When Accepting Scars on the Breast Gives You a Prettier Breast Shape & Position

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No one wants scars on their breasts but every woman wants pretty breasts.  In cases where ptosis (droop) exists, accepting incisional scars to lift the breast results in a prettier breast shape as opposed to augmentation alone.  An implant that augments the breast alone often doesn’t necessarily make it more attractive and can at times give an unattractive appearance.  As a plastic surgeon, it is important to educate patients so they get the end result they desire and that requires a determination as to whether a lift must be done in addition to an augmentation. 

Most women want to have upper pole fullness and cleavage and don’t want to be required to wear a bra to have it.  In certain situations, this may require a lift (See Pre-Op photos).  However, if a woman has a low slung breast with acceptable nipple areolar positioning and likes that look and simply wants it to be bigger, an augmentation alone will do the trick.  Overtime, the weight of the implant may worsen the droop. The implant may need to be placed above the muscle which has been shown to increase the risk of capsular contracture or hardening of the breast.  The results may lead to eventual disappointment or the need for additional surgery. 

As a general rule, most women want a breast mound higher on the chest wall and thus the need to position the implant submuscular, in part supported by the muscle.  If a properly placed implant alone is inserted into a patient with a droopy breast, a defect can result where the breast “snoopies” or “waterfalls” off the implant.  This can be very unattractive (Exhibit 1 and 2).  In these patients, a lift is done in conjunction with the implant placement, raising the nipple and breast tissue so that it is centered overlying the implant at the correct higher position on the chest wall (Exhibit 3, 4 and 5). 

To lift the breast, one must accept additional incisional scars on the breast.  Depending on the degree of droop (Grade I-IV), various incision have to be considered.  In mild ptosis, an incision all the way around the areola

(Donut Mastopexy) will suffice.  If moderate ptosis, a lollipop incision around the areola and vertically down to the bottom of the breast will suffice.  In the higher grade ptosis, patients will require a Wise pattern or anchor type scar. 

I understand the aversion to scars but it is extremely important to get what you want appearance wise.  While it is possible to convert the low slung augmented breast into a higher, perky breast, the operation requires an accomplished and knowledgeable surgeon with experience or the risks can be great, including tissue loss.  I look at it like going to the car dealership and buying a car.  If someone gave you the money to buy the car of your dreams and your heart was set on a silver sports car, you would leave disappointed if you ended up with a yellow minivan although the price was the same.  Ask for photos, understand your options, and ask questions.  Technically, an augmentation alone is a much simpler operation for me to perform but I had much rather do a breast lift (Mastopexy) with augmentation if the need is there because I know the patient will likely be happier.

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Jackson Plastic Surgeon