A breast lift, medically known as a mastopexy, can be performed even with existing breast implants. This procedure is common in cosmetic surgery and is often called revision surgery or augmentation-mastopexy. A breast lift addresses breast ptosis, or sagging, by removing excess skin and repositioning the nipple-areola complex to a more elevated position. When implants are present, the surgeon manages the implant while reshaping the surrounding soft tissue. The goal is to correct the droop while maintaining the volume provided by the existing or a replacement implant.
Why Implants Do Not Prevent Sagging
Implants add volume and projection, but they do not prevent the natural aging process of the surrounding breast tissue and skin. Although implants provide internal support for their own shape, they do not counteract the forces acting on the native tissue. The implant’s weight can contribute to stretching the skin envelope and internal support structures, known as Cooper’s ligaments, over many years.
Breast sagging is primarily a consequence of gravity, weight fluctuations, and the loss of skin elasticity that occurs with age. As collagen and elastin fibers degrade, the skin loses its ability to hold the breast tissue and implant high on the chest wall. Pregnancy and breastfeeding also frequently cause glandular involution and skin laxity, leading to ptosis even with an implant. A lift is required to tighten the stretched skin and move the entire breast mound, including the nipple, back to a higher position.
Pre-Surgical Decisions Regarding Implants
A thorough consultation evaluates the condition and placement of existing implants before planning the lift. Surgeons assess the integrity and age of the current implants, often recommending replacement for devices over 10 to 15 years old. If the implant is ruptured, leaking, or has developed capsular contracture (a problematic scar capsule), replacement is necessary and performed simultaneously with the mastopexy.
Patients may choose to change the size, shape, or material of their implants during this revision procedure, such as switching from saline to cohesive silicone gel. A crucial decision involves adjusting the implant pocket, the space created to hold the device. The surgeon may move the implant from a subglandular (above the muscle) position to a submuscular (below the muscle) or dual-plane placement. This pocket adjustment provides better long-term support and coverage, helping to reduce the risk of future sagging, or “bottoming out,” and improving overall breast contour.
Techniques for Performing the Combined Lift
The combined procedure involves two simultaneous surgical goals: managing the implant and performing the mastopexy. The surgeon determines the appropriate mastopexy incision pattern based on the degree of existing ptosis and the amount of excess skin that needs to be removed.
Incision Patterns
For minimal sagging, a periareolar incision (a circular cut around the border of the areola) may be sufficient. More significant skin laxity may require a vertical incision, extending from the areola down to the inframammary fold, creating a “lollipop” pattern. The most extensive reshaping uses an anchor or inverted-T incision, which adds a horizontal cut in the breast crease. This pattern allows for the greatest skin excision and tissue rearrangement to tighten the breast envelope around the implant.
During the procedure, the surgeon elevates the natural breast tissue, or parenchyma, and sculpts it into a stable mound that acts as a supportive internal bra for the existing or new implant. The nipple-areola complex is then carefully repositioned to a higher point on the breast mound, ensuring its proper orientation relative to the inframammary fold and the implant’s position.
Recovery and Maintaining the Outcome
Recovery from a combined augmentation-mastopexy is typically more involved than a standalone breast augmentation or lift due to the dual nature of the operation. Patients should expect the most significant discomfort, swelling, and bruising to resolve within the first one to two weeks following the surgery. Prescription pain medication can manage this initial discomfort, and a specialized compression garment or surgical bra must be worn continuously to support the newly lifted tissues and implants.
Most patients are cleared to return to office-based work and light daily activities after about one week, but strenuous exercise and heavy lifting are restricted for four to six weeks. The final aesthetic outcome, with breasts settling into their new shape, will become apparent over several months as residual swelling completely subsides. Maximizing the longevity of the results requires maintaining a stable body weight, as significant weight fluctuations can re-stretch the skin. Consistent wear of supportive bras, particularly during high-impact physical activity, is also recommended to help preserve the lift over time.