How is a breast lift with breast augmentation performed?

Patients with small, drooping breasts can benefit from a combination of a breast lift (a surgery similar to breast reduction, except that no breast tissue is removed) and breast augmentation. Technically, this is a difficult procedure. It is hard to judge how much skin to remove prior to surgery if the breasts are also to be enlarged.

For this reason, some surgeons prefer to stage the procedures: the augmentation is performed first and the lift is done several months later. Alternatively, if the patient wants implants placed in front of the muscle, the lift should be performed before the augmentation. At the 2000 meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), a panel concluded that it is safer to perform these procedures separately.

When done at the same time, the complication rate is 9% and many patients later desire additional lifting. When a lift is performed along with an augmentation, it is much safer to place the implant beneath the muscle. This location preserves the nipple blood supply and decreases the chance of dreaded nipple loss.

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Breast lifting is similar to breast reduction, except that no breast tissue is removed. The incisions are similar to those in breast reductions. If there is just a little drooping, a "donut mastopexy" can be performed.

Skin around the areola is removed, hiking up the breast. Because two circles of tissue of unequal circumference need to be sewn together, any seamstress knows that the result will be bunching of the tissue. Fortunately, this bunching usually settles in a few months.

When more extensive drooping occurs, the next level of lifting requires a vertical incision between the areola and the crease below the breast. This is a hot topic: many plastic surgeons believe that most patients require a full lift. An incision is made along the length of the crease, together with vertical incisions and incisions around the areola.

The search for different, better scars seems never-ending. Horizontal, vertical, around the areola -- all incisions have been proposed. My suggestion is to choose the surgeon, not the technique.