A breast augmentation is performed by placing an implant either under the breast tissue itself or the underlying chest wall muscle. Today most surgeons select the under the muscle option. There are several advantages going underneath the muscle which include a more natural look, less chance of capsular contracture, and more accurate mammography.
A breast lift is a procedure whereby the envelope of skin surrounding the breast is tightened and reshaped by removing excess skin and moving the nipple up to a more centered position.
A breast lift will compact the breast, whereas a breast augmentation will stretch out the skin. Consequently these are two opposing operations. During the course of a breast augmentation combined with a breast lift several different components of the breast are being changed. If one component changes different than the opposite side, a second operation may be required in order to achieve the best outcome. It’s always important to remember that these are two distinctly different operations and when combined together normally have good outcomes. Occasionally, however a second operation is required in order to achieve the best result.
Breast Lift With Breast Augmentation: Two Procedures or One?
The issue of one or two stages for breast augmentation and breast lift continues to represent an area of significant controversy in plastic surgery. This appears to be driven by the large number of variables involved with breast augmentation and breast lift. Some surgeons feel that the additive impact of these variables results in a high revision rate. Some surgeons feel that this may be as high as 20%.
Many surgeons feel that the high rate of revision with this combination of procedures is too high. For these reasons, they prefer to stage these procedures. They typically prefer to perform the breast lift first and then follow with a secondary breast augmentation. They feel that by utilizing this approach, they can control multiple variables and provide an excellent satisfaction rate. The obvious disadvantage of this approach is that 100% of the patients will require two procedures, two recoveries and ultimately more expense.
Another group of surgeons feel strongly that a single, combined procedure is appropriate. They argue that the majority of patients following this approach have a good result. The 20% of patients who require a secondary procedure would have had a secondary procedure anyway if a two stage approach had been utilized. Not only do the majority of patients only have one procedure, but they also only have one recovery and incur less expense.
Ultimately, the type of approach utilized depends upon the patient. Many patients are motivated to undergo a single combined procedure for social reasons. Time off work, child care and the day to day stress of normal life are powerful motivators. When patients choose this approach, it’s important for them to realize that a secondary revision procedure may be necessary. Under these circumstances, they must understand that this doesn’t mean an error has been made, but instead that we’re dealing with a very complex set of variables.
Swelling after Cosmetic Breast Surgery
Patients undergoing breast augmentation with breast lift can anticipate significant swelling in the immediate postoperative period. This swelling resolves quickly with the vast majority being gone in about three weeks. Almost all of the visible swelling is gone in 4 to 6 weeks, but small amounts of residual swelling may be present for up to 3 to 4 months following surgery.
Compression bras and dressings are frequently used following breast augmentation with breast lift to minimize swelling. Swelling can add to a patient’s postoperative discomfort. It can also increase anxiety regarding breast size immediately after surgery.
For these reasons, we feel it’s important for the patient and the surgeon to have good communication regarding this topic immediately following surgery. In this situation, a little reassurance can go a long way towards making this a more comfortable experience.