Augmentation Mastopexy

This can be a challenging procedure, tailored to those women who would like to both improve the shape, but also the volume of their breasts. It is also a common revisional procedure in patients with old breast implants and a deteriorated breast shape, requiring an implant exchange and repositioning of the nipple areola complex (NAC). The improvement in shape is achieved with a mastopexy and the enhancement with a silicone prosthetic implant, or with fat transfer for a more vegan approach. It is vital for you to consider what your priorities are with respect to the desired outcome. Is your goal to achieve a more youthful shape with only a mild to moderate volume improvement? Is your main desire for volume enhancement with a current acceptable shape? Or is it a combination of both? These are very important questions for us to discuss in a face to face consult, so we can tailor the treatment to your individual needs.

The challenge with this procedure is to predict how two independent operations, augmentation and lift, will evolve together over time. There are two opposing forces to consider, the effect of the skin tightening of the breast lift, pushing inwards and the effect of the implant pushing outwards. It is imperative therefore that the implant used is of a lower volume that would otherwise be used in an augmentation alone. If the right implant is used and the surgery is timed appropriately, in a woman with a stable weight and not imminently planning a family, then the results can be long lasting. The result can however change with aging and like all surgery there is no guarantee for a perfect outcome.

This surgery takes approximately 3 to 4 hours

As with any surgery, there is an element of ache and mild discomfort. Local anaesthesia is given during the surgery and in combination with post-operative oral analgesia, should keep you very comfortable during your recovery.

I do not routinely use drains during this procedure, unless it is a revision augmentation mastopexy.

A surgical bra provides support and comfort and depending where your surgery takes place, this will either be provided for you (Spire Clare Park), or one will be recommended to you for purchase. It is recommended that this is worn day and night for six weeks following surgery.

Recovery time varies between one to two weeks. Incisions are generally healed within a week to ten days. As a general rule, you should avoid any heavy lifting or vigorous exercise for six weeks after surgery. You are of course encouraged to move as normal, to minimise the risk of chest infections and leg clots. The final results including scar appearance are usually evident once all the swelling has subsided and this can take up to 12 months. Using a single layer of the provided micropore tape on the scars for 6 – 12 weeks, will give the best results possible. If this is not tolerated, scar surgical massage is a good alternative, starting after the first 3 weeks when the wounds have fully healed. Scars should not be exposed to direct sunlight without the application of a high SPF cream for about a year and products such as Cicaplast contain both silicone and SPF block. There are however other alternatives. A post-operative surgical or sports bra should be worn at all times for 6 weeks.

These include mild discomfort, risk of poor scarring, risk of infection (1%), altered nipple sensation, risk of bleeding, capsular contraction, implant rupture, implant rippling and bottoming out, need for revision surgery, implant animation (if submuscular), implant rotation (teardrop implants), degrees of asymmetry and delayed wound healing. There is also the risk that the breast lift might reduce the ability for a woman to breast feed. If textured implants are used, there is also the risk of BIA-ALCL (breast implant associated anaplastic large cell lymphoma, 1:20,000), which is a type of very rare cancer that can develop in the breast capsule around the implant. The MHRA and BAAPS websites have further information on this condition. The use of smooth implants minimises this risk, but these are not suitable for all women. A detailed face to face discussion is essential on this topic. Other rare conditions that may develop also include BII (breast implant illness), which might be immune mediated and is currently poorly understood. Your nipple sensation may decrease, increase (hypersensitivity), or lost completely (including erotic sensation) and this might be different between the two sides. This can improve over time as the nerves recover, but it is difficult to predict and it is not guaranteed. The nipple remains attached to part of the breast gland when moved to its new position. This is to preserve its blood supply, keep it alive and ensure healing. There is however the very rare risk that the nipple does not survive this transfer, leading to nipple necrosis. This is much more common in smokers and I encourage smokers to stop a month before and after this surgery. I will generally not perform an augmentation mastopexy or any other breast cosmetic procedures on active smokers. On the very rare occasion of an implant infection, this usually requires the surgical removal of that implant. A meticulous non-touch implant technique is used during the surgery, including the use of the Keller funnel and the implant and breast pocket are rinsed with betadine antiseptic solution. You will also be given antibiotics after the surgery for five days to one week. Bleeding after the surgery usually presents as a breast swelling and it is usually evident very soon after surgery. On the whole, this requires a return to the operating room to remove the blood clot and stop the bleeding. This happens very rarely. Lastly like in all surgery, there are no guarantees for a perfect outcome.