Augmentation / Mastopexy
Women who have undergone breast augmentation are susceptible to breast ptosis (sagging breasts), which might be induced by the physical and mechanical stresses exerted by the breast implants upon the internal tissues and the skin envelope. Such over-stretching thins the skin and atrophies its elastic qualities.
Statistically, breast augmentation and mastopexy (breast uplift surgery) are plastic surgery operations with low incidence rates of medical complications.
Yet, when performed as a combined breast-repair procedure (mastopexy–augmentation), the physiologic stresses upon the health of the woman increase the risks of problems such as incision-wound infection, breast-implant exposure, damage to the breast and nipple nerves, malposition of the nipple-areola complex, and malposition of the breast implant in the implant pocket.
Therefore, a mastopexy–augmentation procedure features increased surgical complication rates, when compared to the lesser complication rates of breast augmentation and mastopexy as discrete surgical operations. Likewise, the individual incidence rates of surgical revision and complications, when compared to the revision and complication rates for the combined mastopexy–augmentation procedure.
Recent studies of a newer technique for simultaneous augmentation mastopexy (SAM) indicate that it is a safe surgical procedure with minimal medical complications.
The SAM technique involves invaginating (folding in) and tacking the tissues first, in order to previsualise the final result, before making any surgical incisions to the breast.
In realising a breast lift, a conservative surgical technique produces the fewest, least visible scars after excising (cutting) excess folds of skin from the skin-envelope, when either replacing, rearranging or augmenting the internal parenchymal and adipose breast tissues.
Breast lift techniques are known according to the number of scars produced, which is related to the achievable degree of breast lift.
Pre-operatively, the patient and the surgeon decide upon the appropriate surgical technique (superior, medial, or inferior pedicle) that will achieve the best degree of breast lift.
Generally, breast ptosis (sagging) is determined by the locale of the nipple-areola complex upon the breast; the lower the nipple-areola complex, the greater the degree of breast prolapsation (ptosis).
Nonetheless, in breast-lift surgery, the primary consideration is the tissue viability of the nipple-areola complex, so that the outcome is a functionally sensate breast of natural size, contour, and feel.
The surgical management of breast ptosis is evaluated by the degree of severity.
Grade I: Mild breast ptosis, which can be corrected with breast implant augmentation, or with a periareolar skin resection (crescent lift), with or without breast augmentation.
Grade II: Moderate ptosis, which can be corrected with a circumareolar doughnut mastopexy technique featuring Benelli cerclage suturing; and with circumvertical-incision (lollipop mastopexy) techniques such as the Regnault B Mastopexy and the Lejour–Lassus breast reduction.
Grade III: Severe ptosis, which usually can be corrected with the circumvertical and horizontal incisions of the Anchor mastopexy (inverted-T incision), regardless of the type of pedicle used (inferior or superior).
Repairing False Ptosis
Pseudoptosis, or false breast prolapse, can be addressed in two ways:
1) With a breast augmentation or a skin excision, or with both; and without transposing the nipple-areola complex, which requires cutting the skin of the lower pole of the breast.
2) With the circumareolar suturing that encircles the nipple-areola complex. To achieve the desired degree of breast lift in accordance with the woman’s anatomy, the circumareolar mastopexy technique (circumvertical lift) can be modified with an additional vertical incision.
The extra skin-envelope tissue remaining after a vertical-incision technique can either be gathered in a series of pleats, along the vertical limb of the incision, or resected, cut and removed, at the inframammary fold (IMF), thereby producing a horizontal incision of varying length, as in the circumvertical and horizontal breast lift.
A Novel Technique Of Augmentation Mastopexy
It is not uncommon to lose breast volume in the upper part of the breast subsequent to childbearing and breastfeeding. Furthermore with age, the breast and the nipple tend to gravitate to a lower level on the chest wall, creating breast ptosis. Ladies wishing to have breast augmentation want an augmented, perked breast. To achieve a perfect cosmetic result after breast augmentation, it is of paramount importance that the nipple position is also raised on the chest wall so that the nipple is sitting at an ideal height (at the level of the inframammary fold or at the level of the junction of the upper two-thirds and lower one-third of the arm). Breast implants, chosen appropriately, will raise the nipple and the breast to the desired position in most cases, but at times it is not possible to achieve without performing an additional procedure called mastopexy. Mastopexy is traditionally done with either wise pattern or vertical pattern technique ,which involves further scarring.
To avoid additional scarring, a novel technique of intrinsic mastopexy is possible in certain ladies who only have pseudo-ptosis. This technique is extremely valuable when the breast has lost all the volume from the upper pole, and the nipple position has dropped 3 or more centimetres from its ideal position. There is no additional scarring and the procedure is performed through the same incision as for breast augmentation (5-6cm incision under the breast).