As I continue to practice plastic surgery, I look for ways to improve the operations I have been doing for years to achieve better results. One such procedure is the breast lift (mastopexy), most often using breast implants (augmentation mastopexy). Several aspects of how I do this have evolved, and presently I think I am getting the best results I ever have.
There are three key factors for this: volume placement, advances in implant technology, and support of the breast volume.
1. Putting the Volume Where It’s Needed
Previously, when a woman wanted a breast lift and was happy with the size of her breasts, I did not suggest implants. It didn’t make sense to add volume to a breast if my patient was content with their size. However, this is no longer the case. Unless a woman is larger than she wants to be, I now recommend breast implants.
Even though no breast tissue is removed with the surgery, breasts just appear smaller after a breast lift. This is probably due to compression of the breast tissue when the lift is done.
The most important reason for using breast implants, in addition to enlarging the breast, is controlling where the breast volume is located.
The Plus/Minus Approach
In all augmentation mastopexies, I am doing a plus/minus operation when it comes to breast volume. Essentially, there is too much volume in the lower breast and not enough in the central and upper breast. To correct this, I remove some tissue from the lower central breast (minus) and then use a somewhat larger breast implant, which ends up putting more volume in the central and upper breast (plus).
The key for me to understand is what size a woman wants to achieve – the baseline implant volume – and the amount of tissue I will remove from the breast. The sum of these volumes will be the approximate implant volume to be used.
This plus/minus approach redistributes the breast volume to where it is needed for better results.
2. Better Breast Implants
Allergan’s new Soft Touch Silicone implants have a more cohesive gel and are definitely my go-to implants for breast lifts. These implants tend to have less collapse of the upper part of the implant when they are upright, compared to the regular (Inspira) gel implants. Thus they help enhance the upper breast fullness giving more volume where it is wanted.
3. Newer Technique For Breast Support
The other very important advance I’ve made is that the way I am removing the breast tissue allows me to better reconstruct and support the breast volume. In doing a breast lift, I remove a wedge of tissue (like an inverted “V”) from between the lower aspect of the nipple-areolar complex and the bottom border of the breast (the inframammary fold). In doing this, I am removing both skin and breast tissue. When I repair this (once the implant is placed), I am tightly reconstructing the lower breast tissue. Thus tissue is removed from where it is unwanted, and the repair of the lower breast gives better support to the remaining breast tissue and breast implant.
Better Results Even Without Implants
Approaching the augmentation mastopexy in this manner has resulted in a better-looking breast from the start, and the shape is better maintained over time. I can also adapt this technique to someone who does not want implants and wishes to maintain as much volume as possible. In these women, instead of discarding the lower breast tissue, it is moved into the upper breast to “auto-augment” the breast.
These techniques can be altered somewhat for women who have a great deal of sagging of their breasts and are larger than they desire. But the goal remains to put the breast volume where it is needed and then support it with the repair of the lower breast tissue.
I must always add a bit of a disclaimer here. A woman’s breasts will always look fuller in the upper part of the breast when a bra is being worn. This is natural and is inherently part of an attractive breast. The other thing is that gravity is always at work and can change everything. Wearing good support in a bra most of the time is crucial in maintain breast shape over time.
One of the great things about plastic surgery and plastic surgeons is that we are always students of our profession. We are always trying to learn new ways to make what we do better and to give our patients the best outcomes possible. If we do this right, we will continue to improve up to the last time we walk out of the operating room.
All the best,
David B Reath, MD
By the way, if you or one of your friends are wanting to learn more about breast augmentation, our staff has written an informative and entertaining 42-page eBook called A Girlfriend’s Guide to Breast Augmentation. It’s a free download, so you might want to check it out.
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