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Breast Lift with Implants - Orange County, CA

What is a Breast Lift with Implants (Mastopexy-Augmentation)?

A Mastopexy-Augmentation is a surgery that combines both breast implants and a breast lift into the same procedure. The breast size is increased, and the sagging tissue is repositioned higher.

The Breast Augmentation (breast enlargement) portion is performed first to increase breast volume and fix any asymmetry. Patients usually want to restore the breast size and shape lost from pregnancy or weight loss.

Once the breast implants are in place, the Mastopexy (or Breast Lift) portion lifts and improves the contour of the breasts. This helps to improve breast sagging that was caused by aging, pregnancy, weight loss, and gravity. Often, we will remove excess skin and tighten the supporting tissue. This moves the breast higher onto the chest and repositions the nipple and areola.

Mastopexy Augmentation (Breast Implants with Lift) - 240cc SRM (Moderate Profile) Silicone breast implants with Wise-pattern breast lift (Anchor scar)

Who is a Candidate for a Breast Lift with Implants?

Patients being evaluated for a Mastopexy-Augmentation should be in good general health. They should try to maintain the lowest possible stable weight prior to surgery. They should also have realistic expectations about what this surgery can actually do. A breast lift with implants can help treat the following:

• Breasts with loss of volume or shape
• Sagging breasts
• Flat/elongated breasts due to weight loss
• Downward pointing nipples or areolas
• Asymmetric breasts (one lower or more lateral than the opposite side)
• Tuberous breasts

Anyone planning to have (more) children should be cautious about undergoing a mastopexy-augmentation because pregnancy and nursing can worsen sagging again.

How Do I Prepare for a Breast Lift with Implants?

You will have to make many decisions about your implants, which we will discuss below. First, you should know that you will have the best results if you obtain your lowest possible weight prior to surgery and maintain it. You should try to reach a BMI below 32.0 (click here for a BMI calculator). Big fluctuations in weight after surgery can cause your breast tissue to sag again.

What Type of Breast Implant Should I Get?

You'll want to discuss a few characteristics of your breast implants with Dr. Nguyen prior to surgery.

Saline versus silicone: 99% of Dr. Nguyen's patients choose silicone implants. The new "gummy" implants are much better than their previous versions. They are made to be more cohesive, so the tendency to spill everywhere after rupture is greatly decreased. In fact, you could even take a pair of scissors and cut a chunk out of the implants. The piece would come out looking like… you guessed it, a gummy bear!

Silicone implants have less rippling than saline implants. Rippling is the wavy look of the skin when it is thin and the implants are visible underneath. Rippling = bad. Silicone implants also feel much more natural than saline implants.

Saline implants can rupture due to trauma, a faulty valve, or "wear and tear" over time. When saline implants rupture, the breast flattens and looks smaller compared to the other side. Additionally, if the deflated implant is not exchanged, the capsule shrinks and the internal anatomy of the breast becomes distorted. Deflated implants just about guarantee that you will need another surgery to get them replaced, which can be very costly.

Taking these factors into account, silicone implants tend to be the better choice for most patients long term. However, Dr. Nguyen will discuss your specific needs and goals to determine which type of implant will be best for you.

Round versus anatomic: Round implants are circular and symmetric across the entire implant. Anatomic shaped implants have a teardrop shape that tapers towards the top of the implant. Dr. Nguyen's opinion is that anatomic implants are more expensive without providing any extra benefit for the majority of patients.

Most patients will not notice any difference between having round and anatomic shaped breast implants placed. This occurs because most patients will have enough tissue covering the implant so that it doesn't make any noticeable difference in shape. Anatomic implants usually only provide benefit when placed above the muscle in very thin patients.

Additionally, anatomic implants can rotate inside the breast. If the tapered portion of the implant flips to the side, it will cause a deformity in the shape of the breast. If it cannot be corrected manually, you may need another surgery to fix the position. Round implants don't have this problem because they are completely symmetric. They always look great because it never matters how they rotate inside the chest. Therefore, Dr. Nguyen usually recommends round implants for his patients.

Smooth versus textured: Implant shells come with either a smooth or textured surface. Almost all of Dr. Nguyen's patients choose to get smooth breast implants.

Textured implants were originally developed because they were thought to decrease the risk of capsular contracture. With modern implants, the rate of capsular contracture shows no difference between smooth and textured implants, especially when placed underneath the muscle. Texturing also helps prevent implants from rotating inside the chest. This is more important for patients who get anatomically shaped implants, but it does not matter if you have round implants.

Textured implants have also been associated with a rare form of cancer, called BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma). This may be related to the texturing process itself. One of the implant manufacturing companies, Allergan, has recalled its textured implants while this association is being further studied. We will eventually learn more about the risks of BIA-ALCL as it is studied more. However, we ask our patients, "Why accept the additional risk of having cancer? Even if it's rare." That's why we recommend getting smooth, round implants for most patients.

Mastopexy Augmentation (Breast Implants with Lift) - 195cc SRM (Moderate Profile) Silicone breast implants with Wise-pattern breast lift (Anchor scar)

Where/How Should I Have My Breast Implants Placed?

Patients will need to discuss with Dr. Nguyen the risks and benefits of placing the implants above or below the muscle as well as which incisions would be best for their breast augmentation.

Subglandular versus submuscular: Subglandular breast implants are placed above the pectoralis major muscle. They are immediately below the breast gland. Submuscular breast implants are placed below the pectoralis major muscle. They are deep to both the breast gland and pectoralis muscle.

Dr. Nguyen generally only places implants above the muscle in special cases. Implants above the muscle have more contact with the breast tissue and ducts. This may expose it to more bacteria within the milk ducts and has been shown to lead to higher rates of capsular contracture. In patients with a low BMI, the upper pole breast tissue is also so thin that implants placed above the muscle will be visible through the tissue. Many patients do not like this look and prefer to have a smooth contour on all sides. Lastly, placing implants above the muscle can disrupt the blood supply to the nipple. This is problematic when combining breast augmentation with a lift because the nipple and areola may lose too much of its blood supply and necrose (or die).

Implants are placed above the muscle for patients who are especially enthusiastic body builders or athletes. Releasing the lower portion of the pectoralis major muscle in order to place breast implants does weaken the entire muscle slightly. This doesn't affect most patients. It is generally only noticeable in patients who depend on the strength of their muscles competitively, i.e. for sports or bodybuilding.

Placing implants underneath the muscle lowers the risk of capsular contracture. The muscle acts as a drape over the implant, giving a nice smooth transition between the chest wall and the implants. Placing implants under muscle also protects the vital blood supply to the nipple and areola, decreasing the risk of necrosis (or death of these structures). The overwhelming majority of Dr. Nguyen's patients get their implants placed beneath the muscle.

Incisions: Breast implants can be placed through an incision in the lower breast fold (inframammary fold or "IMF"), along the outer rim of the areola (periareolar), in the armpit (transaxillary), or through the belly button (transumbilical). Keep in mind that if you are getting a breast lift at the same time, you will likely already be getting a Wise-pattern (anchor-pattern) incision, so you won't actually have to make a decision about where to place the scar.

The majority of plastic surgeons across the country use the IMF approach (placing implants through the lower breast fold). The scar is well hidden within a natural fold, so it's almost invisible when it heals. The breast avoids contacting any of the breast ducts, which helps reduce the rate of capsular contracture. Your surgeon has optimal visibility to be able to perform your surgery safely and accurately. Your surgeon also has direct access to all dissected areas to be able to control bleeding and make sure the pocket is the perfect size for your implants.

Periareolar incisions are the second most commonly used incision by plastic surgeons for breast implants. Visibility of the pocket is good. The scar is well hidden within the rim of the areola. However, the rate of capsular contracture has been shown in the literature to be higher when using this access incision. Implants placed through the area likely pick up a small amount of bacteria from the breast ducts as they are being placed. The bacteria don't cause an overt infection. Instead, they cause a low grade inflammation over the years and decades that irritates the breast capsule. This causes it to constrict and tighten. The results can include pain and a hard, displaced implant that rises higher onto the chest. Stretching of the periareolar incision can also cause numbness and loss of sensation to the nipple. No one would like that!

Dr. Nguyen does not use the transaxillary or transumbilical incisions to place breast implants for several reasons. The transaxillary incision exposes the breast implant to the "dirtier" area of the armpit where it can pick up bacteria, increasing the risk of capsular contracture down the line. The visibility from both incisions is poor and requires the assistance of a scope to be able to see the areas of dissection. The surgeon would also not have direct access to all areas of dissection, potentially leaving the patient at higher risk of bleeding or poor implant positioning.

What Goes Into The Mastopexy-Augmentation Procedure?

A Breast Lift with Implants typically takes 2 to 3 hours to complete. The anesthesia team will place you under general anesthesia for the whole case. You'll go to sleep, wake up, and be completely done!

After you are asleep, local anesthesia is injected into the incisions to help reduce pain after the surgery. An incision is made into the lower breast fold, and dissection is performed underneath the pectoralis major muscle. The implant pocket is created to fit the size of the chosen implant. The implants are inserted with the help of a Keller funnel as part of the "no touch" technique. This avoids the implant's contact with either the skin or breast ducts and allow placement through a much smaller initial incision. The pocket is then sutured closed.

The incisions for the breast lift are then double-checked to make sure they work well with the implants that were just placed. More numbing medication may be given that this time for increased comfort after surgery. Excess skin is removed from around the nipple and areola. The nipple itself is never removed. It is left down attached to the breast tissue, so it always stays connected to its blood supply.

Flaps of breast skin and tissue are raised on the medial and lateral sides of the breast, and the nipple and areola and moved into the optimal position. Any redundant and sagging breast tissue is then removed from the lower portion of the breast. The incisions are then sutured closed. Drains are not normally used as part of the procedure.

If you want to see full videos of the surgery, visit our Instagram page @heavenlyplasticsurgery and check out our highlights!

What Is The Recovery After A Mastopexy-Augmentation?

Patients will be able to go home the day of surgery. Most patients will complain of some soreness for the next several days to one week, but the pain is usually only mild to moderate. You may notice some bruising and swelling that will subside over 2 to 3 weeks. You will be given a special surgical bra to wear after surgery. You can substitute this with a sports bra if you feel comfortable doing so.

Most patients will be able to return to light duty work in one week. Patients should try not to raise their arms over their head for 3 to 4 weeks. Full exercise can be resumed in 4 to 6 weeks depending on the progress of healing. Dr. Nguyen will see you in clinic several days following surgery, then at 1 week, 3 weeks, and 6 weeks to ensure that everything is healing well.

For full postoperative instructions, click here.

What are the Risks Associated with Getting a Breast Lift with Implants?

Surgery and anesthesia always come with associated risks, and the anesthesiologist will discuss these with you. Every effort is made to minimize them. However, risks do increase if patients have more underlying medical problems. Risks related to getting a Breast Lift with Implants include:

• Bleeding
• Infection
• Dehiscence - minor to major separation of the incisions that require wound care
• Asymmetry
• Suboptimal aesthetic result
• Poor scarring
• Recurrence of sagging (especially with weight fluctuation after the surgery)
• Abnormal skin sensation (temporary or permanent numbness of the nipple and areola)
• Partial or total loss of the nipple and/or areola (rare)
• Capsular contracture
• Implant rupture or leakage
• Need for revision surgery

Breast Implants with Lift (Mastopexy-Augmentation - 275cc SRM (Moderate Profile) Silicone under the muscle with Wise-pattern breast lift (anchor scar)

Always be sure to consult with a Board Eligible or a Board Certified Plastic Surgeon to determine if getting a Mastopexy-Augmentation is right for you! Dr. David Nguyen would be happy to see you in consultation to walk you through the process and discuss your results. Call 657-900-5055 for a complimentary consultation today!

Breast Implants with Lift Cost: Starts at $10,750 $9,250 (Limited Time Only!)

Prices includes anesthesia fees, surgery center fees, implant fees, surgeon's fees, and follow-up fees.

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