To Lift or Not To Lift, That is the Question

The decision making involved in evaluation, planning and executing cosmetic breast implant surgery is critically important. Many patients come to see me knowing that they need a breast lift along with implant augmentation. Some patients, however, present with little idea that they need a lift, (mastopexy) along with implants. In the New York – New Jersey area, they just assume an implant will improve everything. This is true in some cases. Let me elaborate.

If a patient has minimal sag and minimal excess but good quality skin then implants alone, saline or silicone gel, can provide the lift needed without other incisions. Placement of implants under muscle should always be used. Never have them placed over muscle. (more about this in future blogs)

If the skin quality is poor, such as stretch marks, or the sag is great, or if the nipple position is low, especially when there seems to be a disconnect between skin, gland and chest wall, then a lift is mandatory to give the best cosmetic outcomes.

Mastopexy incisions vary based on the above mentioned variables. They can be just periareola or circumareola, circumareola plus vertical, or circumareola- vertical plus horizontal. The objective should always be the best breast outcome. Never minimize incisions as a marketing scheme. Understanding the dynamics and relationships between skin, gland, muscle, implant, and chest wall are paramount.

Some surgeons are fearful of the dynamics of changing three dimensions and anatomy constraints in these surgeries and therefore shy away from the combo. My marketing is the best possible breast outcome. Scars fade, aesthetic outcomes are the key. Sometimes this just requires a series of shared incisions. We’ll discuss how I treat revisions – patients who come to me to revise breast implant or mastopexy surgery done elsewhere by others in future blogs.

For now, check out my web site- Spiro Plastic Surgery  to see these and other outcomes.


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Graphite/Pencil Hybrid-Painting by Dr. Scott Spiro