BANFF PLASTIC SURGERY
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Is Mastopexy-Augmentation Right for You?

A breast lift (mastopexy) can give you a more youthful silhouette and the confidence to match. Often a mastopexy alone will give our patients a good result, but if your breasts are too small or if there is a significant loss of fullness in the upper part of your breast, then the addition of an implant may be needed. You may also like your breast size but want to improve their shape by correcting the sagging and improving the emptiness in the top half of your breast.

 

Introduction

Women looking for ways to enhance the appearance of their breasts have a number of options available to them today. We take care to understand your desires and explain the differences between what an augmentation alone would achieve, what a mastopexy (lift) alone would achieve, and when an implant is needed to enhance the mastopexy results. Our patients often choose a breast lift when they are bothered by drooping, sagging breasts that affect their confidence and prevent them from wearing certain types of clothing. Dr. Hall-Findlay has provided Banff Plastic Surgery patients with breast lift procedures, with and without implants, for more than three decades.

Dr. Hall-Findlay is known around the world for her modifications of the vertical breast reduction procedure and she has adapted this method, often called the “Hall-Findlay” technique, to the breast lift – with and without implants. She gives teaching courses on all aspects of aesthetic breast surgery numerous times throughout the year and she has performed surgery for demonstration purposes worldwide.

This method not only uses shorter lollipop–shaped scars rather than anchor scars, but it also gives a better shape with more projection and has a more long-lasting shape which avoids bottoming-out with time.

 

The Right Procedure

If you like your breast shape but just want it filled, then an augmentation alone will help. If you don’t like the sagging of your breast then a breast lift (mastopexy) alone will help. But if you wish to have your breasts both filled and lifted, then a mastopexy-augmentation may be the better choice.

When a woman wants a correction of the sagging as well as improvement in the fullness of the upper pole of the breast, then an implant is needed as well as the mastopexy. Her breast size can then be adjusted according to her wishes. In larger-breasted women, we may recommend a reduction-augmentation (minus-plus procedure) that removes tissue in the lower portion of the breast and uses an implant to add fullness to the upper part. We can also add liposuction in the area in front of the armpits and along the sides of the breast to enhance the breast shape.

 

The Right Patient

The best candidate for breast uplift surgery is a woman who is close to her ideal body weight, healthy, and a non-smoker. You must quit smoking before your surgery, because nicotine can interfere with blood supply and the healing process. It is important to have realistic expectations of the results that we can achieve with uplift surgery, either with or without implants. Some women are hoping for a “double push-up bra” look which can’t realistically be achieved with surgery. Some scarring is inevitable, but we will carefully place incisions to minimize visible scarring.

 

The Right Reasons

Many of our mastopexy-augmentation patients feel that their breasts are both deflated and sagging. They are tired of feeling like they always need to wear a bra due to breast sagging, and they feel that there is a gap between their breasts and their bra even with a push-up. A lift combined with an implant can help if there is a ski jump shape, skin wrinkling, or an empty area in the upper pole of the breast.

Many of our patients don’t want to accept the breast changes that can come with aging and weight changes, and they feel that it’s time to invest in themselves. Your newly positioned breasts may take time to settle, but the lollipop technique that we use gives the best results with improved projection and perkiness.

 

The Right Time

Being in good health, both physically and mentally, is essential for optimal results, and it may be appropriate to wait. Your own schedule is an important consideration as well. While recovery from a breast uplift is surprisingly easy, you will need time off to heal after surgery. It takes one to two weeks to get back to normal activities and three to four weeks to return to a more active lifestyle. Patients with small children often worry about lifting them or being hit or kicked. Fortunately, while lifting may be uncomfortable, it won’t damage your results.

Let us answer your questions

Educational Video

Mastopexy-Augmentation FAQ

Can mastopexy and augmentation be done at the same time or do I need 2 stages?

We commonly offer breast lift and augmentation at the same time. The combination is more complex than either operation alone, but many women benefit from the addition of an implant at the same time as mastopexy. Although we understand the concern expressed by other plastic surgeons, our experience has shown that the procedures are safe and effective when performed together. Some women aren’t sure whether they want an implant or not, and in that case, we suggest starting with the lift alone. If more volume is desired, an implant can be added later on for a limited fee.

How can I decide if I need mastopexy alone or with implant?

Mastopexy alone, without implant, is a good option for women who have some sagging or deflation, but who still have a fairly significant amount of breast tissue that can be rearranged. When a woman has a breast lift without implants, her breasts may end up looking slightly smaller than before, even if no tissue is removed. This is because we are rearranging the breast tissue into a smaller area and making the skin envelope smaller. We can improve shape and projection with mastopexy alone, but we can’t realistically offer significantly improved upper breast fullness without adding an implant.

For women who desire a lift but have very little breast tissue or would like to have more fullness in the upper part of the breast, an implant is often added.

Will mastopexy-augmentation interfere with breastfeeding?

Breast lift is done with the goal of reshaping the breast, but preserving its function. The nipple is left attached to the underlying tissue. Every attempt is made to preserve breastfeeding ability and nipple sensation, but some women are unable to breastfeed even without having breast surgery.

Should I wait until after pregnancy to have a lift and augmentation?

Pregnancy and breastfeeding can change breast size, shape, and consistency. While there is no medical contraindication to pregnancy after cosmetic breast surgery, if you plan to have babies in the next 1-2 years, it may be better for you to wait until after you are finished having children so that your result will be more stable.

What are the potential complications associated with mastopexy-augmentation?

As with any surgery, bleeding and infection are concerns, but happen infrequently. Difficulty breastfeeding and loss of nipple sensation are also concerns that we discuss with our patients. Scars can be raised, red, or itchy, and it can be challenging to get symmetry between the two breasts. Breasts will always change shape and re-droop to some extent with time, so it is important to have realistic expectations.

What types of breast implants are available?

Women considering breast augmentation can choose between saline-filled and silicone gel-filled implants, each with a silicone shell. Silicone is a natural element that is used safely in many different medical devices. Both types of implants have been approved by Health Canada as safe options for women undergoing cosmetic or reconstructive breast surgery.
Breast implants are available with both smooth and textured surfaces. The sizes available range from 100 to 800 ccs, and implants can be round or “anatomic” (teardrop shaped). Taking into account the risk-benefit ratio of each type of implant, we most commonly recommend smooth, round cohesive gel implants for breast augmentation, although we have access to the other options as well, and will tailor our approach to your particular goals.

Which is better, over or under the muscle?

Breast implants can be placed either behind the breast tissue (subglandular), or behind both breast tissue and muscle (submuscular, subpectoral, dual plane). Because the pectoralis major ends at the level of the nipple, most submuscular implants are actually only partially covered by muscle, and the lower half to two-thirds of the implant is actually subglandular.

We offer both approaches and have found that the lower incidence of rippling with today’s cohesive gel implants has allowed successful subglandular placement in many of our patients. The advantages of subglandular placement include less pain postoperatively, and avoidance of “animation,“ where the breast implants move in an unnatural way when you flex your chest muscles.  If you are very thin or have minimal padding in the chest area, you may choose to place your implants partially under the muscle instead. This may give you a more natural upper slope of the breast, due to the additional padding of the muscle, but wider cleavage and implant movement with muscle contraction can be downsides.

What is breast “footprint”?

Footprint is the term we use to describe the level at which your breasts are attached to your chest wall. Some women have a high footprint (”high breasted”) and a relatively short distance between the collarbone and the upper border of the breast. Other women have breasts that start out much lower on the chest wall (“low breasted”) with a longer distance between the collarbone and the upper border of the breast. We cannot move the breast higher up on the chest wall, we can only alter your breast shape within its already existing footprint. The addition of a breast implant will raise the upper breast border by about 2cm on average, and this may make a low footprint look slightly higher. Otherwise, your existing breast footprint and shape will be similar to what you had before augmentation, but filled out and fuller, with the implant centred behind the nipple.

Where is breast mastopexy-augmentation done?

Most cosmetic breast surgery is done under general anesthesia in our fully accredited office operating suite. Women sometimes wonder if it is safe to have surgery in an office-based facility. Dr. Hall-Findlay chaired the committee that set the standards, guidelines and accreditation systems for all outpatient surgical facilities in Alberta. Our facilities are state of the art when it comes to safety, staff training, and equipment.

Some patients may also be offered surgery at the Banff Mineral Springs Hospital, where overnight stays are arranged when necessary.

Do breast implants need to be replaced after 10 years?

Just like your favourite jeans, breast implants will wear with time and may need replacement. There is no specific timeframe during which replacement is necessary, but problems with implants can develop over time. Mammograms are not very reliable for imaging breast implant problems, and we may not know for sure if there is a rupture unless we go back to surgery. Cohesive gel tends to stay in the implant pocket like firm Jello, even if the implant shell breaks. Ruptured implants can be removed or replaced, depending upon the individual situation.

What is capsular contracture?

When any medical device is implanted, our body forms a thin layer of tissue around it to “wall it off.” This thin layer of tissue is called a “capsule.” In some women, for reasons we don’t completely understand, the capsule can become thicker or tighter, making the implant feel firmer than it should. Tight capsules can even become painful with time. Capsular contracture can occur at any time after breast augmentation, not just in the early postoperative period. We can decrease its incidence by avoiding bleeding, powdered gloves, and infection, but sometimes capsular contracture occurs despite our best efforts. Repeat surgery can sometimes help.

Are breast lift results permanent?

Your breasts will continue to age over time, and you may, over time, notice that your breasts are drooping again to a lesser extent. We like to follow patients over the course of many years, and find that vertical mastopexy has better predictable staying power than many other techniques.