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Breast Lift? Breast Augmentation? or Both? How To Decide

My breasts seem to be sagging, and I don’t have the volume I used to have. What surgery do I need to restore their shape, and position?

This is one of the most frequently asked questions by women considering cosmetic breast surgery in San Jose. Can they get the desired results through breast augmentation with breast implants alone?  Or, do they also need to get a breast lift?

While most patients would prefer to avoid the incisions and scars associated with a breast lift, sometimes the additional surgery is necessary in order to achieve the best possible breast shape.

Breast implants used in breast augmentation surgery can often provide the illusion of a lift by creating cleavage and more fullness below the nipple.  But, over time,  implants added to moderately sagging breasts, may actually exacerbate the situation.  You’ll need to consider the options and information, and ultimately decide

How Do I Know What Will Work Best for Me?

When evaluating patients for breast augmentation it is critical to address the relationship between the nipple and the crease below the breast (inframammary fold).

  • When the nipple is situated below the fold of the breast, then the surgeon should consider performing a breast lift at the same time as the augmentation.

This maneuver will physically lift the nipple above the fold of the breast so that it is situated over the middle of the implant when viewed from the front and the side. In most cases, this will create the optimal shape of the breast as well as achieve the optimal long-term outcome.

Are There Common Factors in Determining Who Needs a Lift?

Yes. Women who tend to have descent of the nipple (to the point where a breast lift is recommended) are those who have:

  • Lost a large amount of weight
  • Have had multiple pregnancies with breast feeding,
  • or, those who are older patients

These patients tend to have less skin elasticity and a long, flattened breast shape with the nipple positioned below the fold. In these situations, it is almost always advisable to perform some type of breast lift procedure with the breast augmentation (Figure 1).

Before and after breast lift

Figure 1: Example of a patient after multiple pregnancies and breast feeding with nipple below the fold of the breast. This patient is a good candidate for a combined breast augmentation and breast lift to achieve the best possible shape. Scars will continue to fade for up to 2 years. (Steven Bates MD)

The “Snoopy Dog” Effect

In these cases, if the breast implant is placed without performing a lift, then the nipple and underlying breast tissue will “hang” off the implant and create a “Snoopy dog” deformity. This is because when viewed from the side, the outline of the breast looks like the famous silhouette of the Peanuts character due to the mismatch between the implant position and nipple position (Figure 2).

Before and after breast lift - side view

Figure 2: Example of a patient with breast augmentation and no immediate lift. She has developed a “Snoopy dog” deformity with the nipple and underlying breast tissue falling off the implant. We performed a breast lift for her to align the nipple level with the implant and improve the overall shape of her breast. (Photo courtesy of Steven Bates, MD)

In some cases of very mild displacement of the nipple – at or very slightly below the breast fold, the implant can be placed above the muscle. This “sub-glandular placement” creates the illusion of a lift by pushing out the volume of the lower breast in relation to the nipple and surrounding breast tissue.

With the implant above the muscle, the “Snoopy dog” deformity and scars on the breast can be avoided.  However, care must be taken to choose the most appropriate candidates for this procedure to ensure that they can still achieve their desired goal and have a good long-term outcome. (*In addition to only mild displacement of the nipple, these patients should have adequate breast tissue to camouflage the implant when placed above the muscle. They also must have good skin tone and elasticity to hold the implant in place over time.) (Figure 3)

Before and afrter breast augmentation without lift

Figure 3: Patient had breast augmentation without breast lift at this time, due to her concern about scarring. Because she had only mild displacement of the nipple, we were able to perform a sub glandular breast augmentation to “lift” the nipple by pushing out the lower breast tissue with the implant. (Photo courtesy of Steven Bates, MD)

The Scar Question

Patients undergoing breast surgery want to avoid obvious scarring. Your surgeon will do all that’s possible to minimize the appearance of scars, and will guide you through after-care, to maximize your healing. The extent of the breast lift, and the type, will determine where the incisions will be made.

What’s the Best Way To Decide?

Breast Augmentation or Breast Augmentation & Breast Lift?

We can’t stress this enough – it is important to discuss your desired goals for breast augmentation with a board-certified plastic surgeon. Be open, and frank during your consultation. Your doctor will make recommendations based on your individual case, your concerns, and your anatomy. As described above, there are multiple options that exist, and the risks and benefits of each should be thoroughly reviewed before embarking on surgery. Please take a few moments to visit our photo gallery of before & after examples, and let us know if we can answer your questions.

Dr. Steven Bates, Dr. Benjamin Maser, and Dr. Vincent Lepore are board-certified plastic surgeons serving San Jose, Palo Alto, all of Silicon Valley and the Bay Area. Please contact us to schedule a free cosmetic consultation, or call 408-356-4241.

 

 

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