BREAST AUGMENTATION MASTOPEXY

When Breast Augmentation Alone May Be Suitable

In patients without significant ptosis, breast augmentation alone may be considered. This procedure involves the placement of an implant (round or anatomical/teardrop-shaped) to increase breast volume. Implant selection and surgical technique are based on the individual's chest anatomy, tissue characteristics, and surgical goals, which are discussed during a clinical consultation.

Mild Ptosis: Assessment and Management

A simple method sometimes used during examination is the arm-raise test. If, when the arms are raised, the nipple moves to a more favourable position and the lower breast tissue appears more elevated, then augmentation alone may still be a suitable option.

In such cases, additional surgical adjustments may be needed to support the breast tissue and position the implant correctly. An anatomical (teardrop-shaped) implant may be recommended to provide a more gradual slope and better fit with the existing tissue distribution. However, the choice of implant and surgical plan should be tailored to the patient's individual anatomy and preferences after a thorough assessment.

Moderate to Significant Ptosis: Augmentation Mastopexy

If the nipple remains low on the chest wall when the arms are raised, and the breast tissue continues to sit below the inframammary fold, a combined procedure called an augmentation mastopexy may be indicated. This involves:

• Placement of a breast implant (usually under the muscle)
  
• Repositioning of the breast tissue and skin envelope to elevate the nipple and reshape the breast
  

This approach allows for improved control of nipple position and soft tissue support but involves additional incisions and scarring compared to augmentation alone.

Staged Approach for Larger Implants

In some cases—particularly where a significant increase in breast volume is planned—a staged procedure may be advised. This means:

1. A mastopexy (breast lift) is performed first, allowing tissues and scars to settle.
   
2. Implant placement is carried out at a second stage, generally at least 3 months later.
   

This approach may reduce the risk of complications such as poor wound healing, implant malposition, or excessive scar tension.

Alternatives to Implants

For individuals who do not wish to increase breast volume significantly, a breast lift alone may be appropriate. In some cases, fat grafting can be used to add moderate volume and improve shape using the patient’s own tissue. This may be done alone or in combination with a lift, depending on the goals discussed during the consultation.

Clinical Overview: Breast Lift with Augmentation Techniques

Breast augmentation mastopexy is a procedure that combines a breast lift (mastopexy) with the insertion of breast implants to address both loss of volume and changes in breast position. There are several surgical approaches available depending on the degree of ptosis (drooping), tissue characteristics, and individual patient factors.

1. Traditional Augmentation Mastopexy (Single or Staged Approach)

This method involves elevating the breast tissue and inserting implants during the same surgery, or in two separate stages depending on clinical need.

• Single-stage procedures may be suitable for selected patients with moderate tissue laxity and stable skin quality.
  
• Two-stage procedures (lift followed by augmentation) may be advised when more significant adjustments are needed, particularly when larger implants are desired or skin quality is poor.
  

This technique allows for adjustment of nipple position, reduction of excess skin, and restoration of breast volume through implant placement.

2. Peri-Areolar Mastopexy with Augmentation

This approach involves an incision around the areola and is typically suitable for patients with mild breast ptosis.

• The nipple-areolar complex may be repositioned slightly, and breast implants are inserted during the same procedure.
  
• Due to the limited nature of this lift, it is generally reserved for patients not requiring extensive tissue repositioning.
  
• Scarring is typically limited to the areolar border, though scar visibility and healing vary between individuals.
  

3. Vertical Mastopexy with Augmentation

This procedure includes:

• A circular incision around the areola
  
• A vertical incision extending from the areola to the inframammary fold
  

This method is used in cases of moderate breast ptosis and allows for removal of excess skin and reshaping of the breast tissue. Implant placement is performed in the same operation, with adjustments made to ensure appropriate implant positioning and support.

4. Inverted-T (Anchor) Mastopexy with Augmentation

For patients with significant breast ptosis or excess skin, the anchor-shaped incision pattern may be used. This includes:

• An incision around the areola
  
• A vertical incision down to the breast fold
  
• A horizontal incision along the inframammary crease
  

This technique allows for the most extensive skin removal and tissue repositioning. It is commonly chosen when a greater degree of lift and support is required. Implant insertion is performed during the same operation and tailored to the patient’s anatomical needs and surgical goals.

Important Considerations

• The selection of technique depends on factors such as breast volume, skin elasticity, degree of ptosis, and patient preferences.
  
• Implant type, size, and placement (subglandular or submuscular) will be discussed during consultation based on physical assessment.
  
• All surgeries carry risks, including infection, bleeding, scarring, changes in nipple sensation, and implant-related complications. These should be discussed thoroughly with your specialist plastic surgeon.
  
• Recovery time, scar pattern, and postoperative care will vary depending on the chosen surgical approach.
  

If you are considering breast surgery, it is important to have a consultation with a qualified specialist plastic surgeon who can assess your clinical needs and discuss the potential benefits, risks, and limitations of each option.

Best Practices in Surgery

• Use of the 14-point plan of infection prevention
• Use of the Keller funnel. This is used to insert the implant with minimal contamination and shortest possible scar. It has become the new standard in Breast implant surgery to try and minimise risk of capsular contracture. You will be able to see and feel the funnel during your consultation.
• Prevention of breast implant animation (through careful muscle dissection)
• Prevention of bleeding through Meticulous haemostasis
• Special blocks to prevent post operative pain
• Use of the internal bra sutures. These are used to anchor the tissues down to near the rib cage. These reinforce the inframammary fold which help prevent implant migration downwards with time.
• Use of fat grafting as needed. This can give you fuller cleavage or help hide the upper part of the implant in very thin patients.

Potential Risks – Breast Augmentation Mastopexy

As with any surgical procedure, breast augmentation mastopexy carries risks. These include general surgical risks as well as those specific to combined breast lift and implant surgery:

• Infection at the surgical site, which may require antibiotics or further treatment
  
• Bleeding or haematoma (collection of blood under the skin)
  
• Changes in breast shape, size, or symmetry following surgery
  
• Scarring, which can vary depending on incision technique and individual healing
  
• Altered sensation in the breast or nipple area, which may be temporary or permanent
  
• Capsular contracture (scar tissue formation around the implant), which may affect breast appearance or require further surgery
  
• Implant-related complications, such as rupture, leakage, or displacement
  
• Nipple or skin necrosis (rare), due to compromised blood supply
  
• Seroma formation (fluid accumulation), which may require drainage
  
• Asymmetry or unevenness after healing
  
• Persistent pain or discomfort beyond expected recovery time
  
• Anaesthesia-related risks, including allergic reaction or respiratory complications
  

Recovery and Aftercare – Breast Augmentation Mastopexy

• Swelling, bruising, and mild to moderate discomfort are common and usually improve over several weeks
  
• Pain relief may be prescribed or managed with over-the-counter medications as directed by your surgeon
  
• Dressings and wound care instructions should be followed carefully to promote healing and reduce infection risk
  
• Supportive bras or compression garments are typically recommended for several weeks to support the breasts and minimise swelling
  
• Strenuous activity, heavy lifting, and upper body exercise should generally be avoided for 4–6 weeks, or as advised by your surgeon
  
• Driving can usually be resumed once you are off prescription pain medication and feel physically capable of doing so safely
  
• Incision scars will fade over time but may remain visible; your surgeon may suggest scar management options
  
• Follow-up appointments are important to monitor healing, assess outcomes, and address any concerns
  
• Smoking and alcohol should be avoided during recovery, as they may impair wound healing
  
• Final results may take several months to become apparent as swelling subsides and tissues settle

FAQs

Where to place the implant?

In augmentation mastopexy, the implant is commonly placed beneath the pectoral muscle, while the breast tissue is elevated and repositioned over the implant. This approach may assist in supporting the implant and reshaping the breast tissue for improved anatomical positioning.

How to choose the right implant for you

When you come to see us, you will have two consultations with Dr Hadi This includes listening to what you want, assessment of your breast, chest and body shape.

You will then have 2-D photographs and 3-D photographs with the vectra camera system. Different implants can then be placed into the system allowing you to see what you can expect with different implant shapes and sizes.

These can be combined with a mastopexy so you can see what augmentation alone looks like vs augmentation mastopexy.

Your images are treated with utmost privacy and respect. They will only be used for you. Imagine the You will also be able to see and feel examples of different implants. So you can choose the right implant for you. You will then be able to think about your options and are welcomed back for a second consult with Dr Hadi at no extra charge to go through what you have chosen and to answer all your questions. Once you have decided to proceed to surgery, you will be looked after by Dr Hadi every step of the way. You will have an all-female theatre for your comfort.

How can I prepare for surgery?

When you decide to proceed, there are a few things you can do to prepare:

1. Eat healthily by avoiding excessively fatty foods and foods high in sugar.
2. Stop smoking as this significantly increases complication rates. No smoking for 6 weeks prior and 6 weeks after surgery.
3. Stop all blood thinners such as warfarin, Plavix, aspirin unless discussed with Dr. Hadi. Also, avoid over-the-counter medications that may thin the blood.
4. Shower with a medicated soap like phisohex, sebomed, or sapoderm the night before or morning of surgery to reduce bacteria on the skin.
5. Fast (do not eat anything) at least 6 hours prior to surgery, as instructed by Kareena Hospital.
6. Wear loose, comfortable, dark clothing and remove all jewelry.

How long will the operation take?

You will need to be fasted at least six hours before surgery. The operation will take around four hours and is performed under general anaesthetic. A Specialist Anesthetist will be present during the operation. Kareena Hospital is the preferred hospital.

Our surgical technique

• 14-step plan of infection prevention to reduce the chance of capsular contracture.
• Use of the Keller funnel to minimize contamination and scarring.
• Prevention of breast implant animation through careful muscle dissection.
• Meticulous haemostasis to prevent bleeding.
• Special blocks for postoperative pain prevention.
• Use of internal bra sutures to anchor tissues and prevent implant migration.
• Use of fat grafting as needed for improved results.

What is a Keller funnel?

A Keller Funnel is a sterile, cone-shaped device that may be used during breast implant surgery to assist with the insertion of implants. It allows for a no-touch technique, which can help minimise implant handling. Some studies suggest this approach may reduce the risk of complications such as capsular contracture. The decision to use this tool depends on the surgeon’s preference and the specific needs of the procedure.

What is the 14-point plan?

The 14-Point-Plan is endorsed by the Australian Society of Aesthetic Plastic Surgeons. It minimizes bacteria during surgery to prevent capsular contracture. The plan includes steps like using antibiotics, avoiding specific incisions, and more.

How long will I stay in the hospital?

The surgery is usually performed as day surgery or overnight stay. You'll receive antibiotics and pain relief tablets. Contact Dr. Hadi if you have concerns postoperatively.

What about the sutures?

Your wound is closed with dissolvable sutures. An internal bra technique is used to anchor tissues, and overlying sutures are also dissolvable.

What about scar management?

Post-operatively, wounds will be dressed with comfeel, changed to brown tape after two weeks. Apply tape for at least 2 weeks then start using Giovene scar gel. Protect scars from sun exposure for 6 months using tape or sunscreen.

When can I shower?

You can shower 2 days post operatively.

When can I drive? When can I exercise?

Don't drive for 24 hours after General Aneasthetic. You can drive once comfortable, generally after one week. Gentle walking is encouraged from the next day. Leg exercises and light cardio can start after four weeks, and upper arm/chest exercises after six weeks.

When can I go back to work?

Depending on your work's physical demands, take 1-2 weeks off before returning to work.

What can you do after surgery?

Your role in the operation is essential:

• Follow post-operative exercises as shown.
• Do deep breathing exercises to prevent pneumonia.
• Take prescribed antibiotics to avoid infection.
• Avoid smoking for at least 6 weeks.
• Tape the wound for around 6 weeks to achieve the best scar.
• Attend regular reviews for healing progress.
• Take antibiotics before dental/medical procedures to prevent implant contamination.
• Keep your implant card containing implant details.