Breast augmentation / mastopexy (breast lifting)
surgery is one of the most commonly requested breast contouring surgeries
performed. Patients who seek to have this operation done generally wish
to improve the contour of the breast by lifting the nipple-areola complex
by tightening up the “skin envelope” and achieve increased fullness of
the breasts especially superiorly and along the cleavage area.
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 increase with
breast augmentation / mastopexy surgery done at the same time. Revision
mastopexy may also be necessary if the patient gains or loses weight or
becomes pregnant. Loss of breast skin elasticity may contribute to the
earlier need for revisionary surgery (repeat lifting) as well.
When breast augmentation / mastopexy surgery is performed, an implant
is used below or on top of the pectoralis muscle. The breast tissue and
skin is then elevated lifted) to cover the breast implant. This “lifting”
often involves skin excision, the areola, vertically and sometimes horizontally.
This skin excision serves to tighten the “skin envelope”. By doing so,
a lifted appearance of the breast is achieved and the loose-saggy appearance
and feel of breast tissue is eliminated.
Herein lies the competition and the potential risks and complications:
the mastopexy procedure by definition involves reducing the skin envelope
allowing for repositioning of the nipple-areola (and reshaping the breast).
Breast augmentation by definition enlarges the breast and expands the
skin envelope. Also, placement of an implant necessitates dissection of
a “pocket” that reduces blood flow. The blood flow is further compromised
by incisions used to reduce the skin envelope.
Because of these factors, while breast augmentation OR mastopexy surgery
is relatively simple and complication free, breast augmentation / mastopexy
surgery done together carries increased chances of complications and need
for further surgery. For example, there is an increased risk of infection,
implant exposure, breast asymmetry, loss of nipple-areola sensation, inability
to breast feed, mal-positioning of the nipple-areola complex, mal-position
of the implants, wound healing problems, tissue necrosis, loss of blood
supply to the nipple-areola complexes.
Any of these complications may require further surgery,
therefore, increasing the likelihood of revisionary surgery. It is important
that the patient understands the principles behind any planned procedure
of any breast augmentation / mastopexy surgery.
An understanding of the procedure will facilitate an understanding of
the potential risks and complications when they occur. A well-informed
patient may decide to stage the procedures (for example, perform the breast
lifting operation initially followed by breast augmentation at a later
date).