When speaking to a patient who presents with this complaint, I first ask whether or not she likes the shape and size of her breasts when she is wearing a bra. If the answer is “yes”, then I will suggest that a breast lift might be all that is required. In this case, after performing an examination which includes measurements of the breast position, width, and skin stretch, I sit down with the patient and discuss mastopexy, or breast lift surgery. In this operation, incisions are typically made around the areola and vertically on the breast. The breast tissue is elevated on the chest wall, and the base of the breast is re-shaped to create a pleasing, rounded contour.
If patient says, “no” when asked if she likes how her breasts look in a bra, then we need to dig a little deeper and see what specifically about her breasts bothers her. If a patient feels that her breasts are too small when she is in a bra, then we begin a discussion about breast augmentation. The breasts are again examined, with particular note of the base width of the breast and the amount of skin stretch. Both of these items will determine the best implant size and shape for a given patient. The surgery is typically performed through an incision at the base of the breast, or around the nipple-areolar complex, with placement of the implant behind the pectoralis muscle on the chest wall.
In some cases, an isolated technique will not achieve a patient’s goals, and an augmentation-mastopexy may be required. For example, some patients who mainly want to increase their breast size may also have ptosis, or sagging of the breasts. In these patients, an additional incision either above the nipple-areolar complex, or straight down on the breast, may be required to lift the breast tissue into position while also adding more volume. Some breast lift patients will note that while they mainly want the breasts to be lifted, they also desire superior pole fullness. The superior pole of the breast is the area right above the nipple-areolar complex which fills out beautifully during pregnancy and breast feeding. This is also the area that, sadly, tends to lose the most volume following breastfeeding and weight loss. To produce long-lasting fullness in this area with a lift, an implant needs to be placed. Short of implant placement, the only other device which can create the appearance of fullness in the upper pole is a good push-up bra.
Aesthetic breast surgery can be incredibly rejuvenating for many women. It is absolutely my favorite area of surgery, and I am always happy to spend the time needed to ensure that patients make the best decisions to help them attain their goals.[:]