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Breast Augmentation is the placement of smooth, round, silicone implants primarily to increase the size of the breast.
Mastopexy (Breast Lift without Implants) is a reshaping procedure where breast tissue is rearranged to lift a sagging breast. Nipples are often relocated and some skin may be excised. The result is a natural looking breast that sits higher on the chest wall.
Mastopexy Augmentation (Breast Lift with Implants) is a reshaping procedure where breast tissue is rearranged to lift a sagging breast. Nipples are often relocated and some skin may be excised. Placement of implants gives the lifted breasts upper pole fullness and a perky, youthful appearance.
Your goals combined with measurements and observations from your exam will guide which procedure is the best one for you. In addition to measuring the basewidth of your breasts, the other measurements during the exam include:
Generally, a breast augmentation (placing implants only) is a good approach for mildly deflated breasts without excess sagging skin or for patients who want to increase the size of their breasts and/or get more “cleavage” (upper pole fullness).
Patients with adequate breast tissue that sags to a significant extent are good candidates for a breast lift.
A breast lift with implants is the best option for patients who have both deflated breasts and excess skin. The implants restore volume in the breast and the breast is then lifted by re-draping and sculpting the breast tissue to create a more youthful shape.
Breasts change in shape in response to age, breast feeding, and fluctuations in hormone levels. This will often manifest as sagging and deflation of the breast tissues, leading to a less appealing appearance. This sagging is referred to as “ptosis”. There are three main types of ptosis, and they require different approaches in order to correct the sagging breast. The point of reference when measuring ptosis is the inframammary fold (IMF).
Grade 1 Ptosis: The nipple is at the level of the inframammary fold. This is the mildest form of sagging, caused by deflation of the breast tissues. This is easily corrected by placement of an implant as a Breast Augmentation. This requires a small incision under the breast to allow placement of a breast implant. Sometimes this is called “augmenting out of ptosis” because the implant “lifts” the breast without tissue rearrangement.
Grade 2 Ptosis: The nipple is below the inframammary fold, but above the lower pole of the breast. This can be corrected by three approaches, depending on two factors: the patient’s desires of breast upper pole fullness and the total distance from the fold to the nipple. The techniques are Breast Augmentation, Breast Lift (Mastopexy) alone, or Breast Lift with Implants (Mastopexy Augmentation). If the distance is 5-7 cm, breast implant alone will likely be successful in correcting the sagging. Once the distance is greater than 7 cm, the volume of the required implant becomes significantly larger, and may not be desirable to the patient. Placing just an implant without performing a breast lift on distances over 7 cm will cause the breasts to be overly large. Large implants weigh more and will stretch the overlying breast tissue, which can result in worsened sagging over time.
Grade 3 Ptosis: The nipple is the lowest point on the breast. This requires a Breast Lift, with or without implants. Most people elect to have implants placed (Mastopexy Augmentation), as the breast is generally very deflated with a flat upper pole if it is simply lifted without placing implants.
The reasons for choosing breast augmentation may differ between patients, but most have thought about making the change for months or even years. Dr Camp performs this procedure to provide one or more of the following improvements:
It is important to keep in mind that breast augmentation does not correcting a sagging breast. For patients with a very mild amount of sagging, placement of an implant can make the breast appear lifted, but some individuals need an additional lifting procedure to correct sagging breasts. Dr Camp will evaluate your form and provide a strategy for an optimal result.
Measurements taken during your consultation and your personal goals for this procedure determine the best implant size and profile (projection for you). We use top of the line smooth solid silicone breast implants.
Base Width: Base width is a primary factor in determining the right implant size for you. If you have a naturally narrow base width, large implants with a large base width are not an option. Extremely thin, flat-chested patients have more limited options in selecting an implant size. A small breast simply cannot accommodate too large of an implant and placement of too large of an implant can cause extensive problems such as arm breast (breast slides off toward the arm) and incision dehiscence (wound splits apart and exposes the implant). For patients with ptosis (sagging) or breasts that have an extremely flat upper pole (“cleavage area” on the top part of the breasts), a certain minimum volume of implant is necessary to fill out the top of the breast and restore volume to that area.
Volume: Implants’ volume is measure by cubic centimeters (cc). Your actual breast measurements and amount of tissue determine the upper and lower limits of what volume will work for your breasts. A patient with a small frame and small base width has a maximum volume that can be accommodated by her breasts. A patient whose breasts have been stretched and are currently sagging has a minimum volume of implant that must be placed to improve the breast shape and avoid the “rock in a sock” effect which is when too small of an implant is trying to fill too large of a void inside the breast.
Implants are not measured by cup size since that is not a standard measurement and varies by manufacturer. Most people cannot perceive anything less than a 50cc difference, so if you are waffling between a 350 cc implant and a 375 cc implant, the difference in real life would be not obvious, even to a trained professional. Implant volume is certainly not a one size fits all situation. If you are 5’2″ and 110 pounds, a 350 cc implant will have a more pronounced impact than if you are 5’10” 180 pounds.
Profile (or Projection) of Implants: The profile is how tall an implant is when its base is resting flat on a table. Moderate profile provides a very subtle change in the breast shape. Moderate Plus tends to provide a pleasant and natural looking breast shape. High Profile implants provide more volume on the upper pole to give a perky appearance. Extra High Profile implants give a look of extremely prominent cleavage and look similar to the way a nursing mother’s breasts look when they are engorged. The fullness is apparent throughout the breast. Even when the volume remains the same, the higher profile implants pack more volume into a smaller base width and appear bigger when compared with lower profile implants of the same size.
There are two main locations where an implant is placed: subglandular (under the breast tissue but over the pectoral muscle) and sub-muscular (under the pectoral muscle). This choice can have a significant impact on the result. Our preferred approach is to place round, smooth, form stable silicone implants over the muscle.
In the past, submuscular placement was thought to help prevent capsular contracture (the formation of excessive scar tissue around implants). However, recent studies have shown this is not the case and there are other best practices to reduce the chance of capsular contracture. Generally, we recommend subglandular placement for most patients (over the muscle). The reason for this is that submuscular placement causes the implants to animate in an unnatural way when flexing the pectoral muscles. This is apparent when doing activities such as yoga. Additionally, submuscular implants can “bottom out” which is when the implant shifts to the bottom of the breast from the muscle pushing down on it. Patients who are good candidates for submuscular placement include patients with very small breasts and a small amount of breast tissue. Although solid form stable silicone implants have much less of a rippling effect than saline implants, rippling can occur in patients with a small amount of breast tissue if placed over the muscle. Submuscular placement helps hide the implant. Massive weight loss patients or others whose breast tissue has been extremely stretched out are also good candidates for a submuscular placement (in addition to a breast lift).
Dr Camp performs this procedure in an accredited outpatient surgical center, staffed by a board certified anesthesiologist. The procedure itself generally takes 45-60 minutes to complete. The incision, which is in your breast fold, is closed with buried dissolving sutures and sealed with surgical tape. No sutures need to be removed.
Most patients experience minor soreness and swelling. Sleeping in a recliner or propped up with pillow will help you sleep on your back and minimize swelling. Your plastic surgeon will prescribe oral pain medication you can use to control discomfort, if needed. Expect to be up and walking on the day of surgery, but not driving. Also consider arranging care from a friend or family member for the first 24 hours following surgery and possibly a day or so longer.
You will have a follow-up appointment approximately 3 weeks after surgery. We will remove the adhesive tape from your incisions and provide a tube of scar gel.
Most patients can return to normal activity within 1-2 weeks. Strenuous activity should be limited for one month or more. Most breast augmentation patients with desk jobs can return to work 3-4 days after surgery.
Dr Camp uses form stable solid silicone implants.
In general, breast augmentation costs $7500 with form stable solid silicone implants. There is an extra fee for inverted nipple repair or significant asymmetry correction due to the extra time in the operating room. Some patients upgrade to extra cohesive implants for an additional charge. We offer bundled pricing at Echelon Surgical Specialists. This includes all facility fees at an accredited surgery center, general anesthesia, smooth form stable solid silicone implants, all followup appointments at our clinic, and a three month supply of scar gel. You will not receive a separate bill for facility charges or anesthesia. Procedure prices do not include medications that need to be picked up at a pharmacy and any outside visits with other health care providers (such as labs or pre-op clearance appointments).
When performed by an experienced plastic surgeon, breast augmentation can be safely combined with other procedures such as tummy tuck. Women appreciate attaining multiple improvements with a single surgery and recovery period.
Yes. The human body is often naturally asymmetrical. Breasts are sisters, not twins. Slight asymmetry may be more pronounced after breast augmentation. For significant asymmetry, we can balance their sizes by placing an implant in the smaller breast only or by placing implants of different sizes. For patients with significant asymmetry, Dr Camp may recommend a breast augmentation on one side and a mastopexy augmentation (breast lift with implant) on the other.
The breast lift is achieved by rearranging the breast tissues and tightening the skin and may be combined with the addition of a breast augmentation implant to improve the upper pole fullness. This procedure is performed in the operating room with the patient asleep under the care of a board certified anesthesiologist. The procedure takes 2-3 hours to perform. After the case is over, you go to the recovery room, and are then sent home. You will need someone to drive you home.
Sleeping in a recliner or propped up with pillows will help minimize swelling. You can expect to be up and about the day after surgery. Some temporary bruising, swelling, and numbness of the breasts can be expected. A long acting numbing medicine is administered that makes the surgical site numb for approximately three days. The recovery is short, with return to normal activities usually occurring within 14 days.
Nipple sensation changes occur in some patients. If the nipples become very sensitive, this generally resolves in 3 weeks. In the event you have a numb nipple, this may be permanent. Sensation, if it does return, comes back in 6 months.
You will have a follow-up appointment three weeks after surgery to check incisions and begin scar gel treatment. Most patients are ready to return to their everyday activities within 1 to 2 weeks, with strenuous activity limited for one month or more.
Many women desire rejuvenation of the breast after child rearing or after massive weight loss. This is a very common clinical challenge presented to plastic surgeons. The overall problem is 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 a Mastopexy to fold and reposition the breast tissue and remove excess skin.The other technique is a Mastopexy Augmentation to place an implant and re-drape the overlying breast tissues.
Mastopexy (Breast Lift without Implant) 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 (“cleavage”) that is accomplished by breast implant placement.
Mastopexy Augmentation (Breast Lift with Implant) 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. Breasts with significantly stretched out tissue and extensive sagging are typically only candidates for a mastopexy augmentation.
Dr Camp’s recommendations vary according to the patient’s desires and body shape. 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.
The lift alone without implant is $12,500. Many patients desire increased upper fullness, which requires a breast implant in addition to the breast lift. A combined breast lift with implants (mastopexy augmentation) costs approximately $14,000. You will not receive an additional bill beyond your estimate for facility and anesthesia charges. Procedure pricing includes followup visits at the clinic. This estimate does not include medications to be picked up at your pharmacy and any visits to outside providers such as preop clearance with primary care doctor, post-operative lymphatic massage, or visits to outside facilities such as urgent care.
A breast lift improves the appearance of your breasts for years. The natural aging process, pregnancy and weight changes will likely cause your breasts to sag again. Results may be prolonged by the placement of implants during the procedures.
The data supports the ability to breast feed in 75% of patients. However, if you are planning on future children Dr Camp will advise you to hold off on surgery, as pregnancy and breast feeding will adversely affect the results of your correction.
Nipple sensation changes occur in some patients. If the nipples become very sensitive, this generally resolves in 3 weeks. In the event you have a numb nipple, this may be permanent. Sensation, if it does return, comes back in 6 months.
