John E. Gross, MD (retired)

Perhaps you are referring to the 5th generation of breast implants?  

Since the first breast augmentations in the 60's one can look at the development and advances in the implant devices themselves and discern 5 generations of devices.

The mastopexy portion of the procedure you ask about has evolved over the years, but there is no clear 5th generation mastopexy.  Mastopexys have changed somewhat from in the past where most or all procedures involved leaving the inverted T, or anchor scar.

There are options that may leave less scar in the appropriate patient.

One way to think of the mastopexy/augmentation  procedure is to visualize the breast and break it down simply into a skin envelope and contents of that envelope.  The skin envelope is like mother nature's bra, and the contents are your breast tissue.  In patients that are considering a mastopexy there can be a mis match between the contents and mother nature's bra - the skin.  If that mis match is modest, then filling the contents with an implant may achieve a pleasing result--- from augmentation alone.  If the skin excess is significant, then a combination of filling the contents with an implant and a reduction of the skin envelope may be necessary to get a nice result- a mastopexy/augmentation.

The degree of skin excess (as well as the nipple position) determines what type of mastopexy may be appropriate.   As a generalization, the more skin excess and the more the nipple has to move up, the longer the incisions must be.  The options for mastopexy include a concentric mastopexy, with the eventual scar around the areola (taking out excess skin around the nipple only), a "circumvertical" which results in incision around the areola (nipple) and also a vertical scar below in the center of the breast (aka lollipop or tennis racket shape) and the more traditional inverted T (or anchor) shape.

There are many nuances to these decisions and consulting with an experienced, board certified ASAPS member will help sort it out. Get several consultations if you can.   Many times there is not one "right" answer, but finding the plastic surgeon who will review the options with you and discuss the trade-offs is key.

Be wary when someone markets a "New Generation" procedure.  With devices/implants there are distinct advances (or generations). With surgical procedures and surgeon's techniques, there are smaller, more incremental advances in approaches over time.  Many announcements about new procedures are nothing more than marketing.

There are many factors that go into the decision whether a full or mini TT may be best for you. Only after a physical examination can a specific opinion be given.   In general, though, most women of your size , that have had 3 pregnancies, would benefit from a full abdominoplasty.

There are several factors that help determine the need for a breast lift at the time of augmentation. These include the location of the nipple relative to the fold beneath the breast, the location of the breast gland relative to the fold, and the relationship of the existing skin/soft tissue envelope and the planned size and shape of the implant. Many times it is obvious to the patient and the evaluating surgeon that a lift is necessary to get a good result, eg if the nipple-areola complex is pointing straight down, or if the majority of the breast gland is sitting well below the fold of the breast. The descent of the gland is referred to as "glandular ptosis", the N-A descent is sometimes called "nipple ptosis". The position of the gland itself, as well as the relative position of the N-A complex are both important. For example if you are standing in front of a mirror, and the nipples are pointing straight down and most of the breast itself is below the line that your underwire makes---you would benefit from some type of lift.

Its really important to have great communication with your surgeon in the case of mild ptosis. There may be decisions to make that involve certain"trade-offs". For example it may be that adding a lift, which may involve additional visible scarring, improves the shape and quality of the result. You and your surgeon will discuss whether the anticipated improvement is enough to justify doing the lift.

In some cases placing the implant alone will help improve the appearance of a mildly ptotic breast without adding a lift. The spectrum of "lifts" starts with a limited incision, leaving a scar around the areola, next could be the circular scar with a vertical component(sometimes called a lollipop or tennis racket shape), and a traditional "full lift" with the inverted "T" scar. A consultation with an experienced plastic surgeon will help sort out all the options.

The "droopy mouth corner" you describe may be a result of a combination of several things.

One of the contributing factors may be over activity of a muscle referred to as the DAO(depressor anguli oris). BOTOX, used "off label" in conservative amounts may make a nice change in the position of the corner of the mouth. The number of units would range from 2-5, and starting at the low end of the range. There may also be volume loss in the area just below the corner of the mouth. The addition of a "filler", such as JUVEDERM, in many patients makes a beautiful difference. The use of a filler in this location is also considered "off label". Some patients may have both factors contributing and may get the most natural and beautiful result from combination therapy. A consult with an experienced provider can help you sort it out.

BOTOX is very safe and effective for reducing or relaxing muscle activity that contributes to lines or furrows. In some patients it can also be used to improve the position or shape of the eyebrow.