Breast augmentation remains one of the most frequently performed cosmetic plastic surgery procedures. The question of when to incorporate a breast lift is often discussed during the initial consultation appointment. The combination of a breast lift with breast augmentation is termed augmentation mastopexy. The word augmentation indicates that we a enlarging the breasts, while the word mastopexy means breast lift.
Breast lifts are indicated when the breast sags past the fold under the breast. This fold is called the inframammary fold or IMF for short. Breast lifts are also performed to reposition the nipple higher on the breast. Usually raising both the nipple and the breast are needed.
For breast that have always been small, there is less sagging, and a breast lift is not usually necessary. If the breasts have deflated, but have not dropped, then breast augmentation alone is usually be enough. When the nipples are above the IMF, and the breast tissue is below the IMF this is termed pseudoptosis, or fake sagging. If the goal is to increase the bust size, pseudoptosis can often be corrected with breast augmentation alone.
When there is true sagging, coupled with a desire to increase the size of the breast, then the combination of a breast lift with breast implants is one of the most useful combinations available. The series of videos that follow discuss breast augmentation and breast lifts. There are many variations and combinations of the procedures, so the information here is kept in general terms.
This is segment one of four from a recent airing of KRON’s Body Beautiful with Vicki Liviakis. The 800 number shown was for the live broadcast, so if you have questions please call my office directly at (925) 943-6353, or use the contact form to the left. Additional information can also be obtained from the links at the end of this article.
This episode includes:
Breast Augmentation vs. Breast Lift or the combination Augmentation Mastopexy.
When is Breast Augmentation alone enough?
What causes the breasts to sag (Breast Ptosis)?
How do plastic surgeons define breast ptosis (sagging)?
What is corrected with a Breast Lift (Mastopexy)?
How does a Breast Lift affect nipple position?
How does a Breast Lift affect the breast mound?
How does a Breast Lift affect the breast skin?
How is Breast Augmentation performed?
What is the recovery after a Breast Lift?
What is the recovery after a Breast Augmentation?
Breast feeding after Breast Augmentation and Breast Lifts.
If you are interested in learning what specific treatment will work best for you, a personal consultation appointment would be the best way to find out. A Board Certified Plastic Surgeon can help define your goals and tailor the treatment to best achieve the results you desire. To schedule your consultation, please call (925) 943-6353.
Additional information on Breast Augmentation and Breast Lifts can be found here:
Dr. Joseph Mele appears on the Bay Area's News Channel, KRON4's Body Beautiful
Thank You
Thank you Bay Area plastic surgery patients, for a great show yesterday. We discussed breast augmentation, breast lifts, breast reduction and combinations of all the above. For anyone who missed the show, and is interested in seeing the broadcast, I will be posting it here in the San Francisco Plastic Surgery Blog very soon.
KRON4′s Body Beautiful
Body Beautiful is a live show that allows you to call in with your questions. Unfortunately, it was not possible to answer everyone’s questions in half an hour. However, you can always send me your question by using the contact form found in the lower left corner of this page.
Breast Lift Before and After Pictures
Several pictures where used to illustrate the results possible with Breast Augmentation (Mammaplasty) , Breast Lift (Mastopexy) and Breast Augmentation Lift (Augmentation Mastopexy). While censored for television, the breast augmentation before and after pictures demonstrated the natural fullness that can be achieved with a breast implant. The breast lift before and after pictures showed how the breast and nipple are lifted with the mastopexy. The two procedures can also be combined and the breast augmentation mastopexy, or breast augmentation lift. The breast augmentation mastopexy before and after pictures show what the procedures can achieve when performed together.
Breast Lifts not only lift the breast, but also reposition the nipple. Since the nipple and areola on the before and after pictures have to be censored for the breast lift video segment shown on network television, some of the details are lost. I will show you here, what I cannot broadcast on television.
Before Breast Lift with Breast Reduction: Notice the nipple position. When the nipple is located at the bottom of the breast, this is classified as Grade III ptosis. The breast mound is below the inframammary fold (IMF), and overlies the upper abdomen
After Breast Lift with Breast Reduction: The nipple and breast are now perky. The breast has been moved up onto the chest, and the nipple has been moved up on the breast. Can you find the freckle just above the nipple over in the before picture?
What Can a Breast Lift Do?
The above, breast lift with breast reduction before and after pictures, show what a lift can achieve. The breast has been lifted off the upper abdomen and placed back onto the chest. Since breast reduction was also performed, some breast volume was reduced. Reducing breast volume is not required to achieve a breast lift. A breast lift can be done with breast augmentation to add volume, with breast reduction to reduce volume or by itself when the breast volume is fine.
The pictures show that the nipple has been lifted from its dependent position at the bottom of the breast, to the point that is most anterior. The nipple was at elbow level before the lift, afterward the nipple is at the midpoint of the upper arm. Before the mastopexy the breast look old, sad and tired, afterward, the breasts appear young and perky.
Another measure of how for the nipple has moved is demonstrated by the freckle that is just above the nipple after the lift. The same freckle can be seen (more faintly) in the before picture, near the center of the chest, on the upper breast mound, about half way between the nipple and the collar bone. This shows not only how far the nipple has moved, but also how much breast tissue has been moved up under the skin. Even the cleavage has been moved up on the chest, and this is with volume reduction. Upper pole fullness can be further enhanced with the use of a breast implant.
Many Types of Breast Lifts are Available
The lift used above is an inverted-T mastopexy. This is also called the keyhole lift or anchor lift, and is the biggest lift performed. In the after picture the scar can be seen. It runs around in a circle around the nipple, from the nipple down to the base of the breast, and along the bottom of the breast in the inframammary fold (IMF). The vertical incision and the incision around the areola allow for the repositioning of the nipple higher on the breast. The periareolar (around the areola) incision also allows for reduction of the areola’s diameter if desired. The horizontal incision, in the IMF at the base of the breast, allows the breast mound to be moved upwards and reduces the skin in the lower breast to help support the breast tissue up.
Many types of breast lifts are available. My goal is to always choose the smallest lift that will give us the results we desire. In this case, this is the biggest lift available. While there is more scar length, the quality of the lift, and the control achieved, makes the result worthwhile. Not only is the breast rejuvenated in appearance, but the reduction of breast skin also firms the breasts, resulting in less pendulous breast movement and more patient comfort when physically active.
More Information on Breast Augmentation, Breast Lifts and Breast Reduction
Click on any of the following links for more information on the topic covered in this post courtesy of DrMele.com:
Dr. Joseph Mele appears on KRON4's Body Beautiful.
Write down all your questions about Breast Lift San Francisco and Breast Augmentation Bay Area. Board Certified Plastic Surgeon, and breast enhancement expert, Dr. Joseph Mele, will be answering questions regarding cosmetic breast enhancement, live, on Channel 4, this Monday.
Back by popular demand, Dr. Joseph Mele will be the guest on San Francisco KRON4′s Body Beautiful. Hosted by Vicki Liviakis, Body Beautiful shows you the latest trends and treatments in cosmetic surgery. Bay Area residents can call in, and have their questions answered live, on Monday, September 20, 2010, between 11:00 and 11:30 AM.
A special 800 number will be displayed during the program. If you have plastic surgery questions, call in and ask Dr. Mele. If you are not available Monday at 11 AM, email your question and TiVo the answer. (EDIT: This show has aired, but you can still ask me questions by using the contact form on the lower left of this page, click here, or call (925) 943-6353.)
Please join us. This week’s show will focus on the most popular breast enhancing procedures: Breast Augmentation, Breast Lifts and the combination Breast Augmentation Mastopexy. Questions can also be submitted off air, at any time, by using the contact form on this page (in the lower left corner).
Whether you are considering breast enhancement, or already have breast implants, this video discusses the most frequent reasons why corrective surgery is needed and includes before and after pictures and live viewer questions.
This is part two of two from an episode of KRON 4′s Body Beautiful with Vicki Liviakis that aired last month. This video discusses breast augmentation revision surgery, including before and after pictures and viewer questions.
Specific examples are shown. The first patient (shown below) had breast augmentation in her twenties. Years later, she had children and was not happy with the changes in her breast resulting from pregnancy and breast feeding. Before and after breast augmentation revision surgery pictures are shown. In her case a breast implant exchange and breast lift and were performed to adjust for lost volume and improve the shape of the sagging breasts.
A different patient had breast implant bottoming out. In her case the implants had fallen below the inframammary fold leaving the nipples high and flattening out the normal curve beneath the breast. Corrective beast augmentation surgery included breast implant implant exchange to adjust the volume, and the inframammary fold was reconstructed internally to raise the implant and form a distinct curve beneath the breast.
The caller in this video had a question about ruptured silicone gel implants that were placed in the 1970′s. If any breast implant has ruptured, it needs to be removed. Most frequently, a ruptured breast implant is replaced at the same operation. Silicone gel implants in particular should be removed sooner than later. A ruptured silicone gel implant, over time, can cause increased scarring and hardening of the breasts, as the body tries to wall off the free gel. If not treated promptly, this type of scarring can lead to further problems than may not be correctable.
Silicone gel filled implants placed before 1985 seem to have a higher deflation rate than the new silicone breast implants. In fact, the outer shell of silicone breast implants has changed twice since the 70′s. The first change, in the mid 80′s, was to decrease the rupture rate. The second change, in the mid 90′s, was to reduce gel bleed (the ability of the silicone gel to leak through outer shell without a rupture). Both US FDA approved breast implant manufactures, Allergan and Mentor, offer lifetime replacement of their implants should they fail, and often provide financial support should this occur within ten years of your breast augmentation procedure. For details of the Mentor and Allergan (Natrelle) Breast Implant Warranties click on the manufactures names. It is best to get the information direct from the manufacturer; however, the Mentor site has been going through some changes, perhaps with the merger with Johnson & Johnson, so if you can’t link there, JustBreastImplants.com also has information on breast implant warranties.
Walnut Creek Plastic Surgeon (San Francisco Bay Area, East Bay) Joseph A. Mele, III, MD, FACS, will be appearing on KRON channel 4′s, Body Beautiful this Monday, September 14, 2009, at 11:00 AM.
KRON4′s Body Beautiful, is a weekly news show hosted by News Anchor Vivki Liviakis. It originates right here in San Francisco and is know through out the Bay Area for its coverage of the lastest trends in cosmetic plastic surgery.
This week’s topic will be breast augmentation, specifically breast implant revision surgery. Information about breast augmentation and the most common reasons for breast implant revision will be presented. Topics will include, choosing the best breast implant size, breast implant deflation, capsular contracture, dealing with breast asymmetry, and how to decrease your risk of needing breast augmentation revision surgery.
If you have questions that you would like me to answer on air, please send them via the contact form on this page. Please do mention that you would like me to answer your question on Body Beautiful, otherwise all inquiries are kept confidential. Alternatively, you can send your questions directly to KRON4 via the Body Beautiful web page. You can also phone into the studio while we are on the air, and get your questions answered live.
Previous shows discussing breast augmentation, tummy tucks, liposuction, eyelids surgery and many other cosmetic plastic surgery procedures can be found on my website in the DrMele.com Video Gallery
A unique aspect of Body Beautiful is it live broadcast live. Broadcasting live allows for more a more dynamic and interactive presentation. A segment of the show will be dedicated to viewer questions. So be sure to call in.
Breast asymmetry is more the rule than the exception, and there are many ways in which breasts can be uneven. Size, shape and location all come into play. Asymmetry may effect the entire breast mound (see previous post) or just the nipples. Normally, the differences are small; however, as the magnitude of breast asymmetry increases, so does the desire for correction.
In my San Francisco Bay Area (Walnut Creek) cosmetic plastic surgery practice, I measure the differences between the breasts both subjectively and objectively every day. Small differences frequently go unnoticed. Often, asymmetry is first noted in the consultation for breast augmentation. When the difference is obvious, however, breast asymmetry can be the driving force toward seeking consultation with a Board Certified Plastic Surgeon.
This post is focussed primarily on areola asymmetry (the darker skin around the nipple) and nipple asymmetry (the raised part in the middle). Look for a post on breast asymmetry (the breast mound itself), including breast implant asymmetry, in the very near future.
One of the most common nipple asymmetries is caused by inversion (retraction) of the nipples. Inverted nipples can occur on one or both sides. Inverted nipples and even bifid (split or duplicated) nipples can be treated with minor surgery.
Before correction the nipple and part of the areola are hidden.
Inverted nipples are caused by short mammary ducts that pull the nipple inside the breast tissue. In the most pronounced forms even the areola maybe hidden. The scar for inverted nipple correction is normally hidden in the fold beneath the nipple. Since correction involves releasing the tight ducts, correction may interfere with the ability to breast feed, and this should be discussed with your plastic surgeon prior to surgery.
After correction the relatively large nipple can now be seen.
The size and shape of the nipple can also be adjusted.
Close-up of breast showing appearance of nipple enlargement after pregnancy.
Overly large nipples can be reduced in length and girth. In general, it is easier to reduce a large nipple than to enlarge a small one. Nipple reconstruction is performed after a mastectomy when the nipple is absent. With nipple reconstruction, especially when the breast has received radiation, the most difficult aspect is creating and maintaining nipple projection.
Close-up of breast showing appearance of nipple after nipple reduction.
There are times when the nipples are normally formed, but their location on the breast is asymmetric or they are just too low. Modest changes in nipple location can be improved with a periareolar approach. Several centimeters of motion can be safely accomplished with this method. The same periareolar technique can also be used for areolar reduction or to correct the overly full areola, as seen with a tubular breast deformity.
Larger asymmetries may require surgery similar to a breast lift. Formal breast lifts allow the larger movement of the nipples, and reshaping of the entire breast mound. See the previous San Francisco Plastic Surgery Blog posting by clicking here Breast Mound Asymmetry San Francisco: Breast Mound, Breast Implants. There are many types of lifts, and each has its own pros and cons. The art of Plastic Surgery is choosing the best approach for each individual San Francisco breast asymmetry patient. This will be the topic of a future posting.
There are many ways in which breasts can be uneven. Size, shape and location are the most common. There can be asymmetry of the nipples as discussed in Breast Asymmetry San Francisco: Inverted Nipples and Asymmetry, or asymmetry of the breast mounds themselves discussed here. If the differences are small, everything appears normal; however, as the magnitude of asymmetry increases, so does the desire for correction.
There are times when the nipples are normally formed, but their location on the breast is asymmetric or low. This post will discuss breast mound asymmetry, including breast implant asymmetry and nipple location.
Modest changes in nipple location can be improved with a periareolar approach. In these cases an incision is made around the areola and differing amounts of skin are removed to move the nipple and areola in the desired direction. Several centimeters of motion can be safely accomplished with this method.
The same periareolar technique can also be used for areolar reduction. When the areola is too large, it be reduced to better match the proportions of the breast. The periareolar technique can also correct the overly full areola, as seen with a tubular breast deformity.
Larger asymmetries, require greater movement of nipple areola, and are accomplished with surgery similar to a breast lift.
Before breast augmentation and formal breast lift. Note the asymmetries. On left side (patient's right) both the breast mound and the nipple areola complex are larger and lower.
Formal breast lifts are also know as inferior pedicle breast lifts, inverted-T breast breast lifts or anchor scar breast lifts. This is the most versatile of the breast lift and allows for the largest movement of the areola and nipples, as well as reshaping of the entire breast mound. Larger corrections are possible with preservation nipple sensation and circulation.
After breast augmentation and an "inverted-T" breast lift. The periareolar and vertical components of the scar can be seen. The horizontal scar is hidden in the inframammary fold.
There are many types of breast lifts and each has its pro’s and con’s. The art of Plastic Surgery is choosing the best approach for each individual San Francisco breast asymmetry patient. I call this, using the smallest hammer necessary to get the job done. While bigger lifts leave a longer scar, choosing too small a lift still leaves a scar but it does not correct the original problem.
