When it comes to creating the “beautiful breast” via surgery, Eugene, OR plastic surgeon Mark Jewell, MD says one way to achieve an optimal outcome is through a lesser-known option called augmentation mastopexy—otherwise known as a breast lift–implant combination procedure.
“The typical ‘Masto-BAM’ or mastopexy and breast augmentation patient is on the more mature side,” explains Pasadena, CA plastic surgeon Lily Lee, MD. “They have lived long enough to have developed some sagging in their breast skin and lost volume in actual breast tissue. Of course, there are exceptions, as I have seen the rare young female, who has never been pregnant or breast fed, who genetically developed smaller breasts that are ptotic.”
Dr. Lee also points out that this particular procedure is really two surgeries in one and, similarly, it accomplishes two things: “One, it gives the breast more volume via enlargement with implants and, two, it creates a skin envelope that perfectly fits around the new volume.”
New York plastic surgeon Daniel Y. Maman, MD concurs and says that, usually, the woman he sees as a candidate has both breast ptosis (drooping and skin laxity) and deflation (loss of breast volume). “Doing a lift alone provides inadequate breast volume and projection, and doing an implant alone fails to address the skin laxity and ptosis.”
It’s a significant decrease in breast size—mainly due to pregnancy or weight loss—that Encino, CA plastic surgeon George Sanders, MD says is usually what propels a patient to seek this specific surgery. “They have less breast tissue and more skin, producing a deflated look. When the person puts on a bra to simulate an uplift alone, the breasts are lifted, but the bra appears empty. On the other hand, putting a large implant into the breast without a lift produces a larger, but still sagging breast, which is a poor outcome. The best option is a combination of lift and implant insertion.”
“Everyone ages at different rates and some women have more laxity and drooping than others,” explains La Jolla, CA plastic surgeon Robert Singer, MD, adding that, in spite of claims by manufacturers and marketers, there are no nonsurgical procedures that will lift and improve the cosmetic appearance of a drooping breast. “You can choose to do nothing, have a variation of a lift alone [Donut, lollipop, anchor shape], get implants alone—which will not adequately lift the breast when there is significant sagging, no matter the size, and will not produce a good cosmetic result in a patient who also needs some variation of a lift—get a lift with implants, and then there’s also the option of a lift, implants and fat. Whatever you choose, you have to be realistic with the outcomes for each, as they each produce different degrees of cosmetic improvement.”
Part of that reality, Dr. Singer says, is that there is scarring associated with this surgery, as well as the chance for decreased sensation that can occur with any breast surgical procedure. “Like most surgeries, you must closely follow your surgeon’s instructions for both pre- and post-op, as there is healing involved.”
Likewise, Dr. Maman stresses, augmentation-mastopexy is the most complex type of cosmetic breast surgery. His advice: “Make sure you choose a surgeon who does this all the time and can show you before and after photos of similar-looking patients to you.”
“The combined operation is more technically challenging for the surgeon, but produces a superior result,” Dr. Sanders says. “The recovery period is a bit longer and the patient needs to have periodic MRIs or hi-resolution ultrasound to monitor the implants—but the results outweigh these disadvantages for most patients.”
Reno, NV plastic surgeonTiffany McCormack, MD agrees: “I find that a breast lift with implants can be a very satisfying procedure, in that volume is restored and breast tissue can be shaped around that volume in a better position on the chest. A breast lift with implants is a more complicated surgery than standalone implants or a standalone lift. On one hand, you are adding volume with an implant. On the other hand, you are removing tissue to then close around the additional volume. If there is a substantial amount of tissue to remove because of the degree of ptosis, and very thin tissue, then your surgeon may elect to stage the procedures for a safer, better outcome. In most cases, these procedures can be safely combined, however.”
Plus, Dr. Jewell says, there are some more recent developments in the field that he’s found work particularly well: “My preferred technique is to use the newer-generation, highly-filled gel implants with the medium-cohesive gel to achieve upper breast roundness,” he says, adding that, additionally, he places the implants in the retro-mammary sub fascial location. “This allows the implant and breast tissue to remain connected together versus causing a ‘waterfall deformity’ where the breast tissue falls off the sub-muscular implant.”
“Reviewing the many patients in my practice who have ever undergone this surgery, I have not had one who regrets having the combined procedure,” Dr. Singer assures.
