A common point of confusion for those exploring cosmetic breast surgery is whether a breast augmentation automatically includes a lift. While both procedures enhance the appearance of the chest, they are distinct operations designed to address fundamentally different anatomical concerns. Understanding the unique focus of each surgery is the first step in determining the most appropriate path for enhancement.
Defining the Procedures Separately
Breast augmentation and breast lift are two separate surgical procedures, each with its own specific intent. Augmentation surgery is designed to increase the volume and fullness of the breast mound. Conversely, a breast lift, medically known as a mastopexy, focuses on repositioning the breast tissue and addressing sagging. This distinction means that breast augmentation, when performed alone, does not include the surgical steps required for a lift. The core difference lies in treating either volume deficiency or tissue laxity (ptosis).
Focus of Breast Augmentation
The sole purpose of breast augmentation is to enhance the size and projection of the breasts, primarily through the use of implants. This procedure involves inserting a medical device, typically filled with either saline or silicone gel, into a surgical pocket. Surgeons may place the implant in a subglandular position, above the chest muscle, or in a submuscular position, partially beneath the pectoralis muscle. The implant acts as a volume expander, increasing the overall size and improving the upper pole fullness of the breast.
While the added volume can stretch the existing skin, giving a temporary appearance of fullness, augmentation alone does not address loose skin or reposition the nipple-areola complex. If a patient has significant pre-existing sagging, adding an implant without a lift may actually worsen the appearance of drooping. The weight of the implant can place additional strain on the already stretched tissue envelope. Therefore, breast augmentation is best suited for individuals whose primary concern is small size or volume loss without substantial displacement of the breast mound.
Focus of the Breast Lift (Mastopexy)
A breast lift is a restorative procedure intended to correct breast ptosis, which is the medical term for breast sagging. This condition is characterized by the descent of the breast mound and the placement of the nipple below the inframammary fold. The mastopexy procedure involves removing excess skin from the lower portion of the breast and tightening the surrounding tissue to reshape the breast mound. This action effectively elevates the breast to a more youthful and higher position on the chest wall.
The surgeon also repositions the nipple and areola complex higher up the breast mound to correspond with the new contour. Depending on the degree of ptosis, the operation may require different incision patterns, such as a circular incision around the areola, a lollipop pattern that adds a vertical line, or an anchor pattern that includes a horizontal incision in the breast crease. The lift procedure does not introduce volume and may even result in a slightly smaller cup size due to the removal of excess skin and tissue remodeling. For this reason, a lift primarily enhances shape and position, not fullness.
Rationale for Combining Procedures
Many patients who seek breast enhancement have experienced changes like post-pregnancy deflation or significant weight loss, resulting in both volume depletion and tissue sagging. For these individuals, combining a breast augmentation with a lift, known as an augmentation-mastopexy, is the most effective solution. This combined approach addresses the dual concerns of volume loss and ptosis in a single operation. The lift component restores the proper position and shape by tightening the skin and raising the nipple.
The augmentation component restores the lost volume and fullness with an implant. For example, a lift alone would correct the sagging but leave the breast looking deflated, while augmentation alone would increase volume but fail to correct the displaced nipple or the loose skin envelope. The surgeon determines the need for combination based on a detailed analysis of the patient’s existing anatomy and their specific aesthetic goals.