Breast lift and augmentation? (Photo)

47 y/o previously DD, breast fed 14 years ago. After previous question, realize the best lift procedure is either the 'lollipop' or 'anchor' incision w/ the amount of ptosis I have. Question regarding augmentation. Is fat transfer an option to receive the adequate projection and fill after mastopexy? Are the two procedures usually done concomitantly? What are the pros/cons of using fat transfer vs an implant? I appreciate any information. Thank you.

Doctor Answers 7

Lift with implants of fat ?

You are correct in that you are a candidate for a lift and you are also correct that a lollipop or a small anchor would work as far as the skin incision. So the question is about the internal aspects of the procedure. While there are many approaches to how the breast tissue is handled , this determines whether or not far grafting is feasible and safe. I agree with the prior answer that implant surgery is more predictable but if a patient is absolutely opposed to implants then I feel fat grafting is safe and reliable enough as long as the patient is open to possible second stage of fat grafting at a later date. A consultation with plastic surgeon with extensive experience in both technologies will allow you to choose. This type of technology is cutting edge so be careful to select not only a board certified surgeon , but one who is known for teaching other surgeons , traveling to meetings worldwide  , and being involved in innovative technology. Fat grafting is highly dependent on technique and the techniques have been evolving rapidly over the past few years. Also be sure to get past the hype of advertising and look closely at credentials. I wish you all the best. 

Birmingham Plastic Surgeon
4.5 out of 5 stars 11 reviews

Breast augmentation and lift candidate, some advices:

Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection, and 450ml will be excelent on you, to fill the breasts properly.
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 147 reviews

Breast lift and augmentation?

Thank you for the question.  In my hands,  the most predictable/reliable way to increase  breast size would be with the use of breast implants.   Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%. 

Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.

Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications. 

Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only. For example, some patients who wish to maintain long-term superior pole volume/"roundness" or "implanted look" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc). 

Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved. Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery. Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.

I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future.  The attached link may also be helpful. Best wishes.

Breast lift and implant?

I agree you need a breast lift. If you want additional upper pole fullness then the least expensive most straight forward way is to place an implant at the some time as the breast lift. If you are opposed to an implant and not picky about the exact final size, fat transfer can be a great option, and you get to get rid a some fat from somewhere. However, a major fat transfer would need a second procedure since the breast is so dissected during the lift to receive so much fat then. I love doing fat transfers, but it is not the best option for all. Discuss this with a plastic surgeon who does all these options. Good luck.

Breast Lift with Implants

Hi RN,Please put an index card in your breast fold.  If your nipple is at the edge of the card or below, then you would be a candidate for a lift, either a vertical or anchor or areolar incision.  If your nipple is above the edge, you could be a candidate for an internal lift called the dual plane.  Please see the web reference and video reference below. An implant will often give a good foundation to lift your breast, so you may want to give this some thought. I DOUBT FAT TRANSFER WILL DO IT FOR YOU. Yes, the surgery is done in one sitting, not staged.  I believe you would be a good candidate for a lift with implants.  Be sure to seek a consultation with a BC PS to be sure.  All the best, “Dr. Joe”

Breast lift and augmentation?

Thank you for your question.  In addition to getting a breast lift, augmentation with breast implants will typically give a more predictable result compared to fat transfer.  With fat transfer (especially large amounts), a good portion of the fat will resorb due to atrophy.  It's usually better reserved for touch ups and focal areas to fill.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck.

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 14 reviews

Fat transfer compared to breast implant

In my experience, because the structural integrity of an implant is more solid than that of fat graftin. I've had more success with primary breast implants at the time of mastopexy. I have gone back months two years later to re-augment the upper pole of the breast with fat grafts. If fat grafts were to be done as a primary procedure, it would not be prudent to do it at the same time as a lift for a couple of reasons. The fat preferentially would go into an avascular plane that had been dissected in order to do the left. Likewise, extra tension in the immediate subdermal plan may lead to increased risks of ischemia or lack of blood flow to the tissues. I would think it would be better to come back several months later and add the fat. Hope that's helpful.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.