Breast augmentation: with or without breast lift?

Breast augmentation surgery can either be performed as a stand-alone procedure or in combination with breast lift, but how is the most appropriate technique for each individual case determined?  Dr Athanasios Christopoulos, Consultant Plastic Surgeon at Aesthetic Anaplasis in Athens discusses.

In cases where a woman has small breasts and not especially lax skin, the most appropriate procedure for her is breast augmentation. On the other hand, breast augmentation in combination with breast lift is the best option for a woman with small breasts and skin laxity.  However, there are some cases involving a small degree of skin laxity that make it hard to decide whether breast augmentation alone would be sufficient, or if breast augmentation in combination with breast lift is needed. In these borderline cases, the preferred choice would be to solely use breast augmentation, avoiding any lasting scarring associated with the uplift procedure.

Breast augmentation in borderline cases

The key to determining which breast procedure would be most appropriate in cases of women with small breasts and a small degree of skin laxity is the height of the nipple from the inframammary fold (the place where the breast and chest meet).  If the nipple is above the inframammary fold, even by a few centimetres, the decision to perform breast augmentation alone is clear cut; in these cases the volume that the breast will gain will give the desired shape and lift the breast automatically. If the height of the nipple is lower than the inframammary fold, however, breast augmentation in combination with breast lift is seen as the best course of action, if of course breast augmentation is needed.

But what about intermediary cases?

An intermediary case is when the nipple is at the same level as the inframammary fold, or slightly over it. In these cases, the plastic surgeon’s experience is what matters the most and he must have the full range of breast augmentation techniques at his fingertips in order not to be limited in his decisions.

There are a number of specific techniques that are very useful in the management of these cases:

1. Dual plan technique. This technique, which was developed specifically for cases involving breasts with a small degree of skin laxity, can lift the nipple a small amount. It is a technique that requires the separation of tissues in two levels, mainly under the pectoralis major muscle, but also partly over it.
2. Shift of inframammary. Using specific techniques, the inframammary fold can be shifted a little bit lower in order to fix the height difference between the fold and the nipple. This highly specialised technique should only be performed in particular circumstances by an experienced plastic surgeon.
3. The choice of the correct implant. Some implants, by virtue of their shape, can be of help in intermediary cases. The plastic surgeon must have the experience to choose the most appropriate implant in each case, a decision that is often far from straightforward.

In conclusion, there are cases where it is not obvious whether breast augmentation alone or breast augmentation in combination with breast lift would be the most appropriate line of treatment. In such cases, the experience of the plastic surgeon is critical in order to propose and implement the correct method. The surgeon needs to make a proper evaluation, describe the situation and put forward the indicated solutions to the person in question, who can then make an informed and mature choice as to the procedure that will give her the best results.

The challenge for the surgeon is to view each case as potentially a breast augmentation without the need for a combination breast lift, which has the disadvantage of visible incisions, and therefore scars.

About Dr Athanasios Christopoulos

Dr Christopoulos is a plastic surgeon with over 26 years’ experience in the field of Cosmetic Surgery. He is the director and owner of Aesthetic Anaplasis, a reputable plastic surgery clinic located in Athens, Greece and a member of ELITOUR. He has worked in the United Kingdom (England and Wales), USA (New York) and Greece (Athens and Piraeus).