Thank your very much for your question.
My mommy makeover patients come to me wishing to restore the youthful perkiness they once had - this could be to have larger breasts, reduce droopiness or even to correct asymmetry. Depending on their goals, either a breast augmentation, breast lift or a combination of both procedures (called and aug-masto in short) can be performed to meet her needs.
An in-person consultation is most crucial so that a detailed examination can be done so that we can advise the most appropriate plan for you. Nonetheless, here is an idea of how to determine which procedure is most suitable for you.
Do you want bigger breasts? If yes, then augmentation is the surgical procedure that will be required. You may have had breasts which were once very full and youthful, but have become deflated after pregnancy, breastfeeding or weight loss. Or you could have had naturally small breasts but want an increase in size now. No matter the reason, breast augmentation can be done to make your breasts bigger and improve the shape at the same time. Breast augmentation can be done with breast implants or using your own tissue (that in itself is a separate discussion). A breast augmentation will only lift the nipple by 1-2 centimetres, which brings us to the next discussion on breast lift.
Do you need a breast lift? Loss of breast volume can lead to breast or nipple ptosis (drooping). Breast drooping is especially common as women age, lose weight or have children. Younger women who have good skin elasticity may be able to have a good result with augmentation alone, but others may benefit from a breast lift. If there is sagging of the skin or if the nipples are pointing downwards or are more than 2 cm below the breast crease, a breast lift is the only procedure that can make them more youthful. Otherwise, you would be creating a droopy breast, just larger.
The pencil test. A simple test to determine if you're a candidate for a breast lift is the pencil test. Place a pencil as high as you can under the breast fold. If the pencil holds, then you have signs of breast drooping. If your nipple falls below the pencil, then you have significant ptosis, and more than likely are a great candidate for a breast lift.
What about scars? Some of my patients, especially those who are in the modelling industry are concerned about noticeable scars after breast surgery. Scars from breast augmentation are not typically noticeable and they can be concealed beneath the breast crease (inframmary), around the nipple (periareolar) or in the armpit (axillary).
However, a breast lift often leaves more noticeable scars. There are three types of scar for a breast lift - 1. periareolar (scars around the nipple),
2. vertical breast reduction (scar follows the areolar but also extends vertically down from the areolar to provide a greater lift for moderate drooping) and inverted-T incisions (which is the same as a vertical but with the addition of an incision along the breast crease for maximum breast lift).
The choice of the incision would depend on the amount of breast volume, tissue and degree of breast droop.
Discuss with a MOH-certified plastic surgeon who has experience in treating these conditions so that the right strategy can be selected to give you the most optimal results.
What if I have uneven breasts? Breast asymmetry is more common than one would think. Just like many other parts of the body, the left side does not exactly mirror the right. Breasts are better considered as sisters and not twins. Many of my patients do not release this until they take a closer look during consultation. In situations when the breasts are significantly different in size, two implants of differing sizes can be used or a breast lift can be customised with or without implants to help to even out this asymmetry.
So which is better? Breast Augmentation? Breast Lift? Or Both (Aug-Masto) ? Each procedure offers its own set of unique advantages and disadvantages. The goal of an augmentation focuses on size and shape of the breast but this will not correct drooping breasts and saggy skin. A breast lift, on the other hand, focuses primarily on breast and nipple position but will not increase the size of your bust. Hence, in some patients, a breast lift is done in conjunction with breast augmentation so that the breasts can be restored to a more youthful position and a volume increase is added with the use of an implant. Having a augmentation-mastopexy will give you both upper breast fullness along and allow me to reposition the sagging breasts and nipple.
I hope this helps you to make a more informed decision. All the best!
