A breast lift, or mastopexy, can correct sagging in patients who already have breast implants. This combined procedure is a viable option for individuals who have previously undergone breast augmentation but now experience a descent of the breast mound and nipple-areola complex, known as acquired ptosis. The primary goal is to address the excess, stretched skin envelope and reposition the breast tissue to a more youthful, elevated position. While maintaining or adjusting the existing implant volume, the procedure restores better shape and projection to the breast.
Understanding the Need for a Combined Procedure
A lift becomes necessary because the factors that cause natural breasts to sag continue to act even after an implant is placed. Natural processes such as aging lead to the breakdown of collagen and elastin fibers, which reduces the breast’s structural support and elasticity. This gradual loss of skin tone means the skin envelope stretches over time and can no longer hold the breast tissue and implant mass in an elevated position.
Gravity constantly exerts a downward pull, and the added weight of an implant accelerates the stretching of the surrounding skin. Larger implants, in particular, contribute a greater mass, potentially leading to a more rapid descent of the breast mound. Furthermore, significant fluctuations in body weight, pregnancy, or breastfeeding also weaken the support structure, often necessitating a lift years after the initial augmentation. The resulting ptosis is characterized by the nipple-areola complex falling below the inframammary fold, requiring surgical correction.
Surgical Techniques for Lifting with Existing Implants
Performing a breast lift with existing implants requires a dual approach: simultaneously tightening the skin envelope and ensuring the implant remains correctly positioned. The technique used involves removing excess skin and reshaping the breast tissue, determined by the degree of ptosis present. For minor sagging, a periareolar incision, limited to the border of the areola, may be sufficient to slightly tighten the skin and elevate the nipple.
Incision Patterns
When moderate ptosis is present, a vertical lift, often called a lollipop pattern, is employed, adding a scar line extending from the areola down to the inframammary fold. The most significant correction for severe sagging requires the inverted-T or anchor pattern incision. This pattern includes the periareolar and vertical lines, plus an incision along the breast crease, allowing for the greatest amount of skin removal and maximum elevation.
Addressing the Implant Pocket
The surgeon must also address the implant pocket, which may have stretched or moved over time. The existing implant’s position can be adjusted, or the pocket can be surgically tightened, particularly in the lower pole, to provide better support and projection. If the implant has caused an internal scar capsule to form, known as capsular contracture, the capsule must be released or completely removed (capsulectomy). Adjusting these internal support structures helps prevent the implant from “bottoming out,” ensuring a well-supported contour.
Critical Factors Affecting Long-Term Aesthetic Outcomes
The longevity and final appearance of the combined procedure depend heavily on specific considerations and the patient’s intrinsic tissue quality. A primary decision point is whether to retain the existing implants or perform an implant exchange. Implants nearing the end of their lifespan or those that are the wrong size or shape may need replacement to optimize the aesthetic result.
The degree of scarring relates directly to the extent of the lift required, with significant ptosis necessitating longer anchor-pattern scars that will fade but remain permanent. Patients with naturally thick, resilient skin and stable weight generally experience the most durable results. Conversely, individuals with thinner, less elastic skin are more prone to a gradual recurrence of ptosis over many years.
A mastopexy does not halt the natural aging process, so some subtle descent will occur over time. Managing expectations is paramount, as the goal is improvement and restoration. Patients considering this complex revision procedure should seek consultation with a board-certified plastic surgeon to evaluate their existing implants and determine the most appropriate surgical plan for their specific anatomy and long-term goals.