If a breast is ptotic (“saggy”), for example, the nipple has usually moved to a lower position on the breast and the breast hangs below the normal level. Sagging breasts are corrected by lifting procedures called mastopexies.
“If you make a saggy breast bigger, you get a bigger, saggy breast.”
Many times patients need correction of size AND sag and want those corrections done at the same time during the same surgery. In the past, surgeons frowned on doing a combination lift/augmentation procedure since it carries more risks than either procedure performed alone. However, with today’s advanced techniques, most patients can undergo a single-staged procedure where the breast is both lifted and augmented at the same time with low complication rates.
Like all breast lift procedures, however, breast lifts with augmentations leave permanent scars on the breast. These scars are unavoidable as the incisions needed to move the nipple and remove the sagging skin heal over time. Fortunately, these scars tend to fade away with time as they mature and lose their color.
Because of permanent scarring, breast lift procedures are considered very carefully during a patient’s evaluation. If there is a reasonable expectation of a satisfactory outcome without breast lifting, lifts can be avoided. Different augmentation techniques and different implant shapes can be useful in these cases. And, of course, if a patient absolutely refuses a breast lift, we can discuss the likely cosmetic outcome of augmentation alone and proceed as the patient desires. But, a big saggy breast is usually no better than a small one.
Doing the wrong surgery is never the right answer. If you have gallstones, for example, removing the appendix is not the solution. Using a large implant to correct a sagging breast is usually a very short-sighted strategy. As time passes the skin will stretch to accommodate the volume of the large implant and the patient will be left with a large saggy breast that is more difficult to correct without significant risk.
In the appropriately-selected patient, and when planned and executed well, the combination breast lift with augmentation can create a very pleasing result. Check out the photo gallery for examples of this combination procedure.