Many patients present for breast enhancement, but are unsure if what they require are breast implants or if they require a lift (mastopexy) procedure, with or without implants. Of course, to be entirely sure, a complete assessment by a fully qualified plastic surgeon experienced in breast enhancement surgery is necessary. However, there are a few tips that patients can apply to get a fairly close idea as to which procedure is required to give them the result they are looking for.
The “look in the mirror” assessment:
Patients can gain a quick assessment just by looking at the mirror (with arms down by your side) or at photographs taken of them.
Try to avoid “selfies” of breasts as these are often taken at incorrect angles and distances, rendering them distorted and inaccurate.
When you look at the mirror, make a note of where you inframammary fold or breast crease is. The folds on each side may be at different levels, and this factor in breast asymmetry is common and can be considered normal.
Once you have determined where your breast fold is, take note of the following:
- The NIPPLE position: is this ABOVE the fold, AT the fold, or BELOW the fold.
- The bulk of your BREAST TISSUE: is this ABOVE the fold, AT the fold, or BELOW the fold.
Once the above questions have been answered, we have most of the necessary information required to determine which is the best operation to perform; this however has to be balanced with what result we’re aiming for, as there are sometimes limitations caused by the patient’s anatomy.
In general, if your nipple and most of your breast tissue lies above the breast fold, then you should get a very good and long-lasting result with implants alone. On the flip side, if your nipple and most of your breast tissue lies below the fold, then you will NOT be able to get a good result with implants alone, no matter how large they are. You will in this case require a breast lift, with or without implants (depending on what volume you wish to achieve).
The tricky judgement call arises when the nipple AND/OR the bulk of the breast tissue lies AT around the breast fold level. These “borderline” situations demand one other important question to be answered: What size or volume increase are you looking for?
In cases of borderline droopiness, the patient MAY be able to get away with a reasonable result with an implant alone; however, the caveat is that implant must be of a large enough size that will allow the loose lower skin to be filled. The result of such an approach may give a satisfactory result, but it certainly won’t be as “perky” a result when compared with a lift or the result gained with implants in a non-droopy patient. If you are a borderline case and only looking for a small increase in size/volume, then a lift is often advised.
The trade off with a lift (with or without implants) is, of course, the inevitable scarring. A breast lift (or mastopexy) involves elevating the nipple areolar complex to a higher, more desirable position, removal of lax breast tissue, and tightening of the breast skin envelope. This will result in circular scar around the nipple areola, a vertical scar down the centre of the breast, and often a horizontal scar across the breast fold. This scarring in most patient will fade with time and become quite inconspicuous.
So there you have it. A quick and simple analytical process that enables you a fairly good idea to see if you are a good candidate for breast implants alone or if you require a breast lift. Remember, nothing beats a comprehensive assessment with an experienced surgeon. Know what kind of result you are looking for in terms of SHAPE and SIZE. Discuss these with your surgeon to see if they are achievable. There are many other factors (such as skin quality, breast tissue composition, tubular deformity etc) that play a part in the decision making process, and your pre-existing anatomy may also limit what can be achieved.
The ideal breasts, with a full rounded lower pole contour and the nipple areolar complex positioned at the apex of the breast. Both nipple and bulk of breast tissue lies above the breast crease.
Severe breast ptosis (droopiness) where both the nipple and bulk of breast tissue lies below the breast crease. This will definitely require a lift procedure, with or without an implant.
Breast asymmetry with pseudo-ptosis (nipple ok, breast tissue droop) on the left side. The right side will do fine with an implant alone. The left side however, with the nipple above the fold, but with the bulk of the breast tissue starting to fall below the fold, will either need an implant large enough to fill out the lax lower breast tissue or a smaller implant together with a lift.