Breast Augmentation, Breast Lift: Choose One, Choose Two


As people age, the breasts age: the skin stretches and the shape of the breast changes. Volume may change as well: pregnancy and breast feeding can produce a breast that is smaller than it was a few years ago, drooping as the breast falls and becomes longer. Correction depends upon the changes needed. First, consider your ideal size and shape. Decisions must be made as to the desired size and shape, then how best to produce those changes. One must start with the available tissue, decide what to add, and consider how to reshape what is available to produce an attractive breast.

Over the years I have had the best success in determining the desired size by direct trial, and base size by direct measurement. When women come to my office for a consultation, I ask them to bring a bra that is the size they'd like to wear. The best sort of bra for this sizing purpose is an under wire bra, with a cup that is smooth and not too stretchy. If you are in doubt as to the size bring them all--leave the tags on and return ones you're not going to keep after surgery. We will tuck implants into your bra, increasing your breast volume in front of some well-lit mirrors, to let you decide what the best size is for you. Eventually, we'll find a size that's "too big," a size that's "too small," and the size you've always imagined. This is especially helpful in cases of asymmetry, when one implant size may be very different from the other.

The next step is to determine the base size by direct measurement. We measure the base diameter of the breast, so we'll know exactly where to place the implant: we want the implant to fit the chest wall, extending symmetrically beneath the nipple, with the nipple at the center. As the breast is made larger, the balance extends above the nipple, producing a fullness that some women find attractive and others feel is unnatural. The nipple should remain central to the breast mound: this can often be achieved by careful attention to detail as the implant diameter and volume are selected. On occasion the inframammary crease, or the bottom fold between breast and ribcage, is lowered as the diameter of the base is increased. The breast diameter affects this crease and lateral breast fullness as well, producing some of the curves of the curvaceous figure. It should be possible to find the implant size and shape that is right for you at the initial consultation; however, once you've seen yourself in all those different bra sizes, your ideas about breast size may change, or become clearer to you. It is not too unusual for women to call us the next day, arranging to come back for a second look.

Augmentation Mastopexy Before and After

If the nipples are low or pointing the wrong direction, their correct position is determined with the inframammary crease as a landmark. The nipples should be level and they should be over the center of the breast. The correct position is located and extra skin is identified as a pattern for the mastopexy is developed. If the breast volume is adequate or excessive the breast can be reshaped without the use of an implant. The goal is to produce the ideal shape, using the simplest approach. At times the breast can be repositioned and reshaped: sometimes the volume is in the wrong spot, and an implant is needed to produce the desired shape.

When mastopexy and augmentation are both needed the incision is around the areola, to move the nipple to a new position. A vertical incision at the center of the breast, beneath the nipple, tailors the shape. These incisions heal with scars that are well concealed by their location at the margin of color change at the areola and on the shadow beneath the breast. Check out breast lift or augmentation/mastopexy

Lots of options and decisions, but the options are all good ones for the right individual and should be made on an individual basis. This decision and procedure is all about you. Choose one or choose two.

Asheville Plastic Surgery's Dr. James McDonough discusses augmentation/mastopexy.

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