Many women desire to return to their former breast shape after child rearing or after massive weight loss. To address a sagging breast, plastic surgeons frequently recommend a breast lift (also called a mastopexy) and sometimes recommend combining it with a breast augmentation (breast implants). The change in overall breast shape is caused by a loss of upper pole fullness along with excess skin on the lower pole of the breast. The result is a sagging, pendulous breast. The breast is displaced from the chest and rests upon the abdomen.
The goal is to restore the fullness of the upper pole, tighten the lower pole, and return the nipple to the apex of the breast mound. Often the areola (the colored area around the nipple) is dilated and needs to be reduced to a normal size.There are multiple possible approaches to achieve the above stated goals.
One approach is to fold and reposition the breast tissue and remove excess skin. The other technique is to place an implant and re-drape the overlying breast tissues. The benefit of the tissue re-arrangement technique is that there is no artificial material implanted in the breast. This circumvents the possible problems associated with implants: specifically capsular contracture, possible infection, implant malposition and migration. The drawback of not using implants is that it is very tough to achieve a round shape in the upper pole that holds up over time. Often what is achieved is a shorter, less saggy breast, but with a somewhat flat upper pole. Tissue rearrangement alone cannot achieve the desired upper pole fullness that is accomplished by breast implant placement.
Breast lift and augmentation with a silicone implant is the most straightforward and consistent means of achieving the shape that most patients desire. Breast implants maintain their shape and result in a full upper pole. The downsides are as mentioned above: implants are not a part of your body and cannot resist infection. Also, the implants (smooth gel implants) can slide down the chest with time, resulting in sagging of the breast.
A particularly challenging candidate is the massive weight loss patient. Generally, the tissues of these patients are very delicate, and the skin is stretched and very redundant. The sagging of the breast is significant, resulting in the need to relocate the nipple/areola a great distance superiorly. The breasts in these patients are basically empty sacks of skin. Tissue re-arrangement alone in these patients will only result in shortening and lifting of the sagging breast, but will not result in a pert breast with pronounced cleavage. An implant can restore the volume that was lost, but this does not correct the sagging of the breast tissues. This requires tightening and tailoring of the lower pole of the breast, and relocation of the nipple/areola complex. This combined surgery is often called a Mastopexy (breast lift) Augmentation (enlargement with implant).
Dr Camp’s recommendations vary according to the patient’s desires and body shape. For more information about Dr Camp’s thoughts regarding augmentation, please refer to Dr Camp’s Philosophy on Breast Augmentation. Most patients who have a breast lift elect to have implants placed to achieve an augmented upper pole of breast, but this is a personal choice, based on your preferences.
Matthew C Camp, MD
Board Certified Plastic Surgeon
Member, American Society of Plastic Surgeons
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Colwell AS, Driscoll D, Breuing KH. Mastopexy techniques after massive weight loss: An algorithmic approach and review of the literature. Ann Plast Surg. 2009;63:28–33.
Coombs, Demetrius M. B.S.; Srivastava, Udayan M.D.; Amar, Dalit M.D.; Rubin, J. Peter M.D.; Gusenoff, Jeffrey A. M.D. The Challenges of Augmentation Mastopexy in the Massive Weight Loss Patient: Technical Considerations. Plastic and Reconstructive Surgery: May 2017 – Volume 139 – Issue 5 – p 1090–1099