Do I have to get Breast Implants when I get a Breast Lift?  ~Columbus, Ohio

A breast lift is designed to improve the shape and contour of the breasts; or as many patients put it, ‘Make the girls perky.’  It is most commonly performed on women who have lost their youthful breast shape either due to pregnancy and breastfeeding, significant weight loss or a combination of both.

Breast Implants


Video: Types of Breast Implants

 
 
 

Dr. James McMahan provides insight on the different types of breast implants used in breast augmentation. Dr. McMahan is a skilled surgeon who works with each individual patient to understand her unique needs and help her determine what type of implants are best for her. Dr. McMahan offers silicone, saline, and "gummy bear" style implants.

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Breast implants are used to increase the size of the breasts as well as to improve the shape, particularly in situations where patients have lost fullness in the upper aspect of their breasts known as the upper poles.  Many women who are interested in a breast lift also want more fullness in the upper poles, which is not typically achievable with a lift alone.  In order to create that fullness, which will last a long time, implants are generally needed.

A Lift With Implants

Those patients who are dissatisfied with their sagging (ptosis) only and are otherwise happy with the size of their breasts do not generally get breast implants at the time of their lift.  Implants are commonly placed at the same time that a mastopexy is performed in women who want to increase the size of their breasts or in those who want to increase the fullness of their upper poles.  Although a breast lift will initially increase the fullness in that area, it usually fades as the swelling goes down and the skin relaxes. It generally requires a breast implant to give permanent fullness to the upper aspect of the breasts.

Choosing between Saline and Silicone Implants

Limiting the Implant Size

When performing a breast lift, the skin envelope of the breast is tightened by removing excess skin while elevating the nipple-areola complex and, often times, making the areola a little smaller in diameter.  As a result of tightening the breast, there is less room to place an implant; therefore, by combining the two surgeries at one time, there is a limitation as to how large of a breast implant that can be put in. For patients who have a lot of sagging requiring a full lift and who want to be considerably larger requiring big implants, it may be necessary to separate the two procedures; performing the lift first and a breast augmentation at a later date after the first procedure has healed satisfactorily and the skin has relaxed.

Implants Do Not Lift

Many patients have the understanding that implants alone with provide a lift to their breasts.  Those who are borderline for needing a lift may benefit from the ‘dual-plane’ approach where the lower breast tissue is released from the muscle to allow some upward rotation of the breast.  This technique, however, may provide a very small lift and will not suffice for the patient who has more than just a little sagging. 

Placing the implant on top of the muscle may provide a little more of a lift, however, the tradeoff of more rippling, higher risk of capsular contracture (and, therefore, rupture), less natural appearance, more interruption of breast visibility on a mammogram, etc. is not worth it.

Separating Procedures

Splitting procedures on the breast is also often done for women who have problems with implants on top of the muscle combined with sagging skin where their condition can be improved by a lift and moving the implants under the muscle. In these cases, it is sometimes necessary to remove the implants first, allow the breasts to heal and the old pocket to close, and then perform the lift several weeks later, which may include placement of a small implant under the muscle. If much larger implants are desired, they may have to be placed during a third procedure. This is because blood supply to the nipple and areola may have been reduced by the initial placement of the implants on top of the muscle and it is further reduced by the mastopexy. If blood supply is restricted even more by the pressure from large breast implants, a critical level could be reached threatening the viability of the nipple and areola. 

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