Breast Augmentation with Crescent Lift
Depending on the size of the implant used, breast sagginess can sometimes be corrected by augmentation alone when the nipple is at least at the level of the breast crease or above. If the nipple is lower than the crease, some form of lift will most likely be necessary. If the lower breast skin is tight but the nipple sits low on the breast mound, then a crescent lift of the areola may be all that is needed to elevate the nipple by 1.0 to 1.5 cm to get a more youthful looking breast. The crescent lift is also very useful to correct nipple asymmetry.
This type of lift, though, has limited applications and tends to be overused by plastic surgeons to minimize scarring when a more dramatic breast lift should have been used to achieve the desired results. Depending on the amount of excess skin that needs to be removed and the position of the nipple, improper application of any breast lift for the sake of skimping on scarring will leave the breast still saggy.
Breast Augmentation with Donut Lift
The donut (or peri-areola) mastopexy is best used when the nipples are no lower than 2 cm below the breast fold. The nipples should also not be pointing downwards.
This procedure involves excising the appropriate amount of breast skin around the areola (usually 1.0 to 2.0 cm) and then closing the skin around the new areola. This will tighten the breast skin and elevate the nipple-areola complex over the center of the breast mound. This procedure creates a small amount of rippling at the incision but this usually goes away within months after surgery. It is also an excellent procedure to make the areola smaller after pregnancy and breast feeding.
Breast Augmentation with Vertical Breast Lift
When the nipple descends greater than 2 cm below the breast crease, it is often necessary to incorporate a vertical incision because of the additional skin that must be removed. As breasts sag, they tend to flatten at the top, lose cleavage, and take on a rectangular shape at the bottom.
In these patients, a donut breast lift may elevate the nipple to the right location, but it will not address this saggy, rectangular appearance of the breast. The vertical incision breast lift will remove the excess lower breast skin and create a much more rounded, attractive, youthful appearance of the breast.
Breast Augmentation with Anchor Breast Lift
When the skin excess in the lower breast is greater than even the vertical incision can remove to achieve a round and perky shape, then it is necessary to remove the rest via a transverse incision into the crease of the breast. The length of the horizontal incision is determined by the amount of redundant skin.
Complications of Breast Lift Surgery
If you are a healthy candidate with no pre-existing disorders or diseases which may inhibit healing, the general risks of Breast Lift surgery are very low. However, since it is indeed surgery, there are inherent risks you must consider before choosing to undergo a procedure such as this. Potential complications associated with Breast Lift surgery may include the following:
Infection: Infection can occur if bacteria are introduced during surgery by contaminated implants or instruments. It can be caused by normal skin surface bacteria that survive the anti-microbial scrubbing of the skin. Infection can also occur if bacteria are introduced through an open incision or from pre-existing infections in the body (including disruption of mouth plaque).
Bleeding: Bleeding may occur 48 hours after breast augmentation if a blood vessel opens up spontaneously and begins to bleed. The other possibility is that the muscle or capsule is torn by sudden heavy lifting too soon after surgery and begins to fill the breast pocket with blood.
Rippling: Rippling can occur when there is either not enough saline filling the implant to stretch the shell, insufficient tissue to cover the implant, or internal scar tissue which is visible through thin breast skin.
Capsular Contracture (CC): When an implant or any foreign body is surgically implanted, your body forms a normal layer of scar tissue around the object. This is your body’s natural way of decreasing inflammation. Some materials create significant inflammation, and others create very little, like the silicone shelled implants. Capsular contracture is when the body produces a thick layer of scar tissue around the implant. When this tissue contracts, the implant is distorted and it can also cause pain and even rupture of the implant.
Deflation of the Implant: An implant can deflate due to severe blunt or sharp trauma to the chest or a failure of the implant shell. The risk is very low and would require replacement of the implant.
Breast Tissue Atrophy: This is when the natural breast tissue shrinks due to the pressure of the breast implant. It is usually only noted if the patient chooses to have the implants removed and not replaced.
Bottoming Out: Bottoming out occurs when the skin and the underlying breast tissue at the breast crease separate. This can cause the implant to drop below the natural crease of the breast and form a second, unnatural crease.
Double Bubble: Double Bubble often occurs when a sub-muscular augmentation was performed without a much needed breast lift. The breast implant is held securely under the muscle higher on the chest wall. However, the natural breast tissue and excess breast skin sag below the implant. This creates the appearance of an augmented breast sitting above the natural breast.
Extrusion: Extrusion is very rare. This is caused by the breast basically pushing out the implant. The underlying cause is usually a very large implant in a very tight breast pocket causing internal pressure against the incision or an infection of the breast that causes the skin to open up.
Keloid and Hypertrophic Scars: This is usually hereditary and is based on your genetic potential for healing. This occurs when the scar tissue forms outside the area of the wound. It can result in thick, elevated, and wide scars.
Asymmetry: This occurs when one breast or nipple may appear higher or larger than the other breast.
Loss of Sensation (Numbness): Loss of sensation is common right after surgery. Nerve endings are cut during this surgery, so you must be patient until they regenerate and sensations begin to return. This can take up to a year but usually only takes several months for the sensation to return. However permanent sensation loss in the areola (nipple) area or breasts, in general, can and may happen.
Wound Separation: The separation of the wound edges may be an issue in some cases. If this occurs, keep the area very clean and contact your surgeon as soon as possible. Revision surgeries are rarely necessary but may be required in some cases. The healing process will take longer for a patient with wound separation than it would be in a patient with normal wound healing.