Breast Lift with Breast Augmentation
While a breast implant alone may be all that is needed for women to having small degrees of breast ptosis (“droop”), for the majority of women who want a more uplifted shape together with larger breast size, a combination of implants and a breast lift are needed to give the best result. The first important decision is whether the lift and implant operations must be done separately, or whether they can be combined at one stage.
Staged approach (2-step)
The traditional 2-step approach, in which the augmentation surgery and the lift surgery are done separately, is used for selected patients. It works well for women who are having a breast augmentation that are unsure about having a breast lift, or women who are having a breast lift who are unsure if they want the extra volume from an augmentation. While it has the advantages of a lower overall complication rate and better quality scar formation, the disadvantage is having two anesthetics and two recovery times.
For patients who have had massive weight loss, or those who have very stretchy, lax skin on the breast, the staged approach can be more successful. Stage one is the breast lift, in which the excess skin is removed, and the nipple is repositioned in a higher, perkier position. Four to six months later, the implant is placed, allowing a second opportunity to take care of any breast skin that has stretched out a second time, as commonly occurs in this group of patients with decreased skin elasticity.
For patients with severe droop – and a lot of breast tissue hanging below the level of the breast crease, Fiala Aesthetics usually recommends the two-stage approach, as well.
Combination implant + lift approach (1 step)
The modern approach is to do this as a one-step combination surgery. In women with a mild to moderate degree of breast droop, we can place the breast implant and do one of our short-scar breast lift operations at the same operative setting. This is very popular with our Orlando patients. For example, the “donut” lift and the vertical or “lollipop” lift incisions lend themselves well to this technique in many cases. These operations are described in more detail on the “breast lift” page of the website.
There are, however, a few limitations with this approach. It’s certainly a more complex operation than either a lift or an augmentation separately since many landmarks of the breast are all being changed at the same time. Sometimes, minor adjustments later may be beneficial. Also, since the implant is taking up some of the skin loosenesses, the amount of lifting and tightening that is possible is reduced. The size of the implant used may also be more limited since we don’t want excessive tension on the fresh breast lift incisions from a large, heavy implant.
Also, with the combination of an implant and lift, we can sometimes reduce the amount of external scarring by changing the type of lift that is performed, compared to the lift that would have been necessary if an implant were not being used.
Dr. Fiala also offers the “internal bra” technique, using the Galaflex surgical scaffold material. Galaflex is made from the same material as surgical sutures, and slowly reabsorbs over 18-24 months. It helps to maintain a long-term uplifted breast shape, and has an excellent safety profile.
Dr. Fiala will advise you on the specifics of your situation, at the time of the consultation.