The Cosmetic Surgery Times recently published an article discussing the complexities of combined breast lift and breast augmentation procedures, revealing how doctors assess sagging breasts and make breast enhancement recommendations.
In the article, Dr. Angelo Cuzalina underscored the importance of choosing the correct procedure(s) and surgical incision placement to enhance the breasts. In addition, Dr. Cuzalina encouraged surgeons to use a customized approach and let each patient’s unique goals, breast anatomy and degree of breast ptosis, or sagging, dictate whether breast lift, breast augmentation or both is the best option.
“For many reasons, simultaneous breast lift and augmentation is one of the most difficult of all cosmetic surgery procedures. First, no two breasts are the same, and each patient is seeking a different endpoint, sometimes with unrealistic expectations,” says Dr. Cuzalina
For Eugene breast enhancement patients, Dr. Daniel uses the Regnault classification system to determine which procedure(s) are needed to provide optimal breast enhancement results.
Patients with the most severe ptosis (grades III and IV), breast tissue is often ample and a breast lift alone is needed. However, some patients who have sagging, deflated breasts may opt for breast augmentation as well as a lift.
Lollipop breast lift incision
Incisions for patients with a greater degree of sagging are usually a lollipop pattern (around the nipple and vertically along the bottom of the breast) or an inverted-T pattern (lollipop incision plus incision along the inframammary crease).
Inverted-T breast lift incision
In patients who have a lesser degree of ptosis (grade I and grade II), a breast lift is also recommended, and may be performed with or without implants depending on the amount of natural breast tissue present.
However, patients with less breast droop typically require less extensive incisions that are placed only around each nipple (periareolar) or in a lollipop pattern. Patients who choose silicone breast implants may require an incision in the inframammary crease or along the underarm.
Finally, in patients with “pseudoptosis,” where the nipple is above the inframammary crease on each breast, breast implants alone will often correct mild sagging by increasing breast projection.
In all cases where mastopexy (breast lift) is combined with breast augmentation, Dr. Cuzalina reminds doctors and patients that the procedures can be staged to ensure safety.
“While there is no dogmatic way to approach the simultaneous procedure, it is helpful to remember a few basic guidelines,” said Dr. Cuzalina.
“Avoid the temptation to always do a periareolar mastopexy in order to use the shortest incision possible, understand that it is sometimes good to also remove tissue to maintain implant position long-term and while patients may resist the idea, keep in mind that a staged approach, performing mastopexy first and then augmentation three months later, is always an option with a tried-and-true safety record.”
