Breast lift, reduction, and augmentation: What you need to know

There are 3 operations that are considered in terms of improving a woman’s breasts:

  1. Breast Augmentation (enlargement)
  2. Mastopexy (the technical name for a breast lift)
  3. Breast Reduction

While the decision as to which operation is best or most suitable may seem straightforward it can, in fact, be quite complex. Women’s breasts are subject to the changes of puberty, ageing, pregnancy, breast feeding, weight gain or weight loss.

The breast is dynamic and changes throughout the course of a woman’s life. Dr Goldman will perform a thorough clinical assessment of your breasts which includes a lump check, performance of a series of measurements of the breasts and their position on the chest wall. He will also demonstrate and point out certain benchmarks that are used to determine whether a lift is necessary or not.

Do I need a breast lift?

There is no direct answer; ptosis (AKA breast droop) is a subjective problem and the severity is measurable.

On occasion, women want a breast lift when the degree of droop does not warrant a lift. On the other hand, some women need a lift but refuse to accept the breast scarring associated with this. Dr Goldman will recommend a breast lift if there are no other acceptable alternatives. However, especially in young women, he tries to find the alternative.

Risks associated with breast lifts

On very rare occasions, breast lifts (as well as reductions) can result in the loss of the nipple. The nipple complex is very sensitive to inadequate blood supply and this is a potential risk associated with a breast lift and reduction.

When breast surgery actually cuts into breast glands and ducts, 50% of the women will not be able to breast feed.

Breast lift alternatives

It is common for women to believe they need a lift when in fact, a better, safer, and cheaper alternative is a breast augmentation. This will allow more time before a lift may ultimately need to be performed, especially in women who are yet to have children. This risks of loss of the nipple go up significantly if a second lift or reduction is performed.

In addition, breast lifts and reductions can be performed either with or without implants. Implants are generally used for shape, as they yield a better overall result. This can be a personal choice but Dr Goldman will also make the necessary recommendations.

Breast lift vs breast reduction

The distinctions between a breast lift and breast reduction are blurring. Both operations require the exact same incision pattern and, therefore, the same scarring pattern.

The modern operation and incision pattern is referred to as a vertical mammoplasty (either lift or reduction).

Breast surgery lollipop incision

“Lollipop” incision

Here, the incision pattern is around the areolar skin and a vertical down the front of the breast in the middle into the crease of the breast.

The “old fashioned” version resulted in the same incision pattern around the areola and down the front but also included a long horizontal scar in the crease of the breast. This often was visible both at the cleavage side as well as the outer side of the breast.

Breast surgery anchor incision

“Anchor” incision

Dr Goldman refers to the vertical pattern as a “lollipop” scar and the “old fashioned” op as an “anchor” scar.

On occasion, if the breasts are very large (G cup or bigger), the anchor pattern reduction may still be necessary.

Should you get a breast lift with or without implants?

If the lift is going to be performed with implants, a small amount of breast tissue will typically be removed. Even if no implants are going to be used, it is still common for some breast tissue and skin to be removed. The difference between a breast reduction and lift also relates to how much breast the surgeon will be removing.

The actual “internal” reconstruction technique (stitching method) used is becoming more and more similar in that it is more robust using a reduction technique than a lift technique. A breast reduction is still a very efficient lift operation.

In 2016, some of the world experts in cosmetic breast surgery are using the term “Breast Reduction-Augmentation” to describe a breast lift with implants or a breast reduction with implants.

Dr Goldman has coined the term “Plication Augmentation Mammoplasty”, which is a procedure involving a breast augmentation with tightening and lifting.

Other options

In recent times, specialist surgeons have started to perform fat transfer injecting to enhance and improve the shape and size of women’s breasts. This involves liposuction (often of the abdomen) to harvest the fat which is then prepared and transferred into the breast.

This is not yet licensed for use as a replacement for implants in breast augmentations but is used and an additional technique for lifts and reductions.

Fat transfer injecting carries significant risks and complications that can interfere with the detection of breast cancer at a later time.

In summary, although there are currently 3 main cosmetic breast operations, this may eventually be reduced to 2: breast augmentation and lift/reduction with or without implants.

For a consultation or for more information on cosmetic breast procedures, please contact Dr Robert Goldman.

The True Costs of Medical Tourism in Thailand

Are you thinking about having cosmetic surgery in Thailand?

Here are some facts and things to consider before taking the plunge.

I will take you through all the issues relating to undergoing cosmetic surgery in Thailand vs in Australia.

Disclosure: I am a registered specialist surgeon (breast and abdominal) in Australia. I have never performed surgery in Thailand and do not know anything about their healthcare system. Do you?

I am going to discuss the advantages and disadvantages of the cosmetic tourism industry in Thailand vs Australia. I hope that at the end of this, you will be more informed about the differences before you make your decision.

Firstly, I’d like to give you a warning: Do not be seduced by the cosmetic tourism industry and their claims; surgery is NOT a holiday! Surgery carries potential risks and complications, some of which relate to flying after surgery.

Advantages of cosmetic surgery in Thailand or overseas:

Advantages of Cosmetic Surgery In Thailand

  1. Price: cosmetic surgery procedures are very cheap in Thailand in comparison to Australia and other developed countries
  1. Exciting and glamorous: you can have an operation that will enhance your appearance and go overseas for a “holiday”
  1. Going away and arriving back home as the “new you”
  1. Thailand is world renowned for transgender, gender re-assignment and feminization surgery. No discussion or debate here!

Disadvantages of medical tourism in Thailand

Disadvantages of Cosmetic Surgery In Thailand

  1. Uncertainty: Thailand is a foreign country with many uncertainties in the medical world. Before deciding to undergo surgery in Thailand, you should have answers to the following questions:
  • Do you know what will actually happen?
  • Have you been correctly assessed and sized?
  • Have the surgery and all related options been discussed? Have you made decisions about your options?
  • Have you been listened to and given the opportunity to express your desires regarding the outcome of your surgery?
  • Have your expectations been met?
  • Are you aware of what’s involved with the consent process?
  • Have all the risks and complications been discussed?
  • Were you able to ask questions and voice your opinion?
  1. Process: You are going to undergo an anaesthetic (with its own set of risks and complications) and surgery. This process is very strenuous on the body– far from the glamorous holiday you may be imagining. Surgery and anaesthesia will leave you sore, causing tightness and pressure, and making you feel unwell from the anaesthetic and painkillers. You also may experience significant vomiting post-surgery.
  1. Air travel: flying comes with the innate risk of deep vein thrombosis (DVT). Surgery itself carries risk of DVT so, flying post-surgery “doubles” your risk. Deep vein thrombosis can result in what is called a pulmonary embolus.

This happens when some of the blood clot in a DVT breaks off from the veins in your legs, travels to and lodges in the veins in your lungs. This is a serious risk and can be fatal. It affects otherwise young, fit, and healthy people. It’s essential to examine DVT and other travel risks when considering to have your surgery overseas for cost saving reason.

  1. Regarding breast surgery and specifically breast augmentation, are you aware of the advantages and disadvantages of under the muscle vs over the muscle implants? Have you been properly evaluated and have the options and risks been discussed?

In general, surgeons in Thailand typically place implants behind the pecs (submuscular) and tend to use incorrect size implants in western women (often for cultural reasons).

  1. Despite what you might be told, there is no routine follow-up back in Australia for cosmetic surgery done abroad. When you arrive back, if something is wrong, you will struggle to find a cosmetic specialist in Australia that will see you and assess you for complications. If you have a complication that requires corrective surgery, Australian surgeons, in general, will not perform this surgery as a “no gap” operation.

Revision surgery for complications when the primary surgery is performed by a different surgeon is hard to come by. The outcomes are hard to predict and revision (corrective) surgery done by a different surgeon is more difficult and always more expensive.

  1. Finally, Australian hospitals and anaesthetic services/fees are much higher than non-western countries. There is often a superior standard of quality associated with the higher prices paid for these services.

Please take all of this into consideration when making your decision on overseas cosmetic surgery. Are the surgeons and anaesthetists abroad of the same standard as you would expect in Australia?

Please think about these issues carefully before you make a decision. The saying “You get what you pay for” is often true, especially when it comes to cosmetic surgery in Thailand vs Australia. If you cannot afford to have the surgery at home in Australia, can you afford to have the corrective surgery in Australia for complications with surgery abroad?

Want more information on cosmetic surgery and procedures? Check out Dr. Robert Goldman’s cosmetic surgery blog or if you wish to discuss any of these issues, contact Dr Robert Goldman, cosmetic breast and body surgeon today.