When a patient wears an A-cup bra, it is a fairly easy diagnosis—this requires a breast augmentation at my Columbus, Ohio, practice to increase the size and fullness of the breast. But what about the patient who has a B- or C-cup breast size? Or what about the patient who used to be a C- to D-cup size but after weight loss or pregnancy is empty, deflated, and sagging? And then there is the patient who has a D-DD bra size—and likes the size, but the breast shape is low or saggy?
These can be difficult decisions to make, and there is no one answer for these questions—it all depends on the patient’s anatomy and goals. A board-certified plastic surgeon can discuss all the options and help guide the patient to the right decision for her based on her particular needs.
In this blog post, I will define some common breast enhancement terms used, as this combination of procedures is called many things and can be confusing. After that, I will go over the pros and cons of each surgical option to help narrow down the choice for each patient.
What Is the Meaning of Breast Augmentation?
To begin, breast enlargement or augmentation is straightforward. This, of course, is just making the breasts larger with either implants or fat grafting. The implants can be saline or silicone gel, and the result is what the patient starts with plus the implant. So if the patient has an A cup to start—the result will be mostly due to the implant.
But when a patient has a larger breast size, more options and decisions have to be made about the breast tissue itself. The choices are:
- Do a lift alone, or
- Do the lift with an augmentation
What Do They Do In a Breast Lift?
Breast lift (mastopexy) is a confusing term in this mix. Technically, a lift only removes skin or tightens the skin but does not strictly remove breast tissue. However, the vast majority of the time, the breast lift removes a portion of the breast tissue. (It is not called a breast reduction, though, as this implies the case is a medically necessary procedure to make the breasts smaller to alleviate physical symptoms like neck pain or shoulder grooving.) But in reality, a breast lift or mastopexy is a tiny breast reduction.
It seems ironic or even like we are being facetious when we talk about doing a breast lift to make the breasts smaller and higher but then also adding an implant. The anatomic issue is that the breast tissue has fallen to the lower part of the breast. And while we plastic surgeons have tried to figure out ways to make it stay in the upper pole when we do the breast lift, the skin always stretches out again due to gravity, and the breast tissue falls back down.
So to get around this, the lower tissue is removed, and a small implant is placed in the upper pole to give upper pole fullness—thus, the final result is a higher, perkier breast that is about the same size as the breast before surgery. This can be called an “Aug-Pexy” or sometimes a “plus-minus” breast augmentation—to indicate the implant is added and some of the actual breast tissue is removed.
Should You Get a Breast Lift With Implants or Just a Breast Lift?
To really understand whether an augmentation, breast lift, or both are needed, let’s look at a few situations.
Breasts Deflated by Aging, Breastfeeding
The common scenario is a patient who had very nice D to DD-cup breasts when she was younger. Due to natural aging, pregnancy, and breastfeeding, she now has breasts that are still fairly large but empty with large floppy skin envelopes and enlarged areolas. These patients have visions of the former glory days and just want their old breasts back. So it is a difficult discussion—as even with the best surgery, the result may not be what they remember. I believe these patients must accept the compromise of the mastopexy with the requisite scars and an implant with the upkeep issues. We talk more about this issue in a related blog post.
Slightly Sagging Breasts
A small subset of patients have breasts that are just a little low, just a little saggy, but mostly just empty or deflated. In this case, it is possible to do just the implants and fill up the skin again. The trade-off in this scenario is that the implants may need to be a little larger than the patient first desired, but it is necessary to fill out the skin. And in this scenario, a future breast lift may be needed as the patient ages and her skin envelope continues to stretch over time.
The hardest scenario is when the patient is carrying a little too much weight—usually 20 to30 pounds too much—making the breasts large and low. When she asks to have them up high again, the best answer is just the mastopexy. Adding implants to a large breast usually only accentuates the higher BMI and does not add much to the aesthetic goal.
Breasts After Massive Weight Loss
The massive weight loss patient is a separate category completely—their skin envelope is no longer elastic, and often the breast is flat and low. For this subset of patients, I find it safest to do the breast lift first and, at a second stage, add the implants. While this requires two trips to the OR, the final result is better. And many times, there is another operation for body contouring done at the second stage.
Breast Lift First, Augmentation Later?
There are other times that I counsel the patients that a staged procedure is the best course of action. There are times when the patient does not know if she really wants an implant and all that goes with it. In this case, it can be a good decision to do the mastopexy and just see how she likes it. The new, higher, firmer, and smaller breast contour can often be quite acceptable, and no implants are needed. But after living with it for a period of time, if more fullness is desired in the upper pole, an implant can be added then.
You can see some of my answers to questions about these types of scenarios on RealSelf.
Choosing the Right Option for You
The decision-making process for the augmentation-mastopexy question is one of the hardest and most complex decisions in plastic surgery. You can take a look at some of my patients’ breast augmentation before and after pictures and breast lift photos to get an idea of the types of results that are possible.
If you are considering a breast lift or breast implants, just call our Columbus, Ohio, office at (614) 569-2649 to set up your virtual consultation. Or use our online form to request a consultation. Combining the augmentation and the breast lift makes it possible to create an attractive breast contour that is both higher and larger. Breast Wishes!