For many patients a breast augmentation alone will not correct the size and shape issues affecting their breasts. Women who are wanting to increase the volume of their breasts with an implant may sometimes also require a lift (Mastopexy) of the breast along with an Augmentation to lift the areolar and nipple and form a full breast. This most commonly occurs after pregnancy, breastfeeding, or significant weight loss. In this situation often a replacement of the lost volume with an implant is required, and also a reduction in the amount of skin and elevation of the nipple is required to achieve the desired breast volume and shape. However, in many cases, it may be recommended to perform the two procedures on two separate events in order to create a result where the breast is initially uplifted to create the correct orientation and position of the nipple and the second surgery to create fullness by inserting the implant.
- Who is a candidate?
- What does the process involve?
- Types of implants
- Staging the procedure
- What can you expect after the operation
- Post-operative activity?
- What are the potential risks?
Who is an appropriate candidate for breast augmentation with mastopexy?
Women who desire larger, full shaped breasts with the nipple repositioned but are not suitable for a breast augmentation on its own.
What is involved in the operation?
A breast augmentation with mastopexy is a much more complicated operation than either a breast augmentation or a mastopexy alone. It involves placing the implant and adjusting the the breast tissue and skin in order to create an appropriate firm envelope around the implant with an appropriately placed nipple.
The aims of the procedure are:
- To place the nipple in a higher position as there may be some breast ptosis.
- Fill the breast, particularly the upper pole with an implant.
- Tighten the breast in the horizontal and vertical directions and try to keep this as a stable situation.
The operation is performed under general anaesthetic, generally as a day case and takes several hours. In most cases the tightening of the breast envelope will require a scar around the nipple and vertically down the breast, and, not infrequently, horizontally in the crease.
There is the occasional individual who is borderline for a mastopexy, in whom a peri-aerola mastopexy can be performed, leaving just a scar around the nipple, along with the small scar in the crease to place the implant.
What implant should we use?
Generally, for breast augmentation with mastopexy Dr Craig Layt—our experienced plastic surgeon—uses a round, textured, silicone gel implant placed under the muscle. The size of this can be determined using our VECTRA® imaging software. This enables us to take a 3-dimensional image and manipulate that image to perform a lift and then place an implant. This can help the decision-making process with regards to an implant size combined with a dimensional planning approach.
The best way to think about this is to consider it like building a house. The base of the breast is like the basement of the house and obviously needs to fit on the land, that is the chest. Once we have worked out the basement of the implant then the volume really comes from how many floors we place on it. This analogy is a good way to think about both breast augmentation and the implant in breast augmentation with mastopexy. This will be discussed at some length during your consultation.
Breast implants are not lifetime devices and will require replacement or the patient may wish to replace for a variety of reasons.
Breast Augmentation & Lift Photos
These before and after photos are of patients that have had surgery performed by Dr Layt. These patients have consented to the photos being shown. These are actual photos and have not been altered or digitally enhanced. Every patient is an individual and therefore final surgical results will vary from patient to patient.
Staging the procedure?
Classical teaching with regards to a breast augmentation and mastopexy was to stage the procedures and perform a mastopexy first, and subsequently return and augment the breasts. In some cases this can be done as a single procedure safely and with predictable results. Because, in some ways they are the “opposite procedures” (that is, tightening the tissues and placing a weight in them), there is obviously an incidence of revisionary surgery being required to further tighten the tissues to achieve the desired result. However, with many cases, the patient and surgeon will decide on a staged approach –
1. Lift the breast and correct the nipple position, followed by
2. Augmentation to increase the volume of the breast.
This will be discussed during your consultation.
What can you expect after the operation?
Most patients awake feeling a little tight in the chest but generally comfortable. No drains are used in most cases. You will have a bra on and some light dressings. We will either see you at the practice or talk to you on the phone the next day to answer any questions you may have. We will then see you seven days later for a change of your dressings.
Post-Operative activity?
We encourage some gentle stretching exercises (see video in this section) for your pectoral muscles in the post-operative period and this can help relieve the tightness that sometimes happen. Apart from those exercises you should limit yourself to walks for the first week. At one week you can increase your activity to walking on a treadmill and leg workouts. These activities can be slowly increased until full aerobic/weight training at approximately eight weeks.
Breast implants or not, all women and men should self check their breasts and see their GP if there are any changes or concerns regarding their breasts.
What are the potential risks and complications?
Surgery is not an exact science. Incisions and scars are part of any surgery and the location and extent of the incisions will be discussed with you. Every effort is made by the surgeon to minimise scarring. Scars will fade over time, but they are permanent. They can also become hypertrophic or keloid. Scars vary from person to person and are related to each individual’s skin type, genetics and the ability of their skin to heal.
Every surgical procedure involves certain risks and complications (as per the ASPS brochure) including, but not limited to:
Asymmetry is evident physically in every person. No two sides of the body are ever exactly symmetrical in shape, position or size and the surgeon will make every effort to achieve as close to symmetry as possible but some asymmetry is normal.
Delayed Healing, Infection and Suture Reactions can all be possible healing issues and may require antibiotics or in some cases surgical exploration.
Bleeding, Haematoma or Seroma Collections may resolve themselves but, in some cases may require further surgery.
Loss of Sensation and Numbness may also be experienced. In most cases this will improve over time on its own. In some cases this can be permanent.
Bruising and Swelling may also be a short term effect from surgery and will usually settle in one to two weeks.
Allergies to dressings, medical lotions, sutures or other materials can occur with some patients. You will be advised to cease the use of the dressing, lotion or material that is causing the reaction. In some cases anti-inflammatory medication may be prescribed.
Breathing Difficulties may be due to a general anaesthetic or breathing tube during the operation which has caused some swelling, noisy breathing or discomfort.
Blood Clots can also occur in some surgeries and may require urgent treatment and hospitalisation.
Pain thresholds vary from patient to patient. This may lead to different pain management and/or different recovery times to resume normal activities.
Achieving excellent results with minimal risk is a joint effort. It is important to disclosed to the surgeon and clinic and understand the following:
Full disclosure of your medical history including: allergies, personal, physical and mental history, previous surgeries, current medications and co-morbidities (including but not limited to, smoking, vaping, diabetes, prescription and illegal drug addictions, blood or heart disease, obesity or anorexia).
Co-morbidities may impact on outcome and healing post surgery.
Smoking, vaping, or taking recreational drugs must be ceased in the 6 weeks prior to some operations and during the healing phase. Failure to do so may increase the risk of complications, decrease your healing ability and affect your surgical outcome.
You should not take aspirin based prescription drugs 14 days prior to surgery and during the healing phase of the operation unless advised otherwise by the surgeon.
As per the Australian Health Practitioner Regulation Agency (AHPRA), all non-rebatable (cosmetic) procedures require a validated screening of Body Dysmorphia to be undertaken.
If Dr Layt is concerned about your mental state or physical state prior to the procedure, he may request evaluation by a psychologist, psychiatrist, general practitioner or other specialist. This referral is to assess your suitability, increased risks during surgery or any underlying physical or psychological problems which may affect your recovery or mental health.
In some cases this may require surgery to be postponed or cancelled by the doctor in his primary role to consider your care and personal well-being.
Risks if having breast implantation:
Pregnancy may cause breast enlargement, cause breast tissue to stretch and a degree of ‘drooping’ of the breast tissue. This may require the breast to be surgically lifted however some poor skin integrity may have a tendency to stretch and continue to ‘drop’.
Capsular Contracture (less than 1%) occurs when the scar surrounding the implant thickens and tightens around the implant. This can make it feel hard, look unnatural, feel uncomfortable and may occur months to years later. Should this occur, a capsulectomy and a remove and replacement of implant/s may be required in the future.
Implant Rupture can occur after injury or years of repetitive action in the same part of the implant. MRI is the gold standard to assess this as Ultrasound shows a false positive reporting for rupture in approximately 30% of cases. A ruptured or leaking implant will require surgery of removal and replacement of the implant.
Implant ‘Wrinkles’ and Palpability can also be noticed. All implants ripple to a degree. If there is reasonable tissue coverage this will not be noticeable. If there is little overlying breast tissue and fat this is more likely.
Anaplastic Large Cell Lymphoma (ALCL) is a rare tumour of lymphoid cells in the breast which has recently been found to have an increased incidence in patients with textured breast implants. ALCL relates to a patients genetics, a textured implant and bacteria being present. This may present as a unilateral swelling of a breast due to fluid accumulation. When detected early, this is treated by removing the fluid and the implant. Dr Layt has and continues to perform this procedure utilising the 14 point plan to minimise the risks of ALCL, capsular contracture and other complications relating to using an implant.
In summary, the risks of bleeding, haematomas, capsular contracture, ALCL, infection, asymmetry, scarring, seroma, pain, palpable implant, loss of cleavage, sensation, implant malposition, implant rupture/leakage and breast feeding are discussed through the ASPS and The Layt Clinic information on Breast Augmentation. Implants may be removed and replaced over time and they are not lifetime devices. Implants used are registered with the Therapeutic Goods of Australia (TGA) and patients will be sent Patient Information Leaflet (PIL) regarding the implants chosen.
There is no such thing as “risk free” surgery. The important things are to understand potential risks, minimise their occurrence, and treat them early to avoid small issues becoming more severe. Please see Breast Augmentation and Breast Lift for further information.