AESTHETIC MEDICINE AND SURGERY
BREAST AUGMENTATION AND MASTOPEXY
Breast augmentation and uplift
Pregnancy, breast-feeding or weight fluctuations can determine resorption and descent of breast tissue. Of course, the natural ageing process contributes to a progressive loss of skin elasticity in the breasts. If the issue relates to residual gland and fatty tissue (fat), simple mastopexy would only achieve skin lifting with unsatisfactory aesthetic outcomes in terms of volume and shape. In these cases, to achieve breast augmentation and uplift, it is necessary to place a mammary implant during the mastopexy.
This surgical technique involves the excision of excess skin, concomitant glandular moulding and use of mammary implants. An accurate pre-operative examination allows the surgeon to select the most appropriate technique, based on the severity of the defect:
- Circumareolar mastopexy technique
This technique, used only in cases of minor/moderate breast ptosis, aims to uplift the breast and the nipple-areola complex by removal of a skin strip from around the areola with concomitant use of mammary implants. In this case the scar is circumferential and lies along the areolar border. Only deep dissolvable sutures are used.
- Short scar mastopexy technique (vertical or “J” scar)
This technique, used in case of severe breast ptosis, provides excellent results in terms of breast uplift and glandular moulding by removal of a skin portion at the lower breast pole with concomitant use of mammary implants. This technique aims to mould the lower breast pole by working on the glandular tissue. Again, scars are minimal: circumferential along the areolar border, with a vertical extension, or “J”, in the lower pole of the breast. However, the resulting scar can be hidden by a standard bra. Only deep, dissolvable sutures are used.
Regarding implant size and the resultant degree of augmentation, boundaries are set by the patient’s anatomical features, such as breast and chest width, i.e., the space available for implant placement. Another important factor to consider is the implant weight; the force of gravity contributes to the recurrence of tissue descent: the bigger the implant, the heavier the weight. Therefore, in breast augmentation with mastopexy, it is advisable to place moderate volume implants. Also, generally speaking, very big implants tend towards a less natural result. The surgeon will show the patients implants of a range of shapes and sizes in order to illustrate the expected augmentation in a tangible way to arrive at the best solution in each individual case.
Implants are usually positioned, in the upper pole, underneath the pectoralis major muscle (dual-plane technique). This guarantees better coverage of the implants, resulting in a less palpable implant and ultimately more natural results. Additionally, the new breast configuration will be more stable with a lower risk for capsular contracture (hardened and/or abnormal looking breast).
After the surgery, especially in the case of “J” scar technique, breasts are excessively high, more swollen in the upper region and stretched and square in the lower pole. Gradually, in the following weeks, they settle and achieve the appropriate shape.
Breast augmentation with mastopexy is performed under general anaesthesia (the patient is asleep) with a one-night hospital stay after the surgery.
Careful administration of pain-killers during and after the surgery ensures that post-operative pain and discomfort are kept to a minimum.