Breast Augmentation with Lift
One of the more vexing cosmetic issues women face, related to pregnancy, breastfeeding, and aging, is sagging or drooping breasts. As the breasts lose their youthful, full appearance and as they descend lower on the chest, and as the nipples enlarge post-pregnancy, many women become very self conscious and they see these events as definite signs of aging.
Because of widely available information about cosmetic breast surgery, many of Dr. McCluskey’s patients know their options prior to consultation. A breast lift can elevate the breasts and restore the youthful appearance of a higher breast with a smaller, more centered areola. But patients know that it typically requires an implant to restore fullness & volume.
One of the more popular combined procedures in cosmetic breast surgery is a combined breast lift (mastopexy) and breast augmentation with saline or silicone gel implants. The idea is that combining these procedures is safe, requires only one general anesthetic, and requires only one recovery period. For these reasons, the breast augmentation – mastopexy can save both time and money for both the doctor and the patient.
Dr. McCluskey does perform combined breast augmentation – mastopexy in women who are excellent candidates for the combined procedure. An example of an excellent candidate for this procedure would be a woman with mild to moderate breast droop (breast ptosis) who desires placement of a small to medium sized breast implant.
But in many cases Dr. McCluskey strongly feels that he can achieve much better results by performing the procedures separately. He prefers to perform the breast lift first, especially in patients with moderate to severe ptosis. This procedure elevates the breasts, reduces the diameter of the areola, and centers the breast on the chest for a more rounded, youthful appearance. Very fine sutures are used beneath the skin to achieve minimally visible scars. It is important to then allow time for the incisions to heal, for swelling to dissipate, and for the breasts to settle into a natural position.
After the breasts heal, many patients are so happy with the results that they no longer desire breast augmentation. But in those patients who desire breast augmentation, the stage is set to achieve excellent results. The breast and nipple are now centered on the chest and a breast implant can be placed with relative ease beneath the chest muscle (pectoral muscle) to provide natural-appearing fullness to the breast. Dr McCluskey uses the prior breast lift incisions for this secondary procedure so there is no additional scarring.
What is the advantage to performing a breast lift & augmentation in two separate stages? There are many advantages actually. The preferred placement of a breast implant is beneath the pectoral muscle. Submuscular placement reduces the risk of capsular contracture, and allows for mammograms to be read properly. In a patient with moderate to severe breast droop, the breast hangs far below the pectoral muscle. If one combines the procedures, performing a breast lift with an augmentation, the implant can still be placed submuscular, but it is now supported by injured, healing breast tissue. This tissue is now trying to heal in a tighter, higher position on the chest, but it is being stressed underneath by a breast implant. The results of this can be disastrous, often leading to a “bottomed-out” appearance in which the implant drops below the healing breast. This can only be corrected by additional surgery to repair the breast tissue and raise the implant to the desired position.
At the skin level, the nipple diameter has been reduced and the nipple position has been raised. There are many finely sutured, healing incisions that in a lifted breast can heal tension-free with time and proper breast support. Placing an implant while performing a breast lift, however places a great deal of tension on those fine suture lines. Again, the results can be disastrous, causing widened red scars around the nipple and along the vertical incision. It can also cause the nipple to spread, giving it a very odd, un-natural appearance. Dr. McCluskey has seen many patients with these complications who have undergone combined mastopexy with breast augmentation by other physicians or in other countries. He has also had to perform revisions on his own patients who have had these issues after combined breast augmentation-mastopexy. They often feel that they look worse than before the surgery and now they require corrective surgery to restore their appearance.
Dr. McCluskey really enjoys performing breast lifts with augmentation because the procedure(s) can turn back the clock and restore a woman’s pre-pregnancy appearance. In certain candidates, as said above, Dr McCluskey will combine these procedures, performing the breast lift and implant placement simultaneously. But in many other women he strongly feels that separating, or staging the procedures results in a much better appearance, and ultimately the patients are much happier. The information written above related to complications from combining these procedures is not meant to scare patients. Instead, read it with these thoughts in mind: Dr. McCluskey knows that most patients would prefer to combine mastopexy and augmentation, and there are good reasons for doing this. But if he recommends that a patient undergoes these cosmetic breast procedures separately, then he is doing so because that is how he feels the best results can be achieved for that patient.