is the implant placed, either above the chest muscles, or below the chest muscles
• Where the incisions are made to allow repositioning of the nipple areolar complex

1. IMPLANT TYPE AND SIZE
   The first decision is whether to use silicone gel or saline implants. In general, many women find the silicone gel implants have a more natural look and feel, compared to the saline implants. Saline implants are essentially a silicone shell filled with sterile salt water.Your ideal breast size, shape and appearance is a very personal decision, and a safe range of implant sizes that would be compatible with your chest and body proportions will be considered. As part of your consultation, with the use of sizers and a custom sizing bra, you can visualize in the office how the different size implants will augment your breast appearance.

2. PLACEMENT
   The breast implants can be placed on top or underneath the chest muscles (pectoralis major muscle). Part of this decision depends on the aesthetic goals you have for your breasts and your starting breast size. Placing the implants directly below the muscle provides more coverage over the upper portion of the implant. This can potentially create a more natural breast appearance. There is a spectrum of looks that can be achieved, from a natural breast appearance to a very augmented look to the breast. One of the main goals during your consultation is to determine where you feel your ideal breast appearance is on this spectrum.

3. INCISION LOCATION
   An important goal is to make your incisions as unnoticeable as possible, however, there will always be a visible scar around the areola. The scar pattern will depends on the degree of ptosis, with a greater degree of ptosis requiring a greater lift and therefore a longer incision. An area of skin is removed above and below the nipple areolar complex, and at times even a small amount of breast tissue is removed or repositioned to give the breasts more fullness and optimal shape. The most popular scar patterns are:

• Periareolar mastopexy– circular or “donut” pattern around the areola.
• Vertical mastopexy –  around the areola with a vertical limb that extends from the 6 o’clock position of the areola to the breast crease, and commonly referred to as a “lollipop” scar.
• Wise pattern mastopexy (anchor or inverted-T pattern) –  scar around the areola, a vertical scar from the 6 o’clock position down to the crease, and along the breast crease.

Breast Augmentation Mastopexy is performed as an outpatient procedure at a private surgical facility. Immediately after surgery, you will be taken into a recovery area for close monitoring and will be permitted to go home the same day with a responsible adult when you are stable for discharge, typically after an hour. It is important that you have someone that will stay with you for the first 24 hours. While a breast augmentation mastopexy yields larger and lifted breasts right away, the final result may take several weeks to a few months as the swelling subsides, the skin stretches, implants settle, and scar matures. All patients wear a Surgical Couture bra by Labratory, to support their breasts during the healing period. The implants initially will be sitting unnaturally high, but with time, the implants will drop down into a more natural position. Some patients wear a bandeau to help guide the implants into their final position. There will be a gauze dressing over the incisions which can be left on for up to two weeks. Patients can start to shower the next day after surgery. You will receive a prescription for pain medication and antibiotics before or on the day of surgery. It is recommended that you set an alarm for the first two days of surgery every 4-6 hours so that you remember to take your pain medication regularly.   You will be given detailed postoperative instructions that you should follow carefully.

Possible complications include unfavourable scarring, hematoma (blood collection), seroma (fluid collection), sensory changes to the nipple, breast or nipple asymmetry, infection, nipple necrosis, DVT and PE.  A scar forms internally surrounding the implant that is called a capsule. This may harden or tighten, a process known as capsular contracture. Breast implants may have to be changed or replaced if they are damaged (a saline implant deflates or a silicone implant ruptures). These risks are low and will be explained to you by Dr. Ho during your consultation.

Acute pain typically subsides after one to five days, but you may experience some discomfort from time to time for the first few weeks. You may also experience some altered skin or nipple sensation that can you may find uncomfortable while your nerves adjust after surgery. You will be able to start driving one week after surgery if you are no longer taking pain medication

We recommend that you wear your medical brassiere during the recovery period to ensure optimal comfort and support of the breasts.  It is important to refrain from exercise and heavy lifting during your recovery period in order to limit complications. Because it is possible to bleed into the pocket around the breast implants for the first several days, take it easy until you have permission to increase your activity level. You will be able to return to upper body workouts (pectoralis and lattisimus) 6 weeks post-op.

When thinking about time off work, or away from social commitments, 2 weeks is most likely a safer window of down time. The final results can appear gradually over the first few months as the implants settle into the correct position and the swelling subsides. Scar tape and massage of the incision is used for the first 6 weeks. All stitches used are dissolvable and are placed under the skin so there are no stitches to remove. It is important to realize that the final scar varies between individuals and is highly dependent on a person’s genetic predisposition. It is possible for the scars around the areola to stretch and widen over time. Scars typically fade over time but their final dimensions and colour are difficult to predict.