With the evolution of the passage of time, after maternity or after slimming methods, the mother sometimes loses volume, empties and falls. It also occurs with prolonged lactation. The patient comes to seek a solution and for this it is essential to first assess how the breasts are, to determine if they are symmetrical and to determine the height of the nipple-areola complex. The submammary fold should be at the level of the sixth rib and the nipple-areola complex (NAC) should be at the level of the fifth rib. Sometimes empty breasts seem to need to be lifted, but if the nipple-areola complex is in place, the breasts should be filled, not lifted. If you make the mistake of raising them above the fifth rib then the nipple comes out of the bikini.
It is very important to assess the condition of the skin, if it has many stretch marks, if it is like a plastic bag with water half empty. It is also very important to take into account if the patient is happy with the volume of her breast even if it is sagging or if she wants more volume. All this must be discussed with the patient to see exactly what we want to obtain.
The issue of volume can be solved in two ways or with a breast prosthesis or with lipostructure if we have enough fatty tissue or combining the two procedures. If we only want to place the breast in its place and we have enough volume then depending on the descent of the CAP we have several techniques: Periareolar Pexia with the Hammond technique when the fall is less than 4 cm and there is not much skin left.
With this technique we only make a periareolar scar. When the PDA is between 4 to 6 cm lower than the sulcus and if there is not much skin left over we can use our vertical scar technique that we published in the American journal of aesthetic surgery: Journal of Aesthetic Surgery. When it is lower and there is more skin left over, it is necessary to use the inverted T-scar technique.
In all techniques it is very important to anchor and suture all the breast tissue to the muscle so that it does not fall and remain in place. It is also important to use fat through lipostructure to finish remodeling the intermammary space, the canalillo, and to fill the upper poles.
If we want to place a prosthesis, all these techniques can be used, but taking into account that it will be necessary to keep more skin. If we apply the Hammmond periareolar technique, we must explain to the patient that at the beginning the scar is a little puckered and that when it is healed we place some sheets of silicone areola that looks very good.
If we decide to make a vertical scar we first make the vertical incision and the submuscular pocket, we place the chosen prosthesis and then we resect the remaining skin. If we decide to perform the inverted T, we also place the prosthesis through the horizontal scar in the groove and then we resect the excess skin.
At the end of the lipostructure we remodel the intermammary space or canalillo and fill well the upper poles so that the neckline is beautiful. With all this we get a beautiful breast, at the right height, the nipple at the height of the fifth rib, the groove at the height of the sixth and also with a good gutter with full upper poles being a very nice breast and giving much satisfaction to the patient.