Augmentation mastopexy is used to treat breasts that need to be lifted and reshaped as well as enlarged. Both a lift and an enlargement can give a better result than either alone in a number of situations. Breasts can sit in a low position (mammary ptosis) after pregnancy, breastfeeding, weight loss, due to aging or can naturally have developed with a low-lying shape. If you have a low breast with a reasonable breast size (volume), then a breast lift alone can lift and reshape your breasts. Or if you have a small breast with a good shape, then breast augmentation alone will enlarge your breasts and give a good shape. But if you have very small breasts that are low-lying and/or with very loose skin or would like larger breasts as well as more lifted breasts, then a breast lift combined with breast augmentation (augmentation mastopexy) is a better procedure.
Augmentation is usually done by adding a breast implant but can be done using your own fat as well (lipoaugmentation). Breast implants come in a wide range of sizes and shapes. Most commonly, silicone gel implants are used but they may be a silicone shell filled with saline. A range of different implant surfaces are also used. Lipoaugmentation tends to be more subtle and lower volume than implant-based augmentation. However, the implant used needs to fit your breast and chest shape and size and should not be too large. Excessively large implants are heavy and will stretch and weigh down your breast tissue, thus counteracting the effect of the mastopexy (lift).
The mastopexy is done by lifting and reshaping your breast tissue. Excess skin is removed and small amounts of breast tissue may be removed for shaping purposes. Reshaping is done to both your outer breast and skin and to your inner breast gland as well. Small mastopexies may be done via an incision around your nipple only. Larger mastopexies where more lift and reshaping are needed, are done via a circumvertical or lollipop incision around your nipple and running down to your breast crease or via an inverted T or anchor incision running around your nipple, down to your breast crease and in the breast crease.
Most commonly both the mastopexy and the augmentation are performed together in the one procedure. There are a few situations where your surgeon may advise you to undertake them in separate procedures.
Light dressings and a support bra will be needed afterward. Support bras are usually advised to be worn between one and three months after surgery. You will also be advised on the care of your breast scars while they heal and fade.
Ensure you consider all aspects of a procedure. You can speak to your surgeon about these areas of the surgery in more detail during a consultation.
1.5 to 3 hours depending on the extent of lift and type of augmentation mastopexy
General anaesthesia (most common) or local anaesthesia and sedation
Day surgery unless combined with other procedures that require an overnight stay
Risks can include early risks of surgery such as bleeding, infection, seroma (fluid build-up), wound healing problems, clots in your leg veins, breast risks such as altered sensation of the nipple (usually numbness but can be oversensitivity, usually temporary but can be permanent), asymmetry, recurrence of lax, sagging tissue, loss of tissue including the nipple and areola, poor scarring and implant risks such as capsular contracture (tight scar tissue around the implant), implants not sitting in the correct position, implant rupture, development of breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) or breast implant associated-squamous cell carcinoma (BIA-SCC) (uncommon forms of cancer found in the capsules around breast implants), breast implant illness symptoms.
Risks can be reduced by having your surgery at a healthy and steady weight, planning your surgery in relation to pregnancies and your lifestyle, avoiding nicotine in the run-up to and recovery from your surgery, optimizing any health conditions e.g. diabetes and following your surgeon’s aftercare advice.
Your breasts will be swollen, tight and tender, particularly in the first two weeks, but usually up to six weeks. Your breast tissue will gradually soften as you heal and as the swelling goes down. Depending on the technique and implant used, you may have to allow some time for the final shape and implant position to take place. You will need to wear a support bra and look after your scars as your surgeon advised. One to two weeks off work is usual. Return to exercise is after six to eight weeks.
Results are long-lasting but are affected by weight gain, weight loss and hormonal changes such as pregnancy or breastfeeding. The average lifespan of a breast implant is 10 to 15 years so you will need to allow for future surgeries to change your implant. Breast aging will continue as well but from a new, more lifted position. Mammograms and other breast scans can be performed once you have healed but you should notify the radiographer of your implants and surgery.