What is breast lift with enlargement surgery?

The shape of the breast can change over time. The cumulative effects of aging, pregnancy, breast-feeding and weight fluctuations can influence the position of the nipple and breast to appear less full, hang lower, or “sag”. This process is called ptosis. Some women also want to increase the breast size, perkiness or fullness in order to achieve a more youthful and enhanced appearance of the breasts. A breast lift with enlargement through insertion of an implant (mastopexy-breast augmentation) is a combined surgical procedure designed to lift and reshape the breast and increase its size to address this common phenomenon.

Who is a suitable candidate for a breast lift with enlargement surgery?

The ideal candidate for breast lift surgery is in good physical health and has a stable weight. A candidate’s typical concerns would be breasts that droop or sag, show stretched skin with downward-pointing nipples that rest below the breast crease, in addition to wanting fuller, more shapely breasts. Most importantly, the patient should be self-motivated with realistic expectations of what mastopexy-breast augmentation can achieve. Most women can undergo both procedures at the same time during a single surgery, but a small group of patients will require two separate surgeries in order to derive the greatest benefit.

What are the goals of a breast lift with enlargement surgery?

The goals of mastopexy are to improve breast shape and restore the position of the nipple and areola (the pigmented skin around the nipple). The goals of breast augmentation are to increase the breast size and fullness to meet cultural ideals and the individual’s preferences. A priority for both procedures is to achieve these goals with an acceptable surgical scar.

What is done during surgery?

Several mastopexy and breast augmentation techniques exist, and your surgeon will discuss which would best achieve your goals given your breast size, shape, and the extent of ptosis present.

In the preoperative area, surgical markings are drawn on the breasts to plan the operation. Three major approaches exist, based on different scar patterns. In general, a greater degree of ptosis will need a greater lift, which requires a longer incision resulting in a longer scar. A variable portion of the skin is removed, allowing the nipple and areola to be repositioned. The procedure can also involve removal of a small amount of breast tissue, with repositioning of breast tissue so that the breasts appear higher and fuller. When combined with breast augmentation, the breast implant can be placed below the breast tissue or below the pectoralis muscle that sits under the breast tissue. Surgical drains may or may not be necessary after mastopexy-breast augmentation. A dressing is applied to the surgical site and a bra is usually worn for several weeks after surgery.

Where is the surgery performed?

All surgeries are performed at Women’s College Hospital as day surgery by the plastic surgery senior resident under the supervision of a faculty plastic surgeon.

What to expect in the recovery? How long will I be off work? When can I resume exercise?

The procedure itself can take from 1 to 3 hours depending on how much work is required. Mastopexy-breast augmentation is performed as day surgery. Specialized skin tape and/or a bra will be applied at the end of your surgery. After the operation you will be brought to the recovery room, and medications will be given to help relieve any pain or prevent nausea. You will be discharged home with a prescription for pain medication, postoperative instructions and a follow-up appointment. For the best results, you should plan on resting and taking it easy after surgery. For the first few days after surgery, most patients experience some discomfort at the surgical site. Pain should generally subside after one week, and it is normal to experience some minor oozing around the incisions. After which you will starting feeling better and returning to your normal self. Recovery from the surgery varies between individuals and the specific procedure performed. Swelling and bruising in the area of the surgery will be present and generally begins to improve about 1 week after surgery. You should plan on being off work for 1 week. During your recovery, you should refrain from strenuous physical activity including lifting and pulling for 6 weeks following surgery.

Where are the scars?

As plastic surgeons, we realize the importance of the cosmetic outcome.  We will make every effort to optimize the scar size and conceal it in the least visible area of the breasts. In many cases, it is possible to improve the appearance with very little scarring. Mastopexy scars vary depending on which technique is performed. The most common patterns are:

• Periareolar – circular pattern around the areola (pigmented skin around the nipple)
• Vertical – around the areola with a vertical portion extending to the breast crease. This is also referred to as a “lollipop” scar
• Inverted-T – around the areola with a vertical line to the breast crease, and extending horizontally in the breast crease

It is important to realize that scar formation varies between individuals and is highly dependent on a person’s genetic predisposition. Scars typically fade over time but their final dimensions and colour are difficult to predict.  At the consultation, the plastic surgeon will talk to you about this.

What are some common complications of surgery?

Complications of breast lift with enlargement surgery, like those of other cosmetic procedures, are uncommon but may include unfavorable scarring, asymmetries, bleeding, infection, swelling and numbness. Specific to breast lift surgery, risks including recurrence of the sagginess and the rare possibility of loss of feeling or skin loss around the nipple can occur. Complications specific to breast enlargement surgery are also uncommon but can be serious. Mild infections are treated with antibiotics, but severe infections may require surgical removal of the implant. In rare circumstances implants may rotate, deflate, rupture, have visible edges, or develop a hard and painful scar capsule called capsular contracture. Your plastic surgeon will speak to you in greater detail about expected outcomes including potential complications.

When will I see the final results of the surgery?

An improvement from mastopexy-breast augmentation surgery should be apparent immediately after surgery, and will continue to improve over 3 to 6 months as incisions heal and swelling resolves. Scars mature over time, and will become fainter and lighter up to one year after your operation.