Augmentation Mastopexy is a procedure that combines a breast uplift procedure with breast implants.

When is there a need to combine a breast uplift procedure with implants?

Augmentation Mastopexy is the ideal procedure for those women who are looking to increase breast volume but also address concerns with breast droopiness. It is a relatively complex breast operation, which aims to totally reshape the breast. The implants are used to enhance the volume, whilst the breast lift allows repositioning the breast tissue and nippe-areola complex into a higher position, as well as removing the excess skin.

It is not uncommon for me to recommend this procedure to my patients who have initially enquired about either a breast augmentation or a breast lift on it’s own, if the above applies.

For women seeking a breast augmentation, why would an uplift be necessary?

Female breasts, like any other tissue part in the body, are subject to the ageing process. In women who have had children, have breastfed, or have lost a significant amount of weight, this process can be accelerated. Over time, these changes lead to sagging of the breasts - also known as ptosis. The nipple along with the majority of the breast tissue gradually drops below the level of the breast fold, leaving the ‘upper pole’ (upper half) empty.

Ptosis is then further compounded by a loss of breast volume and excess skin. This loss of volume gives the appearance of a “deflated” breast with a variable amount of excess skin due to the loss of elasticity that comes with aging, and the inability of the skin to contract again.

1. Normal ____2. Mild _____3. Moderate ___4. SevereCLASSIFICATION OF BREAST PTOSIS — 1. Normal ____2. Mild _____3. Moderate ___4. Severe
**CLASSIFICATION OF BREAST PTOSIS**

How much ptosis is too much for implant only surgery?

In some cases, where either the breasts size is relatively small or the degree of ptosis is mild (nipple sitting at the level of the breast fold), it is possible to achieve a satisfactory result by using an implant only without an uplift. For this purpose, a breast augmentation technique called “dual plane” is used. This technique consists of placing the implant in a pocket partially under the muscle, as well as disattaching the breast tissue from the underlying muscle, up to a level above the nipple (dual plane type 3). With this manoeuvre a small lift of the breast tissue and nipple can be achieved.

This technique however, is not suitable for breasts in which the nipple has dropped below the level of the breast fold. In cases of moderate to significant breast ptosis an augmentation on it’s own will give a temporary lifting effect, however the breast tissue will soon drop and fall over the implant. This effect will create a specific deformity know as the “waterfall” effect or “snoopy” breast deformity. This is unfortunately an unsatisfactory distortion, which will get worse relatively quickly and can only be corrected with revisional surgery.

Snoopy / waterfall deformity. The breast tissue (yellow) has dropped over the implant (white), which is held under the muscle (red layer). — **Snoopy / waterfall deformity.** The breast tissue (yellow) has dropped over the implant (white), which is held under the muscle (red layer).

As a rule of thumb, any augmentation performed in cases of moderate or significant ptosis (the nipple and the majority of the breast tissue sits below the inframammary fold), will require an additional uplift procedure. The mastopexy will remove the excess skin, tighten the breast tissue around the implant with lifting of the nipple, and overall provide a better structure for the new breast.

What are the scars like with an Augmentation Mastopexy?

A mastopexy is performed by introducing additional scars on the breast, which can be one of three types illustrated below.

The “donut” or circumareolar (scar around the nipple only), the “lollipop” or vertical ( around the nipple and vertical line only), and the “anchor”, also known as inverted “T” or wise pattern (around the nipple, vertical line, and horizontal line in the fold).

This scar choice will depend on the amount of excess skin and the degree of nipple lift required. Although the donut mastopexy gives the smallest amount of scarring, it is only indicated for a small degree of nipple elevation. Additionally, it carries the risk of a stretched nipple with a poor quality scar.

see our before & after gallery

When do I need an implant if I want a breast lift?

Traditionally in cases where there is a degree of breast ptosis with excess skin, but the breast has maintained a significant amount of volume, an uplift (mastopexy) procedure on it’s own can be sufficient. Click here to learn more about Breast Lift without implants.

However, for women who want to increase breast volume, or in those with severely ptotic breasts looking for a fuller upper pole and better structure, then a combination of uplift with implants should be considered.

The need or not for added volume can be determined by answering the following simple question; Is the patient happy with their breast volume when wearing a non-padded bra?

If the answer is no, then additional volume is required. This is usually provided by an implant. If only a small amount of additional volume is desirable and/or the patient wants to avoid implants, then we can use the patient’s own fat, a procedure known as fat grafting.

Fat grafting can be performed at the same time with the uplift and involves harvest of fat from one area through liposuction. This fat then is processed and transferred to the breast. The limitation of fat grafting is that only a small amount of augmentation can be achieved in one procedure -usually no more than 150 cc for each breast. Additional fat grafting procedures may be required to achieve higher volumes. Moreover, fat grafting is unlikely to achieve a “perky” look with upper pole fullness.

To learn more about fat grafting click here.

In order to determine the volume required to achieve the desired results, Mr Orfaniotis is using Crisalix 3D Simulation technology. During your consultation you will be able to see a simulation of your uplift result, the simulated scars and also try different sizes and types of implants. You can learn more about Crisalix and the 3D simulation process by clicking here.

The second indication for use of breast implants in patients considering a mastopexy procedure is for those women with severely ptotic breasts, who are looking for breast fullness in the upper pole (the upper half) of the breast. In the severely ptotic breasts an uplift procedure on its own is unlikely to achieve and maintain a full upper pole in the long term .

Even in the most experienced hands, the breast tissue which has been repositioned higher will not resist gravity and stretching and will eventually start to drop, sometimes as early as few months after surgery. This is in part due to the ageing process of the tissue as mentioned above, and the loss of elastin and structure in the skin and breast tissue. In these cases a small to moderate size implant can enhance the upper pole and provide a better structure for the uplifted breast tissue that can last longer.

You can read more about breast implants and their complications by clicking here.

Augmentation Mastopexy Details.

- Duration: 2.5 -3 hours.

- Anaesthetic: GA (fully asleep)

- Length of stay: Day case - Home the same day. Overnight stay can be offered.

- Drains: No drains

- Recovery: Return to work after 2 weeks, resume full activity after 6 weeks

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