When patients have breast hang in addition to small breasts, a frequently asked question is if the two operations can be done together.  The answer is "it depends".

A breast enlargement operation (augmentation mammaplasty) expands the breast tissues whereas a breast lift (mastopexy) reduces the amount of breast skin. This can be thought of as a "push pull operation". On the one hand we are making the envelope of breast skin larger by placing an implant, on the other we are tightening the breast envelope.

The size of the implant and the amount of skin that needs to be removed will influence the decision if the two operations should be done together or as separate procedures. These concepts will be discussed during your consultation. Further, the various types of breast lift will also be discussed according to how much skin needs to be removed, and how this will influence the final scars needed to shape the breast.

The final result of what is called augmentation mastopexy is usually quite pleasing to the patient. Even though all patients worry about the scars, and certainly scars can heal poorly, we have found that there is a high level of patient satisfaction when combining a breast lifting operation with breast enlargement.

Other types of surgery may also be combined with breast lifting and breast enlargement such as an abdominoplasty (tummy tuck), liposuction, arm lifts and neck lifts.

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submitted by Daniel A. Sterling, M.D., FACS

Will a Benelli lift without implants help small sagging breasts?

A Benelli lift or Benelli mastopexy or circumareolar mastopexy can be indicated for certain types of breast deformities.  It is usually not helpful in small sagging breasts as there is minimal breast tissue and will not give the projection and fullness desired. Usually a Benelli lift is used in combination with a modest size breast augmentation to give a nice projection with upper pole fullness and a circumferential reduction in the size of the breast skin envelope.  Breasts with a more severe ptotic or sagging appearance require a more aggressive mastopexy approach to get a nice result.

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submitted by Daniel A. Sterling, M.D., FACS

How painful can a breast lift combined with an implant be?

Augmentation mammoplasty, otherwise known as breast implants, can be combined with a mastopexy, otherwise known as a breast lift.  A mastopexy is not a particularly painful procedure due to the fact that the only tissues involved are skin, fat and breast tissue. The breast augmentation portion of the procedure can be a bit more painful but is readily managed in our practice using pain catheters, as well as short term narcotics and antiinflammatory medications.  Usually, the period of discomfort lasts only for one to two days with rapid improvement over the course of the first week.

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submitted by Daniel A. Sterling, MD, FACS

Can I get breast implants without a breast lift?

 Breast implant surgery or augmentation mammaplasty are routinely done without a breast lift for women who do not have any breast hangotherwise known as breast sag, breast ptosis or mammary ptosis.  Some women who have breast hang will get a much better result if they have a mastopexy either at the time of augmentation or afterwards once the implant has healed well.  A breast lift is also known as a mastopexy and is usually done when the nipple has descended to a point below the inframammary fold or the area below the breast between the abdomen and the chest.  If this is the case a breast lift can be performed to reduce the size of the breast envelope or skin and bring the nipple and areola up to the correct position.  Many times adding an implant to the procedure can return the fullness to the upper breast area that many women desire.  Certainly the majority of breast augmentations is done without a breast lift but many women have a mastopexy or breast lift with or without augmentation with excellent results as well.

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Submitted by Daniel A. Sterling, MD FACS

What is the waiting period for breast reduction or breast lift after weight loss?

It is prudent to wait for a period of time when undergoing any procedure after significant weight loss.  Once one has reached a weight that is near their target, then it is prudent to wait a short period of time to make sure that no significant swings in weight will occur long term.  Once this is done, you can achieve a much better and longer lasting final result since the tissues have reached a stable plateau.

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Submitted by Daniel A. Sterling, MD FACS

Can a Lollipop breast lift and an breast augmentation be performed in one procedure?

There are many types of breast lifts, also known as mastopexy.  A lollipop mastopexy is one of the intermediate procedures for women who do not have a significant amount of breast hang, or ptosis. The combination of breast implants at the same time as a lollipop lift is frequently done and usually results in a very nice outcome.

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Submitted by Daniel A. Sterling, MD, FACS

 Can I have a breast augmentation if I weight 70 pounds?

Depending on your height, 70 pounds may be an appropriate weight. However, if you are significantly underweight at 70 pounds due to health issues it may not be prudent to undergo an elective procedure such as breast augmentation. If however you are totally healthy and this is an ideal body weight, you are no different than any other candidate for breast augmentation. 

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Submitted by: Daniel A. Sterling, MD, FACS

Is a full C cup breast implant too large for a petite frame?

Depending upon the dimensions of your breasts as well as your chest wall, a full C cup may be fine for your frame.  The limiting factor is usually the width of the breast and the size of the breasts prior to surgery.  Very large implants can be associated with eventual breast hang and malposition, thus it is prudent to match your implants to your overall body frame.

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Submitted by: Daniel A. Sterling, MD, FACS

Do silicone breast implants cause autoimmune disorders?

Numerous studies have shown that breast implants do not cause autoimune disorders.  Thousands of breast implants were removed in previous decades due to fear of their causing autoimmune disorders.  There was no science behind this and this has been completely disproven.  Many women were caused undue emotional distress and had their implants removed for no reason. It is for this reason that the FDA has fully approved silicone implants.  They are routinely used for breast augmentation now.

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Submitted by: Daniel A. Sterling, MD, FACS

Are permanent sutures used for breast implants that have been pushed out to the side?

When implants are malpositioned, in particular are lateralized and fall into the “armpit area” revisional surgery is usually indicated.  It is for this reason that when we perform breast augmentation limited dissection laterally is performed.  If the implant needs to be moved medially (towards the stenum) because the outside portion of the pocket is too large, a closure of the capsule can be performed surgically using permanent sutures.  This is called capsulorraphy and permanent sutures are used on a routine basis for this.

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Submitted by: Daniel A. Sterling, MD, FACS

What is the largest silicone implant that can be inserted through the nipple?

Breast implants are not inserted through the nipple; however, they can be inserted through the lower part of the areola which is at the edge of the pigmented portion of the breast.  Depending upon the size of your areola, relatively large implants can be inserted through this approach.  Women with extremely small nipple areola complexes, however, are limited in the size of implant that can be inserted through this incision.  In any case, all breast incisions usually heal very well. Silicone gel implants up to 350 cc or slightly larger can be inserted through areolar incisions.

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Submitted by: Daniel A. Sterling, MD, FACS

Is it safe to combine breast augmentation revision, areola reduction and liposuction?

Depending upon the extent of the revision, it is usually safe to combine the above procedures.  If the nipple areola complex needs to be moved a significant amount, it is sometimes safer to perform this procedure in stages, the reason being that the vascularity (blood supply) of the nipple areola complex can be compromised.  This would result in possible nipple areola loss or compromise.  Pure areola reduction, however, can be combined with removal and replacement of implants on a routine basis.  Liposuction combined with breast procedures is safe and can be performed readily, provided it is not a large volume liposuction.

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Submitted by Daniel A. Sterling, MD, FACS

What can I expect in regards to scarring after breast lift surgery?

Scarring after breast lift or mastopexy (which is the technical name for a breast lift) can vary.  There are a number of different techniques that are used depending upon the severity of the ptosis, or breast hang. A crescent mastopexy is the simplest form of breast lift in which a crescent of skin is removed from the upper part of the areola. This is only skin deep and so there is no interference with the nerves and healing is usually excellent. A "lollipop" mastopexy refers to the lollipop shape of the scar with a circular scar around the areola and a vertical scar extending to the breast fold. This removes the excess skin which is very often part of the breast hang. When the incision continues into the breast fold, the lollipop mastopexy becomes an "anchor" mastopexy because of the shape the scar takes. This removes the maximum amount of skin and is effective for breast shaping.  The vast majority of women heal well and have very acceptable scars. Scars sometimes thicken and we call this hypertrophic or keloid scars.

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Submitted by Dr. Daniel A. Sterling

I have lost 70 lbs through diet and exercise. I am thrilled with the results except for the fact that I no longer have breasts. I am considering breast augmentation. After visiting your website it appears I may need a breast lift, however, want minimal scarring. Is this possible?
 

Following massive weight loss there are usually significant changes to the appearance of a woman’s breasts. The vast majority of women have loss of volume (deflation) due to the loss of fat within the breast. In most cases some type of breast lift (mastopexy) will be required to bring the nipple up to the correct position and decrease the size of the skin envelope. This will improve the contour of the breast. A breast implant may or may not be required and that can usually be determined at the time of your consultation. Regarding scars, there is a broad spectrum of the type of mastopexy that can be used but in most massive weight loss patients, the type of mastopexy required will require some scarring. Most women however are very happy with the appearance of the scars because they heal well, the breasts have a better shape and the lower part of the scar is hidden in the breast fold.

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A study of women who breast fed was published in the 2008 Sept-Oct issue of Aesthetic Plastic Surgery (28: 534) to determine which factors were the most important causing breast hang.

93 patients met the study criteria. It was found that the most important factors were higher age, increased weight, greater number of pregnancies, larger pre-pregnancy bra size and smoking, whereas breast feeding did not appear to be of importance.

It has long been thought that breast feeding does cause breast hang (mammary ptosis) and it is often for this reason that some women choose not to breast feed. This is unfortunate because it is well known that there are many health benefits to the infant who breast feeds.

Breast hang can be corrected with a breast lifting operation.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on breast lifts for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Submitted by Dr. Daniel A. Sterling

I have lost 60 pounds through diet and exercise, I now have saggy breasts.  Will breast implants help?

A loss of 60 pounds is considered massive weight loss.  It is very natural to have sagging breasts after weight loss as a significant portion of the breast is fat.  The older a woman is the more fat she has in her breasts, and thus weight loss will affect the size and shape of her breasts.  Depending upon the amount of ptosis (breast sag) a number of different approaches may be used.  Women with minimal ptosis may be candidates for augmentation mammoplasty alone.  If the degree of ptosis is more severe an augmentation is usually combined with some type of mastopexy, anything from a crescent mastopexy to a full Wise pattern (anchor) mastopexy.  A good way to judge for yourself is to gage the level of your nipple. If your nipple is at or above the level of your breast fold then usually implants alone will be sufficient.  If the nipple is significantly lower than the fold then a mastopexy is usually required in combination with the augmentation.  All of this can be determined at your initial consultation. 

Submitted by Daniel A. Sterling, MD

Breast reduction (reduction mammaplasty) and breast lift surgery (mastopexy) are similar in that both raise the nipple to the correct position and both reduce the size of the breast envelope.  The primary difference between breast reduction and breast lift  is that breast tissue is removed during a reduction while none or very little is removed during a mastopexy. 

Depending upon the severity of your breast condition, various techniques may be used with different scar configurations. The usual technique for breast reduction is an anchor incision (also known as a Wise pattern -- illustration to the right).

The usual technique for a breast lift is a lollipop incision, though at times, an anchor incision is needed.  The lollipop incision (illustration to the left) is made around the perimeter of the areola and vertically down from the areola to the breast crease. The anchor incision (illustration to the right) is made around the perimeter of the areola, vertically down from the areola to the breast crease, and horizontally along the breast crease.

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The breast lifting operation (also known as mastopexy) is a commonly performed procedure for women who have breast sag (mammary ptosis). Many types of breast lift are possible from the simplest crescent mastopexy in which a 1-2cm skin only crescent removal is done for less severe breast sag, to more complex procedures such as vertical or anchor mastopexy for more relaxation of the breasts.

Woman who have major or massive weight loss (more than 100lbs) often experience severe deflation of the breasts, resulting in the so called “empty sacs” in which the breasts consist of mostly skin, and very little underlying fat or gland. In these patients there is usually considerable downward movement of the nipples. Correction of this problem often requires a full breast lift such as an anchor mastopexy together with the insertion of breast implants to recreate the fullness of the breast. Implants can be inserted at the same time or at a later date, depending in the deformity.

Left Photo (Pre-op): 37-year-old female, 5'0", 150 lbs.
Pre-op bra size: 36C
Massive weight loss resulting in breast hang (mammary ptosis). Classic breast appearance of the massive weight loss patient.

Right Photo (Post-op): 2 months after full breast lift.

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We saw a patient recently who had moderate breast hang and wanted "cute small perky breasts." She had enough breast tissue that a full anchor mastopexy (breast lift) would have sufficed; however, she did not want the scars. She lost volume above the nipple and just wanted "small implants (about 180cc)". We explained the expected problem of the breasts hanging off the implants after the surgery (lack of integration of the implant with the breast). Even a larger implant that more adequately fills out the upper chest would have similar problems. She understood where we were going and commented: "I guess I'm trying to kill two birds with one stone!" The lights turned on for all of us!

This is a common occurrence in our practice and one that is fraught with danger and high risk for a poor outcome. A hanging breast often needs to be lifted, either in association with an augmentation mammaplasty or as a primary procedure to "set the foundation" with later delayed breast enlargement.

We settled for a small breast enlargement with crescent mastopexy, though the patient understands that a full breast lift may be needed in the future. "Cute small perky breasts" are not an option when small implants are placed in hanging breasts without a breast lift. Nevertheless, we expect that the patient will have an improved appearance, and now she has a more realistic expectation.