BREAST LIFTS Part 2 – THE SURGERY with or without implants

Blog |  Dr Eddy Dona

Wed 29th Jan 2020

A breast lift procedure simply means lifting up the breast tissue and nipple area to create a better breast shape. This can be done with or without the use of an implant.

Whether an implant is required or not, there are three types of scar patterns that can be used for breast lift surgery.

Circumareolar or “doughnut” technique  or Benelli technique – this involves a circular incision made around the areola. This technique is a minimally invasive procedure that achieves a small degree of lift. It results in a scar around the areolar and is also suitable for reducing the size of the areolar. However there is a limit to how much the areolar can be reduced as they typically tend to stretch back out again especially when implants are also used. It can also create a very flat looking breast.

Vertical or lollipop technique – this is named a lollipop because of the type of scar it leaves. It results in a scar that extends around the areola and down the midline of the breast to the lower breast fold. Although this procedure is slightly more invasive, it achieves a larger degree of lift with some slight reduction in natural breast tissue volume.

Anchor technique – involves an anchor-shaped scar that extends around the areola, down the lower midline of the breast and along the lower breast fold. This is required in those who require a significant lift and possibly need a reduction in natural breast tissue volume.

Often extra volume is required as well as a lift of the breast tissue – therefore implants are used.

When performing a breast lift with implants, the basic principle means that the surgeon must use the correct technique for that patient to ensure that the breast tissue is lifted in such a way that there is a uniform distribution of breast tissue over the implant to create a uniform breast shape.

There are a number of options available when someone needs a breast lift and also desires extra volume. These include:

First option – if a mild or borderline sagging problem exists, sometimes a good result can be achieved with an appropriately planned augmentation alone. In other words, no formal breast lift scar, just a routine augmentation scar. Of course once things have settled and if the results are not ideal, then you can still proceed with a lift at a later date.

The second option is to perform a combined breast lift and Augmentation* – The ideal candidate for this is someone who has minimal breast tissue. However, there are some technical limitations with the implant size that can be used with such an operation. Furthermore, even in the ideal candidate, I would typically quote around a 20% chance of patients requiring further surgery to “fine tune” the results. However, you would need to wait a minimum of 6 months to allow the results to settle before contemplating and planning this.

*Specialist Surgery – it is important to note that a combined breast lift with implants, otherwise known as mastopexy augmentations, is the most difficult cosmetic breast surgical procedures to perform. Therefore they should only be performed by specialist plastic surgeons that have an expertise in these cases.
However, many plastic surgeons opt to not perform this operation because of the inherent difficulties in doing it.

The third and final option for those needing a lift and wanting extra volume is to have a two staged approach – in other words, two planned operations. This typically means performing a breast lift first, and an augmentation as the second operation at a later date. There are a number of issues that I use to determine is this is the best option, however the typical patient who is offered this is someone who has a significant amount of natural breast tissue that has softened and sagged. Trying to do a lift and augment in one operation in these patients generally has a greater risk of complications and a very high chance (often greater than 50%) of requiring further surgery. That is, whilst only one combined breast lift augmentation surgery is planned, more often than not a second unplanned surgery is required to fix problems and improve the results.

Therefore, in these patients a two planned surgeries approach is preferred. The first operation is to perform a lift and create a good breast shape. The second operation, performed a minimum of 6 months after the first, is to make that new good breast shape larger with a carefully planned augmentation. However, many patients don’t proceed with this augmentation as they are just happy to have a better breast shape with the nipples sitting at a better level.

Not to confuse the issue, but some surgeons may opt to do the two stage approach in reverse – doing an augmentation first, and then performing the lift at a later date and there is nothing wrong with this approach.

Finally, many women who need a lift don’t want to pay the additional costs and/or have the scarring associated with a breast lift. Therefore, they only want an augmentation so that they have the fullness they desire in lingerie and clothing. And whilst they will not look great naked with breast tissue hanging from an implant type look, this is not a concern to them because they simply state that everyone sees them in clothing and extremely few people see them naked. Of course, if at a later date it does bother them, then they can have a formal lift then with no problems.

In Part 3 of my Breast Lift Surgery series I’ll discuss the technical aspects and reasoning behind some of the surgical decision making in more detail.