Breast procedures generally serve two separate purposes: changing the position and shape of the tissue, or altering the overall volume and size. A breast lift, known medically as a mastopexy, focuses solely on the first goal, which is correcting the downward displacement of the breast mound. Implants, conversely, are used for augmentation, the process of increasing size and projection. Implants are not required for a breast lift, as the two procedures target different aesthetic concerns.
The Distinction Between a Lift and Implants
A breast lift, or mastopexy, is a surgical procedure specifically designed to address ptosis, which is the medical term for breast sagging. Ptosis occurs when the skin envelope and internal support structures lose elasticity, often due to aging, pregnancy, or significant weight fluctuations. The goal of a mastopexy is to elevate the nipple-areola complex and tighten the stretched skin, restoring the breast to a more youthful contour.
Breast augmentation, by contrast, is the procedure focused on increasing the volume of the breast, typically through the placement of silicone or saline implants. Implants add fullness, particularly to the upper pole of the breast, and increase the overall cup size. While an implant can sometimes provide a minimal lift by stretching a deflated breast mound, it is not an effective solution for moderate or severe sagging, which requires tissue manipulation. They are often performed simultaneously.
When a Lift Is Performed Without Implants
A standalone mastopexy is the appropriate choice when a patient is satisfied with their existing breast volume but is concerned about the shape and position of the breast on the chest wall. This procedure uses the patient’s own glandular tissue and skin to achieve a rejuvenated appearance. The surgeon repositions the internal breast tissue and removes excess, lax skin, effectively reshaping the natural contour.
The degree of sagging determines the specific incision pattern used, which directly affects the resultant scarring. For mild cases, a crescent or circumareolar incision around the areola may be sufficient. Moderate sagging often requires a vertical incision, known as the lollipop pattern, extending from the areola down to the inframammary fold. For the most pronounced ptosis, an anchor or inverted-T pattern, which includes a horizontal incision along the breast crease, is utilized for more extensive skin removal and tissue reshaping. Some advanced techniques, such as auto-augmentation, use glandular tissue that would otherwise be discarded to provide internal volume without the need for an implant.
Addressing Both Volume and Position
When a patient presents with both significant sagging and a lack of volume, the combined procedure known as augmentation-mastopexy becomes necessary. This combination is frequently required following substantial weight loss or after pregnancy and breastfeeding, which can cause both deflation and stretching of the skin envelope. Simply placing an implant in a significantly sagging breast without performing a lift may only address the volume deficit, leaving the nipple in a low position.
Augmentation-mastopexy integrates the implant placement with the tissue reshaping and nipple repositioning within a single surgical session. The implant provides the desired increase in size and projection, while the mastopexy corrects the ptosis and tightens the skin. The challenge of this combined procedure lies in reconciling the opposing goals of increasing volume with the implant while simultaneously decreasing the skin envelope through the lift.
Careful planning is required to ensure that the implant size does not compromise the blood supply to the nipple-areola complex, especially when the surrounding tissue is already manipulated. Surgeons must also consider that an excessively large implant can be heavy, which may counteract the lifting effect over time by stretching the newly tightened skin. For patients with severe ptosis, some surgeons may opt for a two-stage approach, performing the lift first and the augmentation several months later to ensure optimal tissue healing.
Factors Guiding the Surgical Plan
The decision to perform a lift alone, an augmentation alone, or the combined augmentation-mastopexy relies on a detailed anatomical assessment and the patient’s aesthetic goals. The primary anatomical factor is the degree of existing ptosis, which surgeons classify using systems like the Regnault grading scale. Ptosis is graded based on the position of the nipple relative to the inframammary fold, the crease under the breast.
Patients with Grade I (mild) or Grade II (moderate) ptosis who have sufficient existing glandular tissue volume are often excellent candidates for a lift without implants. Skin elasticity is another factor, as skin that has lost its ability to contract may not adequately support a lifted breast without extensive removal. When skin quality is poor and glandular tissue volume is minimal, the addition of an implant is necessary to achieve a full, rounded contour.
The patient’s aesthetic desire regarding cup size and projection guides the final choice between the procedures. If the patient wishes for a significant increase in size beyond what their natural tissue can provide, an implant is incorporated into the plan. Conversely, if the patient only seeks to restore the youthful position without adding volume, a mastopexy alone is the appropriate intervention.