The breast lift with prosthesis is the most difficult intervention of all in the field of cosmetic breast surgery. The reasons for its difficulty are multiple, so let’s go by parts to understand well what it is.
When is a breast lift with prosthesis performed?
The term breast lift implies an intervention to correct the descent or fall of the breast and breast prostheses are used to increase the size of the same.
Thus, a breast lift operation with prostheses is performed when the patient’s desire is to have high (less sagging) and full (less empty) breasts.
Why do breasts droop or sag?
Within the breasts of all women there are the same components – gland and fat, and a third element that surrounds it all, the skin. The difference between some breasts and others is in the percentage of its components … there are breasts with a lot of gland and little fat, others have more fat than gland If we consider that the gland weighs more than fat, a very glandular breast is easy to weigh more and depending on the skin that surrounds it will have more tendency to fall than if the content is fat.
As we have said, the quality of the skin surrounding the breast is very important.
While it is true that there are ligamentous elements that support the breast, these are closely related to the type of skin of the breast, so that we can say that the breasts with thick skin will fall less and more slowly than breasts with thin skin, which will hold less.
There are two situations that greatly favor breast sagging. Female hormones linked to pregnancy and lactation increase the size of the gland, which weighs more and stretches the skin. Repeated pregnancies and breastfeeding will enhance the effect that will be more evident in thin-skinned breasts, which will fall without remedy.
Also major changes in weight have a similar effect by varying the amount of fat in the breasts that also distend the skin that hardly recovers if it is thin and end up being excessive when losing weight, resulting in an empty and sagging breast.
Thus the breasts may already be somewhat sagging in very young women if they have very thin and striated skin due to rapid growth.
Are all sagging breasts the same?
Surgeons always talk about different degrees of breast ptosis or sagging breasts, we can summarize them in minimum degree, medium degree and important degree.
In addition to assessing the degree of sagging or ptosis of the breasts, we must assess the quality of their tissues. For example, a medium sagging breast but with a very thin skin will be more difficult to treat than an equally sagging breast but with thicker skin.
Properly understand what clinical case we are in front of, that is to diagnose it properly in the first step to correct it later in an effective and lasting way.
What does a breast lift operation with prosthesis consist of?
The surgical techniques of breast lift consist of reconstructing the components of the breast in a higher position than in which they are, giving them a more beautiful shape, often fill more the upper pole of the breast that is empty in sagging breasts or ptosis.
Once the shape and position of the breast has been changed, excess skin must be removed so that it covers the contours of the new breast without excesses. In doing so, the areolas are almost always elevated and are reduced in size to fit the new shape. Finally, a cohesive silicone gel prosthesis is added to increase the size of the new breast.
How is the size of the prosthesis decided?
First of all we must take into account the patient’s wishes regarding the final size of her breasts, but nevertheless it is important to consider all the alternatives.
We must remember that the prosthesis that we place, whether it is placed in front or behind the pectoral muscle, will weigh…. and the weight will have to be supported by the skin, which remains the same. This operation does not change the quality of the tissues. So, if we want to have lasting results, it is important not to use very large prostheses. Many women think that the prostheses do not fall never …. false, the bigger they are, the more they fall.
Where are the scars of a breast lift with prostheses made?
In the minimum degrees of sagging or ptotic breasts, it is often sufficient to correct them by placing an anatomical prosthesis of full projection through a scar in the submammary fold of only 4.5 cm in length. In the middle grades of sagging or ptosic breasts there are two options, depending on the quality of the skin.
If the skin is of good quality the full projection anatomical prosthesis will be placed as in the minimal cases through an incision of 4.5 cm in the submammary fold and the excess skin is removed around the areola which decreases in size, leaving a scar around the areola.
Before After Before After
If the skin is of poor quality it will be necessary to remove more of it and there will also be a vertical scar from the areola to the submammary fold.
Finally, in the important degrees of sagging or ptotic breasts, when the lower pole of the breast rests completely on the rib cage and the quality of the tissues is usually not the best, there is no choice but to remove as much skin as possible so that the resulting scar will be an inverted T or anchor.
Deciding what should be done in each case requires a first visit with enough time to evaluate all the variables including the pros and cons.