Women often develop changes of their breasts following pregnancies, breastfeeding, weight loss, and aging. Ptosis gradually develops, which refers to a lowered position of the nipple and breast mound on the chest wall. The breasts may also lose volume, particularly in the upper pole. Women often present for cosmetic breast enhancement wishing to achieve two main goals relating to these changes:
- Lifting the breasts
- Adding breast volume
Breast augmentation alone will not significantly raise nipple position or achieve results comparable to a breast lift. A breast lift tightens the skin envelope and raises nipple height, however it does not add volume. Augmentation mastopexy combines these two breast surgeries to achieve a more youthful breast appearance with greater volume. It raises nipple position and may also reduce an enlarged areola for the best aesthetic outcome.
"What’s your superpower? We will help you find it."
- DR. STEPHANIE POWER
A candidate for this combined breast surgery presents with concerns regarding breast ptosis and loss of breast volume. Many women wish to achieve an outcome closer in appearance to their pre-pregnancy selves, while also increasing breast volume. Breast lift with implants may be performed on patients following completion of pregnancies and breastfeeding. It is essential for patients to be non-smokers given increased risk of complications, particularly for this combined procedure. If an infection or delayed skin healing develops following breast lift with implants, exposure of the implant or infection may result which could necessitate temporary implant removal.
Breast lift with implants is also an option for patients following massive weight loss after bariatric surgery. Loss of skin elasticity and breast volume is quite pronounced in these cases. A breast lift alone often will not achieve a patient’s goals following massive weight loss since breast volume may appear deflated. Breast implants may restore volume and create a rounder breast appearance, while the lift tightens the skin envelope.
Although many patients following history of pregnancies and breastfeeding may present for breast augmentation alone, if ptosis is present a combined lift may be recommended to better achieve a patient’s goals. Breast augmentation alone may improve the appearance of mild cases of ptosis, however is not as powerful as a combined lift with implants if indicated based on clinical presentation.
As for all patients seeking cosmetic breast enhancement, a comprehensive consultation will be performed to ensure that Dr. Power understands your aesthetic goals and that you are a healthy and appropriate candidate for elective surgery. A medical history will be performed to understand all medical conditions and whether any personal or family history of breast disease is present. A detailed pregnancy history will be useful in understanding breast changes that have developed. Dr. Power will inquire regarding any future plans for pregnancy. If future pregnancies are planned, it is recommended to delay any cosmetic breast surgery until at least 6 months post-completion of breastfeeding.
When placing a breast implant at time of breast lift, no additional incisions are required other than those planned for the lift. The three main approaches for breast lift are as follow:
- Periareolar approach
- During a periareolar mastopexy, the resultant scar is placed around the periphery of the areola at the junction with breast skin. The trade-off for this approach, which generally results in least visible scarring, is that the lift effect is not as powerful as that of more invasive approaches.
- Short vertical scar
- The so-called lollipop approach leaves a scar around the areola in addition to a vertical extension down the front of the breast.
- Traditional mastopexy (Wise pattern)
- For cases requiring more skin resection to tighten the skin envelope and greater nipple elevation, the traditional mastopexy pattern involves the lollipop incision plus a horizontal extension within the fold below the breast.
The technique of mastopexy will be based on a patient’s clinical presentation and degree of breast ptosis. The most appropriate technique will be discussed during consultation.
You will receive detailed instructions regarding the time to arrive at the surgery center. It is important to begin fasting – no eating or drinking – at midnight before surgery. If you take any prescription medications, Dr. Power will advise whether to take with a limited sip of water on the morning of surgery.
Dr. Power will see you upon arrival to perform surgical markings and to answer any further questions. You will meet the nursing and Anesthesia teams before being taken into the operating room. Surgery is performed under general anesthetic and you will awaken following surgery in the recovery room. A supportive breast garment will be in place, which is recommended for one month post-operatively. You will be closely monitored immediately following surgery to ensure adequate pain control and that you meet appropriate criteria for discharge home. It is important to have a friend or family member accompany you to surgery as you will require a ride home and someone to stay with you for 24 hours following general anesthetic to ensure personal safety.
During breast lift with implants, the breast implant is first placed below the pectoralis (chest) muscle. The approach is performed through the planned breast lift incisions so no additional scarring will result. The implants are carefully placed to ensure adequate pocket size and satisfactory position when comparing sides. Following implant placement, the breast lift is then performed through an approach based on the amount of planned skin resection and nipple repositioning. The approach will be discussed in detail during pre-operative consultation. Excess skin is removed and the underlying breast tissue resuspended to change the shape and position of the breast mound. The nipple is raised to a higher position based on breast proportions to achieve the best possible outcome.
Prescription pain medication will generally be required for a few days following breast lift with implants. It is recommended to transition to Tylenol plain or extra-strength when able. You will generally be able to return to office-based work within a week. If job responsibilities are more strenuous, longer recovery time may be needed. You will be able to drive within a few days of surgery once no longer taking
prescription pain medication and able to mobilize sufficiently. It is recommended to refrain from exercise or heavy lifting for one month post-operatively to decrease risk of bleeding and further swelling.
This is a challenging area in plastic surgery given that the implant and breast lift are essentially working in opposition. The implant increases volume of the breast mound, while the breast lift tightens the skin envelope. Positioning the implant and repositioning the nipple-areola complex are carefully determined. In select cases, it may be recommended to perform augmentation mastopexy in two stages to achieve the best aesthetic outcome. Given that the blood supply of the breast tissue and nipple is challenged during the surgical procedure and that a foreign body is also placed, smoking is a contraindication for breast lift with implants. If patients commit to smoking cessation for at least one month pre- and post-operatively, the risk of delayed wound healing and infection is decreased.
Routine screening will be required following breast lift with implants as for all females regardless of history of breast surgery. Mammogram screening is recommended every two years beginning at age 50 as per the Ontario Breast Screening Program. It is important to advise your mammogram center that you have breast implants to ensure that appropriate screening may be performed. Given that breast augmentation is one of the most commonly performed cosmetic procedures, most mammogram centers, even in smaller cities, are quite accustomed to imaging patients with breast implants. If a patient is at higher risk for breast disease based on personal risk factors or family history, imaging will be performed at an earlier stage, which should be discussed with your family physician.
Options for cosmetic breast enhancement will be discussed in detail during pre-operative consultation. Alternatives will depend on your aesthetic goals and clinical presentation. If patients are not interested in having breast implants but wish to increase breast volume during a lift, fat grafting may be an option. This procedure involves harvesting fat from other body sites (most commonly abdomen, flanks, or thighs) through gentle liposuction, careful fat preparation, and then reinjection into the breasts to increase volume. Fat grafting will not achieve equivalent results to breast implants in terms of fullness and roundness, however the tissue generally feels quite natural since a foreign body is not placed. Although there was initial concern regarding fat grafting of the breasts, research thus far has demonstrated that it is a safe procedure. It is an area of ongoing research both in cosmetic and reconstructive cases. Other alternatives include breast augmentation alone for cases of very mild breast ptosis or breast lift without implants to reposition the breast mound and nipple position without adding volume.
Breast lift with implants may correct breast ptosis while also increasing breast volume to achieve a more youthful appearance. Please contact us to schedule your consultation if interested in cosmetic breast enhancement. Dr. Power will discuss the most appropriate technique for you based on your aesthetic goals and clinical presentation.
Can you get breast implants and lift same time?
Yes! Breast implants may be placed during a breast lift procedure to add volume to your newly lifted breasts.
How long is recovery after a breast lift and implants?
After your breast lift with implants, you will be able to resume all activities by 6 weeks post-op. Exercise and heavy lifting should be avoided over the first month and avoiding upper body work-outs until 6 weeks following surgery is also recommended.
How long does a breast lift with implants last?
Results from breast lift with implants should be long-lasting if your weight remains fairly stable and you’ve finished having children and breastfeeding before undergoing surgery.
How painful is a breast lift with implants?
You will likely experience moderate pain for a few days after your surgery, but prescription pain medication should alleviate most of the discomfort. After a few days, pain should be minimal and you should be able to move around more easily.
How long does it take for a breast lift to settle?
Swelling will reduce and your breasts will settle over the first few months. It takes a full year to achieve your final outcome.
When can you lift your arms above your head after breast lift with implants?
You may gently lift your arms above your head right after breast lift with implant surgery to lower risk of developing stiffness. If you experience discomfort or a pulling sensation, proceed more cautiously.
How do you take care of a breast lift with implants?
After your procedure, avoid strenuous activity for 4-6 weeks and wear a supportive bra to minimize swelling over this time period. It is recommended to stay close to home over the first few days, while continuing to walk short distances from room to room to lower risk of developing complications.
What exercises not to do with breast implants?
Most exercises Most exercises can be performed at one month following breast implant surgery. You should avoid intense chest exercises such as push-ups until 6 weeks post-op. be performed once your breast implants heal but you may want to avoid intense chest exercises such as push-ups.