Baltimore Breast Lift Surgery
When Is A Breast Lift Needed With Breast Augmentation?
Many women who are interested in breast augmentation also inquire about a breast lift. Woman often would benefit from a breast lift if their breasts have dropped over time as a result of pregnancy, aging or if they have just naturally developed this way. The medical word for the breasts dropping or becoming saggy is "ptosis".
Depending on several factors, including the amount of ptosis, a breast lift (mastopexy) is often performed at the time as the augmentation. There are actually four main factors in determining whether a woman would benefit from a mastopexy. These are: 1) Nipple/areolar position; 2) Soft tissue position and volume; 3) Desired implant size; and 4) patient goals.
Nipple Areolar Position
The degree of ptosis is identified by the nipple/areolar position relative to the crease under the breast, known as the "inframammary fold" or IMF. Surgeons will evaluate women by placing their hand underneath the breast to feel the crease and then see where the nipple/areolar position is relative to this crease. If it is above the crease, almost always the breast implant will fill out the breast and a separate breast lift procedure will not be required. If the nipple/areolar complex is at or below the crease, often a lift is required in order to achieve the proper shape.
This is fairly straightforward to understand if you imagine that the implant will be placed and rest on the crease itself. If the bottom portion of the implant is at the level of the crease and the nipple/areolar complex is sitting below this, it will not provide a satisfactory shape and result for the patient. The degree of ptosis or descent of the nipple/areolar complex below the crease often determines what type of lift is required. Many woman are at the borderline as to whether they will require a lift and then other factors come into play.
Soft Tissue Position/Volume
Many women present with most of their breast volume being above the crease (IMF) and the nipple/areolar complex sitting somewhere near the crease. For these women, many times a lift will not be required. The implant can be placed at the level of the crease and, if they are willing to accept a good overall shape to the breast with just a slightly low position of the nipple/areolar complex, a separate lift can be avoided.
If, however, a lot of the breast volume is below the crease as well as having the nipple at or below the crease, then a lift generally is required. The implant needs to be placed to fill up the breast tissue wherever it is. In other words, if the breast tissue has descended below the crease then the implant would need to be placed below the crease as well in order to achieve a satisfactory shape. This would cause the implant to sit too low on the chest wall and give an unnatural result.
Implant Size
A separate factor in determining whether a lift will be required is the implant size desired by the patient. As a rule of thumb, the implant should sit with approximately half of the implant above the nipple and about half of it below the nipple. If patients have some soft tissue that is below the crease as well as a nipple that is slightly low and they choose a fairly large implant, it is possible to fill out the bottom of the breast where there is soft tissue and still have enough volume to give fullness in the upper pole so that the overall shape is acceptable.
If a woman with ptotic soft tissue chooses a small implant, if one were to place the volume of the implant low to fill out the sift tissue, this would place too much of the implant low down on the chest wall and would not give enough upper pole volume, thus creating an unsatisfactory result.
Patient Goals
The final factor in determining whether a woman requires a mastopexy is the patient’s goals. Many woman would be very happy with a natural shape such that the implant is slightly lower on the chest wall and the nipple/areolar position is slightly lower as well. For these patients, it might be possible to avoid having to perform a lift. Others, however, wish to have the implant volume much higher on the chest wall to give more cleavage and more fullness, as well as having an elevated nipple/areolar position.
If this is the case, many times these women will need a mastopexy if they have a slightly low nipple position to begin with. It is very important to understand the goals of the patient involved in order to make the best decision. Of course the trade-off of doing a lift is that there will be incisions on the breast which will ultimately be visible to some extent. It is important to discuss this with the patient in detail. For some women, visible scars are not acceptable; however, they are willing to accept a natural result and undertake an augmentation without a mastopexy.
In summary, the main determinant in deciding whether a patient requires a breast lift with an augmentation is their nipple/areolar position relative to their inframammary fold. For women whose nipple/areolar position is near the level of the fold without being significantly above or below, the other factors such as soft tissue volume, implant size and their goals will come into play to make the final determination.
All of these factors need to be balanced with the patient's desire to have an elevated nipple position, as well as their other preferences.
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