“I want aesthetic surgery on my breasts, but I can’t decide between breast augmentation with implants, or a simple breast lift. What should I do?”
This is a question I hear from patients at my Kitchener-Waterloo clinic all the time. They are unhappy with their breasts and are looking for a surgical solution. They’ve heard of breast lift surgery and breast implant surgery, but they’re not sure which option is the best for them. Here’s my approach to how we manage this often confusing question.
Are You Happy With Your Breast Size?
The first question I always ask the patient in this scenario is simply this: Do you want to have larger breasts, smaller breasts, or do you want to keep approximately the same size you have now?
The reason I ask this question is that first and foremost, breast implants (whether they are saline, silicone, shaped, round, smooth) are primarily used for one purpose and one purpose only: to make your breasts larger. As a secondary feature, they can also provide some shape and projection to the breast, but their primary purpose is to simply increase the breast volume.
What Implants Can and Cannot Do
There are two important things to understand when you choose a breast augmentation:
- First, a breast implant cannot lift the breast.
- Second, if a breast implant is placed in your breast, your breasts are going to be larger. Occasionally patients think that a breast implant can impart shape and upper pole volume without making the breast larger. That is quite simply not the case.
If a patient has well-shaped and well-proportioned breasts that are not as large as she would like them to be, then usually the answer is a breast implant. In these cases, the skin envelope does not need to be changed, the nipple and areola do not need to be elevated, but the breast simply needs to be projected and augmented with regard to volume. That is the role of the breast implant.
What a Breast Lift Can Do
When there is droopiness of the breast (what plastic surgeons refer to as ptosis) then a different approach is needed. If the goal is to put the nipple and areola on the most projecting part of the breast and to tighten up the skin envelope around the existing breast volume, then it is a breast lift, or a mastopexy as we call it, that is needed. In that case, the skin is tailored in such a way to bring the nipple and areola to the front and most projecting part of the breast, but no volume is added or taken away. Check out before-and-after photos here.
When Both Are Needed
The last points to be made with respect to these two operations is that they can be and are frequently combined. Placing a breast implant in the breast to increase its size and projection, followed by tightening up the skin around that implant to put the nipple and areola on the most projecting part of the breast and give the breast a good shape is referred to as an augmentation mastopexy, or an aug/pexy for short. This combined operation gives patients the best of both worlds. Increased size, volume, and projection, in addition to a well-proportioned breast without any droopiness. Check out before-and-after photos.
How Does Fat Grafting Help?
Last but not least, the final potential step in these operations evolves fat grafting, which is the transfer of fat from one part of the body where it is not wanted to the breast where it can be useful. At The Cosmetic Surgery Clinic, we use fat in almost all of these scenarios. When we do a composite breast augmentation, we use fat to finesse the upper pole of the breast when we put an implant above the muscle. In a simple breast lift, we use fat to augment the upper pole and cleavage area which can be done without adding unwanted volume to the breast.
In summary, all of these procedures are very common, very useful, but very different. Still confused? Come on in for a consultation then we’ll talk about it some more!
