For the majority of women, the ultimate appearance goal for breast augmentation surgery is fuller, shapelier breasts with attractive cleavage. However, adding volume alone may not be enough to achieve the desired look, especially in women with drooping breasts. By combining augmentation with a breast lift, an enhanced breast size, shape and position is possible.
Evaluating Breast Sagging
Women whose breasts are already naturally uplifted can increase volume with breast implants while maintaining their existing youthful profiles. However, for women who notice visible sagging in their breasts, a breast lift may be indicated. The primary deciding factor is how much sagging is present. Breast sagging naturally occurs over time, though women who have been pregnant often notice a greater degree of sagging following their pregnancies, and women who have lost a substantial amount of weight also will commonly see sagging breast tissue. When you talk with a plastic surgeon about the appearance of your breasts, he or she will "grade" the degree of sagging, which influences the type of procedure that may be recommended. There are three grades of breast sagging.
- Grade I: The central point of the nipple is at the height of the inframammary crease (the fold where the bottom of the breast connects to the chest wall). If you are in this category, a breast augmentation only may provide a satisfying outcome.
- Grade II: If the central point of the nipple falls between 1 - 3 centimeters below the inframammary crease, a lift still may not be necessary. However, if only an augmentation is performed, the implant placement may add volume lower within the breast than is desired.
- Grade III: At a distance of 3 centimeters or more from inframammary crease to nipple, it is generally a good idea to combine breast augmentation with a breast lift. The areola and nipple will typically be resized and recentered during the procedure as well.
In addition to these three grades, there is also the possibility that the breasts will appear droopy even though the nipple remains higher than the inframammary fold. Patients may wish for a combined breast lift and augmentation even if not technically necessary to improve the aesthetic appearance of the breast shape and placement after augmentation.
While performing a breast lift and augmentation can be staged in completely separate procedures, there are a number of benefits to scheduling one surgery that incorporates both at the same time. Patients largely prefer the option of a single surgery, as the convenience factor is higher and the overall cost is lower. Both breast augmentation and a breast lift are straightforward procedures, and both have low immediate and long-term complication rates. While in the past some surgeons believed that combining cosmetic surgery procedures could increase the risk of complications, it is now generally accepted that many common plastic surgery combinations such as breast augmentation/lift and tummy tuck/liposuction have very similar complication rates and revision rates compared to performing the procedures separately.
That said, surgeons still need to pay careful attention to the technical considerations that need to be addressed in order to achieve an optimal outcome. For instance, beginning a combined augmentation/lift with the augmentation piece allows for more accurate evaluation of the amount of skin and tissue that will be necessary to cover the additional volume before proceeding to lifting, shaping and excision. The ideal final results of combined breast augmentation and breast lift surgery are firmer, higher breasts that have more volume as well. As with any cosmetic procedure, surgical skill and experience are integral to achieving this superior augmentation outcome for women with drooping breasts.