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