The procedure known as augmentation-mastopexy combines a breast lift and breast augmentation into a single surgical session. This approach is designed to address two distinct aesthetic concerns simultaneously: breast ptosis, or sagging, and a lack of overall volume or upper-pole fullness. By integrating these two operations, the surgeon can restore a more youthful breast contour that is both elevated and well-projected. This dual procedure allows for the removal of excess, inelastic skin while also increasing breast volume through the placement of an implant.
Determining Candidacy for a Combined Procedure
A surgeon recommends a single-stage combined procedure when a patient exhibits both significant breast sagging and a desire for increased volume that a lift alone cannot achieve. The degree of breast ptosis is assessed by measuring the position of the nipple-areola complex (NAC) relative to the inframammary fold (the crease under the breast). Patients whose nipples fall below this fold are candidates for a lift. Combining the procedures is particularly beneficial for those with volume loss resulting in a deflated appearance. The skin and breast tissue must possess adequate health and elasticity to safely accommodate the internal reshaping and the additional volume of an implant. A thorough consultation ensures the patient is at a stable weight and in good general health.
Step-by-Step Surgical Process
Incision and Anesthesia
The comprehensive augmentation-mastopexy begins with meticulous preoperative markings on the patient while they are in an upright position, which guides the precise location of the incisions and the new nipple position. The choice of incision pattern is determined by the severity of the sagging, with options ranging from a periareolar incision for minimal ptosis to a vertical (lollipop) or an inverted-T (anchor) pattern for more extensive skin removal. The procedure is performed under general anesthesia and typically lasts between two and four hours.
Implant Placement
The augmentation component involves creating a pocket for the breast implant. Placement can be subglandularly (above the pectoralis muscle) or submuscularly (beneath the muscle). The choice depends on the patient’s existing tissue thickness, as placing the implant partially under the muscle can provide better coverage and a smoother transition. The implant is inserted first to provide the new volume and establish the final shape that the remaining breast tissue must be re-draped over.
The Lift (Mastopexy)
Following the implant placement, the mastopexy portion commences by removing the pre-marked excess skin envelope. The underlying glandular tissue is then reshaped and tightened internally to create a stable, conical breast mound that will support the implant. This internal tissue restructuring is crucial for long-term shape retention. The nipple-areola complex is carefully elevated and repositioned to a more youthful, higher point. Care is taken to maintain the connection of the NAC to the underlying tissue to preserve nerve sensation and blood supply.
Closure
Finally, the incisions are closed in layers using sutures. This often includes deep, dissolvable stitches for internal support and fine sutures or surgical glue on the skin surface. Small, temporary drainage tubes may be placed to collect any excess fluid buildup, which helps reduce swelling and promotes optimal healing.
Immediate Post-Operative Recovery
The immediate recovery phase focuses on managing discomfort and protecting the newly contoured breast shape during the first one to six weeks. Patients should expect moderate pain, typically controlled with prescribed oral medication, and noticeable swelling and bruising. Swelling usually peaks within the first three to five days before beginning a slow, gradual resolution. A specialized compression garment or surgical bra must be worn continuously to minimize swelling and provide necessary support. Physical activity is severely restricted to prevent undue stress on the incision lines. Patients are instructed to avoid lifting anything heavier than five pounds and to refrain from strenuous activities or exercise for at least the first four to six weeks. If surgical drains were used, they are generally removed within the first week. Patients must avoid raising their arms above shoulder level for a specified period to protect the incision sites.
Long-Term Results and Maintenance
The final aesthetic outcome becomes apparent as residual swelling fully subsides, a process that can take several months. Incision lines are permanent, but they mature and fade in color and texture over twelve to eighteen months. Scar care, including the use of silicone sheeting or topical treatments, is recommended to minimize their visibility. While the surgical correction of ptosis is permanent, natural aging, weight fluctuations, and gravity will continue to influence the breast shape. Significant weight gain or loss, or future pregnancies, can compromise the longevity of the lift results. The mastopexy portion typically lasts for ten to fifteen years. Implants require long-term care and monitoring, as they are not considered lifetime devices. Silicone implants require periodic magnetic resonance imaging (MRI) screenings to check for silent ruptures. Implants may require replacement or revision surgery after ten to twenty years due to rupture, capsule contracture, or the desire to address future aesthetic changes.