When it comes to creating the “beautiful breast” through surgery, Eugene, OR plastic surgeon Mark Jewell, MD says one way to achieve the best result is through a lesser-known option called augmentation mastopexy—otherwise known as a combination lift breast-implant procedure.
“The typical ‘Masto-BAM’ or mastopexy and breast augmentation patient is on the more mature side,” explains Pasadena, CA plastic surgeon Lily Lee, MD. “They’ve lived long enough to have broken down their breast skin and lost volume in the actual breast tissue. Of course, there are exceptions, as I have seen the rare young woman, who has never been pregnant or breastfed, who has developed genetically smaller breasts that are droopy.’
Dr. Lee also points out that this particular procedure is really two surgeries in one and, similarly, it accomplishes two things: “First, it gives the breast more volume through augmentation with implants, and second, it creates a skin envelope that fits perfectly around from the new volume.”
New York City plastic surgeon Daniel Y. Maman, MD agrees, and says that, typically, the woman he sees as a candidate has both breast prolapse (dropping and sagging of the skin) and deflation (loss of breast volume). “A lift alone provides insufficient volume and projection to the breast, and having an implant alone fails to address skin sagging and sagging.”
It’s a significant reduction in breast size—mostly due to pregnancy or weight loss—that plastic surgeon George Sanders, MD, Encino, CA, says is usually what prompts a patient to seek this particular surgery. “They have less breast tissue and more skin, creating a deflated look. When the person wears a bra to simulate a self-lift, the breasts lift, but the bra appears empty. On the other hand, placing a large breast implant without a lift produces a larger but still loose breast, which is a bad result. The best option is a combination of lifting and implant insertion.”
“Everyone ages at different rates, and some women have more laxity and tightness than others,” explains La Jolla, CA plastic surgeon Robert Singer, MD, adding that despite manufacturers’ and marketers’ claims, there are no nonsurgical procedures that will lift up and improve the aesthetic appearance of a sagging breast. “You can choose to do nothing, have a variation of a lift alone [Donut, lollipop, anchor shape], only get implants – which will not lift the breast sufficiently when there is significant sagging, regardless of size, and will not produce a good cosmetic result in a patient who also needs some variation of a lift – get a lift with implants and then there is also the option lift, implants and fat. Whatever you choose, you need to be realistic with the results for each, as each produces different degrees of aesthetic improvement.”
Part of that reality, says Dr. Singer, is that there is scarring associated with this surgery, as well as the potential for decreased sensation that can occur with any breast surgery. “Like most surgeries, you should follow your surgeon’s instructions closely both before and after surgery, as there is healing involved.”
Also, Dr. Maman emphasizes, augmentation-mastopexy is the most complicated type of breast aesthetic surgery. His advice: “Make sure you choose a surgeon who does this all the time and can show you before and after photos of patients who look similar to you.”
“The combined operation is technically more difficult for the surgeon, but produces a superior result,” says Dr. Saunders. “The recovery period is a bit longer, and the patient must have periodic MRIs or high-resolution ultrasounds to monitor the implants—but the results outweigh these drawbacks for most patients.”
Reno, NV plastic surgeon Tiffany McCormack, MD agrees, “I find that a breast lift with implants can be a very rewarding procedure as that lump is restored and the breast tissue can mold around that lump in a better way. chest position. A breast lift with implants is a more complex surgery than stand-alone implants or a stand-alone lift. On the one hand, you add volume with an implant. On the other hand, you remove tissue to then close around the added bulk. If there is a significant amount of tissue to remove due to the degree of prolapse and very thin tissue, then your surgeon may choose to stage the procedures for a safer, better result. However, in most cases, these procedures can be safely combined.”
In addition, says Dr. Jewell, there are some more recent developments in the field that he has found work particularly well: “My preferred technique is to use the newer generation gel implants with high fill with the medium consistency gel to achieve upper breast roundness,” he says, adding that , in addition, places the implants in the retromaxillary subfascial position. “This allows the implant and breast tissue to remain attached to each other and cause a ‘waterfall deformity’ where the breast tissue falls off the submuscular implant.”
“Looking at the many patients in my practice who have ever had this surgery, I have not had one who regrets having the combined procedure,” assures Dr. Singer.
