Breast augmentation or enlargement with breast implants is one of the most popular cosmetic procedures both in the UK and worldwide. It has a very successful result for most women. I see many women for cosmetic breast surgery and we have detailed discussions about what is the best procedure for them personally. One of the questions that I am often asked is why a breast liftis needed for some and breast implants alone are fine for others.
Cosmetic breast surgery is not one size fits all. There are many considerations to take into account including:
- Patient goals for cosmetic breast surgery
- Reasons behind wishing for cosmetic surgery
- Current breast size and dimensions
- Changes that have happened to the breast e.g. after pregnancy, following weight loss or with ageing
- Tightness of the breast tissue and skin
- Amount of breast tissue present
- Where the breast tissue and nipple sit in relation to the under breast crease
- If future pregnancies planned
I start by finding out what my patient’s concerns about her breasts are and what changes she is hoping for from cosmetic breast surgery. When I do a physical exam, I am looking at overall body proportions as well as breast size and shape and the quality of the breast tissues. I can then make an assessment of what procedure will best achieve my patient’s goals as well as being suitable for her physically. I always aim to achieve a natural appearance of the breast that will have longevity afterwards for my patient. 3D simulation has greatly helped with my consultations in this regard for my patients.
If a woman has a good breast shape and would like to simply have a larger breast size, then a breast augmentation or placement of breast implants is the best procedure. It is still best to be sensible about the size and style of implant chosen as large implants are heavy and stretch the breast tissue a lot. By choosing an implant that fits your breast well, you can have a very nice, natural appearance that will last for the long term. I use external breast sizers and have recently brought in 3D computer simulation to help my patients visualise the results that they might have with breast implants.
When I see a woman who is happy with her breast size but feels that the breast is sitting too low or has lost shape and dropped, then usually a breast lift or mastopexy procedure is best. Breast lifts lift and reshape the breast both internally within the breast and by tightening the loose breast skin. This gives a more youthful and pleasing shape to the breast. There are different types of breast lift and I tailor my choice of technique to the amount of breast lift needed and the shape of my patients’ breasts. Breast lifts do leave external scars on the breast, which many women are concerned about. The scar is permanent but will fade over time. It is important to look at the improved shape that can be achieved with a lift and this benefit generally outweighs the impact of the scar. Our eyes are drawn to the shape of the breast more than the scar on the breast. It is usually best to have completed your family before undergoing breast lift surgery as future pregnancies may stretch out the breast again and undo some of the lift effect.
There is a third group of women that I see who would like breast enlargement but also have loose or low-lying breast tissue. They will get the best result with a combined breast lift and augmentation (augmentation-mastopexy). The breast implant fills out the breast and the lift reshapes the breast over the implant and raises the nipple to a more central position over the breast tissue. This is a more complicated procedure than either breast implants or a breast lift alone but will give the best result for these women. I always advise not to go for a large implant in this situation. If a breast lift is needed, it means that the breast is not able to fully support its tissue or that it has lost support over time. It will therefore struggle to support the weight of a heavy breast implant as well. Also there are competing biological forces in this procedure; an implant stretches breast tissue, while a breast lift tightens it. The best results will be achieved when there is a good balance between the implant and the breast tissue that is reshaped so that neither is overdone.
To summarise when I see women for cosmetic breast surgery, I first find out what they want to achieve with breast surgery. I then analyse their breast size and shape and together we work out the best procedure to accomplish this.