Breast Augmentation and Lift TechniquesDr. John Q. Cook approaches combination breast augmentation and lift procedures with the option of multiple techniques.
Breast Augmentation Combined with Periareolar Mastopexy
If your breasts have settled beyond where they can be “lifted” with implants but not to the extent that the nipples lie below the level of the fold under the breast, a combined periareolar lift with breast implants may work well for you.
I often use this combination for patients that have lost tone and volume in their breasts after pregnancy and breast feeding and sometimes for patients who have lost significant weight but who haven’t experienced severe breast settling.
The basic concept of the surgery is simple. The surgeon makes a circular incision around the border of the areola or within the areola if it has been stretched out by pregnancy. Another oval shaped incision is made further out in the skin of the breast, and the skin between the circle and the oval is removed. As the outer oval is brought to the inner circle with stitches, the breast is tightened and lifted. There are a number of technical embellishments to this technique, but this describes the basic concept of the surgery.
The periareolar breast lift was developed several decades ago, but it never caught on for one simple reason: the tension that resulted from bringing the outer oval to the inner circle often caused the scar to spread. Dr. Louis Benelli, a French surgeon, made a significant contribution when he developed the “blocking suture” technique. Also called a “purse string” suture, the blocking suture is placed under the skin at the edge of the outer oval so that it runs around the entire margin. When the surgeon tightens this suture and secures it with a knot, this reduces the oval to the size of the inner circle and removes the tension that would otherwise cause the scar to spread. I learned this technique from Dr. Benelli in one of his courses and I have found it to be helpful and effective in the right patients.
PERIAREOLAR MASTOPEXY WITH AUGMENTATION TO CORRECT A POINTED BREAST SHAPE
As I mentioned earlier, I have found that many of the patients who see me in consultation for breast augmentation have significant concerns regarding breast shape as well as breast size. One common issue is the pointed breast, which tends to over-project in the area beneath the areola. Some patients are very self-conscious about this particular breast shape.
The periareolar mastopexy can be a great friend to patients with pointed breasts, since it deprojects the pointed area of the breast right in the area where this is needed. I often combine other advanced breast surgery techniques under these circumstances to help my patients achieve the shape that they desire.
PERIAREOLAR BREAST LIFT COMBINED WITH IMPLANTS TO CORRECT NIPPLE AND AREOLAR ASYMMETRY AS WELL AS BREAST ASYMMETRY
Many patients have breasts that are two different sizes. I can help these patients by placing a larger implant behind the smaller breast and a slightly smaller implant behind the larger breast.
Sometimes the asymmetry of the breasts is accompanied by asymmetry of the areolae, either in position or size. To a degree, it is possible to shift the axis of the breast so that an areola that is pointing too far inward or outward can be oriented in a better direction. I have also used the periareolar lift technique to help patients in whom one areola has a larger diameter than the other.
STRUCTURAL MASTOPEXY WITH IMPLANTS
The development and refinement of the structural breast lift and other forms of structural breast surgery have been a major focus of my creative work in breast surgery over the last seven years. In my opinion, the structural lift has significant advantages over many other breast lift techniques. These advantages include a restructuring of the breast tissue to replenish missing volume in the upper part of the breast, deep multi-level anchoring of the breast to help maintain the lift, and more limited scars than traditional breast lift.
The structural breast lift combined with breast implants is my preferred technique for those patients who need a greater amount of lifting than can be accomplished with a periareolar lift and who also need additional breast volume.
VERTICAL MASTOPEXY WITH IMPLANTS IN THE CONTEXT OF STRUCTURAL LIFTING
There was a time when I did quite a few vertical breast lifts. This operation was significantly refined by surgeons in France and Brazil, such as Dr. Lasus and Dr. Pitanguy. It took the better part of two decades for this operation to be widely adapted in the United States.
The main appeal of this operation was the elimination of the scar that runs along the fold under the breast with the classic breast lift technique, sometimes referred to as an “anchor” lift because of the location of the scars. There are different variations of this operation, some of which just rely on the skin to lift the breast, others that tighten the deeper breast structure. The vertical breast lift technique can be combined with breast augmentation.
With the structural breast lift technique, I believe that I can control more aspects of the breast form than I could accomplish with vertical lifts, so I perform the latter much less frequently at the present time.
CLASSIC (ANCHOR) BREAST LIFT COMBINED WITH AUGMENTATION
Many surgeons in the United States still use this as their main technique for breast lift combined with implants. Those who criticize this operation do so on the basis of the extent of the scars, which run around the areola, straight down from the areola to the fold under the breast and along much of the fold, both in the inner and outer parts of the breast.
Although scars are important, a more significant disadvantage of the classic lift is that it relies on the skin to do the lifting. For many people, skin lifts don’t last very long, and the lower portions of the breast stretch out.
There is a group of patients for whom I still use the classic lift combined with implants. These are patients in whom the main stretching out of the breast is along horizontal rather than vertical lines. This is sometimes seen in patients who have lost a very large amount of weight. Even in these patients, I will often incorporate elements of the structural technique for the deeper parts of the breast, although the pattern of the external scars does not reveal this.
If you would like to learn more about the techniques Dr. John Q. Cook uses for his breast lift with augmentation patients, we encourage you to contact his practice and set up a consultation. Call us today at 312-751-2112 or 847-446-7562.