Written By: Dr. Juan A. Brou
I am often faced with that question from patients that feel their breasts are saggy. Sometimes the answer is obvious, but some other times it’s not that clear cut. Most of the time patients that would benefit from a breast lift already know the answer and they come in requesting that procedure. But there is a selected group that doesn’t want to do a lift but are afraid they are going to need it. Let’s digress here for a moment; nobody really needs a lift, like nobody needs a diamond. You get it because you want it, it’s not essential for life but it makes you happy to have it. Similarly, getting a cosmetic surgical procedure may improve your quality of life, as you are no longer self-conscious about a certain part of your anatomy.
Having said that, the purpose of a lift is to improve the shape and form of a breast that has otherwise experienced profound changes due to pregnancy, breast feeding, loss or gain of significant weight or sometimes they simply developed with an unattractive shape. Most people can tell a pretty breast when they see it and that is because an attractive breast has defined proportions. They are nice and round, they are not too long, and they have nipples and areolas that are located centrally and facing forward. The skin is firm and so is the glandular tissue and even though these last two items cannot be changed we can surely change the proportions of the breast with a lift. Most lifts can be done simultaneously with an augmentation to make the breasts larger but in extreme cases it’s better to do them separately or in stages.
So, how do I know when the breast will need a lift? The answer is in the proportions. I measure the distance from the collarbone to the nipple and if this is greater than 24 cm then most likely it will need to be lifted. Another clue is orientation of the nipples, if they are pointing straight down then they need to be lifted regardless of the measurement. The size of the areolas (the dark skin that surrounds the nipple) is also important, as they get larger when the skin is saggy or stretchy. Reducing their size along with centralizing their position is an essential part of restoring ideal proportions of an attractive breast. This is commonly referred by the vernacular as to going from “bologna to pepperoni”. The ideal size of an areola is about 4 to 6 cm in diameter but certain allowances can be given based on personal preference.
So far we’ve learned that a breast lift, also called a “mastopexy”, is performed to restore attractive proportions when the original breast has developed unfavorable ones. More often than not a mastopexy is performed in conjunction with an implant augmentation to improve the volume of the breast as well as enhancing the roundness and fullness of it. When an augmentation is performed alone in a breast with unfavorable proportions the results can be disastrous. There will be a mismatch between the breast and the implant that will appear worse than the original problem. Some practitioners will try to get around that problem using larger implants in order to expand and fill the saggy stretchy breast. Most often that will lead to unreasonable breast sizes that invariably make the patient uncomfortable and eventually the breast will sag even more in the short term. Fortunately, this situation can be corrected by providing the lift in conjunction with a reduction in the size of the implants. I’ve helped many patients in this situation who also happen to have old saline implants placed over the muscle. The conversion to silicone implants under the muscle along with a mastopexy has proven to be a very useful procedure in my practice restoring breast harmony in many grateful patients.
I think the reason many patients are reluctant to consider a lift is because in order to modify the unfavorable features of a breast you need to create skin incisions and therefore scars that are permanent. Luckily, new techniques available for this minimize the amount of scars. Also, the craftsmanship of a skillful plastic surgeon will help produce high quality scars that are located in a private area that very few people would have a chance to see.
If you still need to decide between a lift and an augmentation, please schedule a consultation with a board certified plastic surgeon with a good reputation and ask around for references. Many people, not just one acquaintance, will recommend the best surgeons.