Breast Augmentation w/Lift

A good candidate for breast lift with augmentation is someone who is looking to address asymmetry and sagging in their natural breast tissue through a cosmetic procedure that combines the benefits of both breast lift surgery and the breast augmentation procedure. Ideal candidates are generally women who have experienced changes in breast volume and shape due to aging, childbirth, or significant weight loss and are seeking to restore or enhance their breast appearance. To achieve optimal results, candidates should have realistic expectations about what the surgery can accomplish and be in good overall health to undergo this transformative procedure.

Burning pain or sensation is a common part of this procedure. It is a result of the nerves that are awakening and will usually last weeks to months. The time frame is really dependent on the patient and everyone varies. After the first few weeks, it will begin to lessen, but I have had patients state as far a year out that they had an episode, although mild.

Breast implants will add volume and increase the upper pole fullness, however adding an implant, no matter how large, will not “lift” the breasts. Some patients make the mistake of going larger to avoid a lift; that is not advice that I would give. Your surgeon should be able to tell you whether you would benefit from a lift or not. Some patients are borderline for a lift and in those cases, you can have an augmentation with breast implants performed and take the wait-and-see approach. If things look good and you are happy with your results at 4 months, then you are good to go. If you feel that the nipple and areola are still too low in relation to your implants, then a lift would be warranted.

There are several different types of lifts and the crescent is the most minimal one. I just don’t consider the crescent a real lift. A crescent is good to use in certain patients like those who have one nipple/areola that is a bit lower than the opposite. In those cases, a crescent can be performed which will help with leveling the nipple/areola.

Recovery should be straightforward. There should not be significant pain, but there will be some tightness which is common. In general, I allow my patients to go back to work 3-5 days after this procedure, as long as they have a desk job. If your job requires physical activity, then the recovery period may have to be extended. Usually, most of my patients take the muscle relaxant and Tylenol for pain relief. At 4 weeks, full activity can be resumed and you may go back to sleep in any position.

All the suturing that I perform is internal and will not leave any suture marks. The incisions are dressed with a special tape that is left on for 2 weeks. After the 2 week period, we remove the tapes, and scar treatment can be started at that time. As long as you are healthy (no diabetes, no smoking) and follow all the directions we provide, then the healing process should proceed very nicely.

Pseudo ptosis is a condition when the nipple and areola are above the fold but there is a significant amount of breast tissue that is sitting below the fold. This can be addressed in several different ways. If the skin envelope is not very loose and there is not a significant amount of tissue below the fold, then a breast augmentation with a dual plane technique would work well. In the case where the pseudo-ptosis is more severe, there is more that may need to be done. In these cases, the patient will benefit from a lift, even though the nipple and areola may be in a good position. This may necessitate an incision along the crease or perhaps a lift incision (donut, vertical or full).

After breast augmentation and mastopexy, I commonly prescribe muscle relaxants and narcotic pain medication. Most patients will usually take the muscle relaxant only and will be comfortable with just that. Some others may need to supplement the muscle relaxant with Tylenol. In certain cases, patients may need to add the narcotic pain medication that is prescribed. However, most patients (if they are taking any pain medications) will not need them after the first 48 hours.

Everyone is different as is every skin type. In general, it will take 1 year for the scar to be completely healed. During this time they will change color, going from being faint to redder or darker by 4-6 months’ time, and then begin to lighten up for the remaining 6 months. The scars will never go away, but depending on the patient’s skin type, they will lighten up tremendously.

I would always recommend waiting about 4-6 months before undergoing breast revision surgery. If you feel that the nipples are still too high, then this can be addressed by performing an inferior mastopexy. This is essentially removing skin along the inframammary fold (in a crescent manner) which will help bring down the nipple/areola. It is a very powerful method and works very well to help address the high nipple/areola.

In general, I advise patients to wait for 4-6 months before undergoing any revision surgery. There is a healing process, swelling, and settling of the lift as well as breast implants that need to happen before we can say this is your final result. If the issue persists after this period, this can easily be addressed in most cases in the office under local anesthesia.

An itching and tingling sensation is usually a sign of the nerves that were disrupted at the time of surgery, beginning to awaken and starting to heal. During this time to help alleviate the sensation and discomfort that some experience, I recommend massaging the area which will help the nerves “calm” down.

I almost always perform a breast lift and breast augmentation at the same time. It can be done safely, in a cosmetically appealing result if the proper steps are taken by the surgeon. In certain cases, where a patient may have significant ptosis or has a great deal of breast tissue but wants the implanted look, I would recommend staging the procedure to get the best outcome. The breast reduction or the breast lift will be done first and then in 4-6 months, implants can be placed.

Placing larger implants to avoid the scars that are necessary is usually not a good idea. The larger implant will not raise the breast nor will it raise the low nipple/areola complex to a higher location. Conversely, the larger implant will cause premature stretch and thin out the tissues faster over time. You will have the same look that you have now but just bigger.

Commonly patients complain of burning sensation and itching of the nipple and skin. These are a result of surgery and disruption of the nerves. This is only temporary and will resolve over time. Also, patients may experience excessively dry skin which is also attributed to the disruption of the nerves that help innervate the glands that moisturize our skin on a regular basis. I always recommend good moisturizing of the skin during this temporary period.

A breast lift will not reduce the size of the breasts but it may give the appearance of a smaller breast. This is because during a breast lift, the excess skin is removed and the breast is made tighter and more compact, therefore changing the appearance from an elongated breast to one that is more compact. Also, the bra size may change, as most patients will be wearing a slightly large bra to accommodate the excess skin. A breast reduction, which commonly uses the same incisions, will reduce the breasts as well as lift them.

Loss of nipple sensitivity is a rare complication of any breast surgery, whether it is with an implant or a lift, this may happen. The rates are very low and are more in correlation with the size of the implant. Adding a breast lift does not increase your chance of loss of nipple sensation. Studies have shown that the larger the implant, the more chance of loss of nipple sensitivity. If nipple sensitivity is lost immediately after surgery, the sensation may come back but it can take up to 1-1 ½ years to return.

A breast lift alone will allow you to keep the same volume but place the nipple and areola in a better location and raise the breast mound higher up in relation to the breast tuck. To achieve a fuller upper pole, an implant will be needed. However, if an implant is placed, the outcome will be a larger breast. Some patients desire to keep the same size breast but achieve a fuller upper pole. In these cases, a smaller implant can be placed with the removal of equivalent breast tissue to help maintain the same volume but now have the implanted look.

If we are not performing a lift, then placing different sized implants would be the best option. If the patient is undergoing a breast lift, then the better option would be to reduce the larger breast and then place implants that are the same size or very close. The problem with one greatly larger implant than the other is that the breasts will age differently over time.

Every surgeon has their own postoperative recipe and recovery schedule. I generally have my patients wear a surgical bra or sports bra (something that is soft and has no wires or cups) for about 6-8 weeks. After that I allow my patients to wear a regular bra. Every patient is different and we adjust things as deemed appropriate during the follow-up visits.

A breast lift with augmentation has the same recovery as a breast augmentation only. The pain or discomfort between the two is very similar and I generally require patients 3-5 days off of work after either procedure. At 4 weeks I allow my patients to resume full activity.

During the breast lift procedure, it is common to reduce the size of the areola to a size that will fit the lifted and augmented breast. Also, we take into account the size of the nipple. If the patient has a smaller nipple then we would want to stay on the smaller side of the areola sizing. If the patient has a larger nipple, then we would obviously want a slightly larger areola. This is all done in conjunction to the patient’s request as well as the ultimate size of the desired breast.