Breast Augmentation Mastopexy
Augmentation-mastopexy refers to an operation where both a breast augmentation is done with an implant and at the same time the soft tissue, including the skin and breast tissue itself, is tailored to produce a less pendulous and more youthful appearance of the breast.
This operation has very powerful pluses but also a few minuses. One major plus is that in one operation lasting just a few hours, a breast can be restored to its original or even improved condition compared to an earlier point of time.
The mastopexy part of the operation includes usually moving the nipple and areola higher up on the chest and then lifting the breast itself such that the breast overhangs the chest and inframammary fold little or not at all as compared to before the mastopexy procedure.
This produces a breast that is more youthful in appearance, less droopy, and often narrower. In some situations, modest amounts of breast tissue might actually be removed. In most cases, a significant amount of skin is removed, particularly along the lower aspect of the breast, where it is hanging below the inframammary crease.
At the same time, while we are reducing the skin envelope and lifting the breast, we can enlarge the breast by adding an implant either in the subpectoral position, the subfascial position, or in the prepectoral position just behind the breast tissue itself.
There are pros and cons to each of these approaches, and the options should be discussed with your surgeon when contemplating going forward with an augmentation alone or an augmentation-mastopexy.
In almost all cases, we recommend doing these two operations simultaneously so that the surgery does not require two separate events. But of interest in studies by myself and a few other surgeons around the United States, we have found that this operation does have a significant incidence or frequency of requiring or benefiting from revision by either moving the implant to a different position later or by tailoring the skin or the nipple to more precisely fit the desired goals of the surgeon and the patient.
A crude estimate of the risk of revision is somewhere in the 15 to 25-percent range over the first several years subsequent to the surgery, and this can be due to the effects of time or the effects of the weight of the implant on the repair of the droopy breast that required the mastopexy to begin with.
Special precautions do need to be taken when performing an augmentation-mastopexy, because unlike a mastopexy alone or an augmentation alone, there are certain risks that come with augmentation-mastopexy that don’t occur at all or with any frequency with either operation done independently.
These risks include actual ischemic or circulatory damage to the nipple that may require removal of the nipple and/or loss of the implant due to exposure or infection as part of the augmentation-mastopexy. The good news is that these risks are rare and happen in well less than 1 percent of augmentation-mastopexy procedures. But they are of important and special concern because they generally do not happen with an augmentation or mastopexy done as an isolated procedure.
On the other hand, perhaps some of the most dramatic results of breast implant surgery or mastopexy surgery occur when augmentation and mastopexy are combined, where you can take or correct a breast that is deflated and pendulous and older looking and in just a few hours convert that situation to a breast which is perky, full, sexy, and youthful looking.
Another thing worth mentioning is that the augmentation-mastopexy, similar to a mastopexy alone, does require incisions and ultimately scars that are placed around the areola, often in a vertical seam from the bottom of the nipple to the inframammary crease, and in many cases even a short incision or scar in the inframammary fold that is hidden by the breast itself.
In the long run, in the vast, vast majority of women, the scars become faint and do not significant detract from the overall aesthetics and beauty of the refashioned breast.
But bear in mind again that these two operations both combined do carry the 15 to 25-percent risk of revision and in very rare circumstances actually result in failure of the operation, either by infection or exposure of the implant or ischemic damage to the skin and/or ischemic damage to the nipple.
With those risks in mind, however, 99 percent of women who undergo this operation will ultimately not suffer those problems and instead will wind up with a vastly improved appearance of their breasts. This is often part of a Mommy Makeover operation, which includes abdominal recontouring combined with recontouring of the breasts with augmentation, mastopexy, or augmentation-mastopexy alone.
Finally, for many years, this operation was feared by some surgeons and discouraged by others, but today, because of a better understanding of the blood supply to the tissues as well as improved implants, most surgeons who are experienced in breast augmentation and mastopexy surgery will do these operations and achieve for their patients excellent outcomes.