Breast Augmentation with Lift

One of the primary gauges of sag is the relationship between the nipple and the fold beneath the breast (inframammary fold/IMF). Breast sag is progressively worse as the nipple to IMF relationship falls from above the fold (a), at the fold (b), and to below the fold (c,d). Sag is at its worst when the nipple is not only well below the fold, but is also the lowest part of the breast (d). There is another type of sag in which the nipple really doesn't fall but stays above the fold, and the entire breast and IMF move downward like a paint drop on a wall (e). Finally some forms of sag are related to poor development of the breast, especially if the breast never developed adequate width. These are "constricted breasts" mentioned above, also known as "tuberous breasts" or the "snoopy deformity." We have to consider the various types of sag in our decision-making.

In any discussion of surgical solutions for breast sag, breast implants should be mentioned. They sometimes are used instead of or along with a breast lift. There are certain lifts that should be used only with breast implants. For more information on this topic please refer to the Breast Augmentation section of the Hubbard Plastic Surgery web site.

Probably the most common surgical approach to correcting sag involves the lollipop scar line pattern. With newer techniques, many patients do not require a horizontal scar in the fold or a very short one.

This general approach provides the surgeon with a variety of options. Sometimes the nipple is not raised but the overall breast tightened and shaped. More often the nipple is raised, the areola (pigmented skin) made smaller and the breast raised, tightened some and shaped. Often better shape is accomplished by removing some breast tissue. There are many options with how much is removed from minimal to considerable in those women that choose to be smaller. Often the choice is made to remove more on one side for better symmetry. Overall, the shaping action in this surgery brings out the true artistic abilities of a plastic surgeon. I place the patient in a near-sitting position in the operating room and progressively sculpt the breast by sequentially tightening in multiple directions. With quite significant sag, patients gladly accept the scar lines as a tradeoff for such great improvement in shape. Breast lift patients owe it to themselves to be well educated about the choices. Just because there was a vertical scar, does not mean the vertical technique was performed. Often the vertical scar was from skin tightening alone, which in most cases is a far inferior result.

With the greater number of implant choices and breast lift types available, a thorough consultation and examination with Dr. Hubbard is more important than ever. Dr. Hubbard customizes his procedures based on chest width, breast and body size, presence of sag, and personal goals to achieve individualized results.