Ruminations on augmentation-mastopexy

Lavinia Chong, MD
Article by
Orange County Plastic Surgeon

Augmentation-mastopexy is a difficult operation for many reasons. From the patient's perspective, scar quality, extent has to be acceptable and the longevity of the "lift" should justify the need for additional cost and uncertainty. Many surgeons feel that this procedure is a contradiction as the implant stretches, thins and possibly compromises scars and relapses. Both parties desire a beautiful breast, excellent, short scars, soft mobile breasts, which don't descend too quickly and no post-op complications. Patients often ask what I do first and it's usually the lift because of a comment offered by my long-term scrub tech. She observed that the most satisfactory breasts were those with equal volumes, congruent nipple position which were implanted with prostheses, whose base diameter approximated the patient's chest and were not overfilled. 

PS are frequently asked how many "cc" are required to produce a specific cup size. My standard response is that eventual cup size is a function of what the patient has and what implant is used. However the dimension of the patient's chest should ideally match the "base diameter" of the implant, to avoid either excessive distance between the breast mounds or conversely insufficient distance ("uni-boob"). The development of intermediate and high profile implants have enabled PS to configure breasts according to the woman's frame and aesthetic ideals. The choice of saline or silicone, smooth or textured depends on the dialogue between patient and PS but ultimately should result in a "hand in glove" fit, so that the implant and natural tissue becomes a single unit. Patients who need a lift often observe that they prefer slightly firmer breasts.

Although there are certain parameters, which should be factored, such as the diameter of the patient's chest, degree of mammary ptosis, quality of the skin and desired aesthetic outcome, we usually "simulate" by sizing a patient's bra. It's a useful technical exercise, which has a high positive correlation with post-op outcomes. Women who have significant droopiness often opt for "high profile" style which creates extra fullness in the upper pole and structures the overlying breast tissue. Others whose chests are wider and target a less exaggerated result choose the mid-range profiles. Choice of saline or silicone? For comparable volumes, and profiles, silicone is slightly less dense and will "drop" slower but project less.So often it's a matter of patient preference, budget and whether the intrinsic skin brassiere will "contain" it.