Breast Augmentation With Lift

You can determine if you might benefit from a breast lift with the “underboob pencil test,” which is simple and can be done at home. Place a pencil under your breast where it meets the chest. If the pencil stays in place without falling, this could be a sign that your breasts are sagging, and a lift might help restore a more youthful shape. However, a personalized consultation with Dr. MaDan is the best way to assess whether a breast lift is right for you based on your unique anatomy and goals.

While a breast lift can reverse the effects of time and gravity, it does not stop time, gravity, or genetics—the major contributing factors to ptosis or sagging. Other factors like pregnancy, hormone changes, and weight fluctuations can affect the outcome of your breast lift. Placement of an implant that is too large may exceed your body’s elastic limit, causing recurrent sagging or ptosis. An ideal candidate for a breast augmentation with lift is a patient who has completed their family and is within 5 to 10% of their goal weight at the time of surgery.

Immediately after surgery, the lower pole of your breast may look flat. As the tissues soften and heal, the pectoralis muscle will relax, allowing the implant to settle and the lower pole to round out. Generally, this process takes approximately 3 months and may not occur simultaneously for each breast.

The breast augmentation with lift incisions will take a minimum of 2 weeks to heal. Avoid underwire bras for a minimum of 6 weeks. We will provide a supportive post-surgery bra to wear during this time.

After the initial 2-week healing period, the scars will soften and start to fade while they regain tissue strength. We will provide medical-grade scar therapy after your surgery. Silicone-based scar therapy is shown to improve the outcome and appearance of scars. Our medical-grade scar therapy also has SPF 30 to add an extra layer of protection against UV exposure.

It is ideal to sleep on your back in your post-surgery bra for at least 6 weeks after surgery. The bra will protect and support the breast tissues as they heal. Most patients will position pillows around them in a horseshoe to minimize the risk of turning over on their side or stomach. Over time, you should be able to return to your normal sleeping position.

Prior breast surgery is unlikely to affect your ability to conceive. It can, however, affect your ability to breastfeed. No research studies have been performed on pregnant or breastfeeding women, so the statistic of women able to breastfeed after breast augmentation with lift surgery is unknown. While a breast augmentation with lift does not remove breast tissue, the architecture of the breast is changed. In general, excess skin is removed from the lower pole of the breast. The nipple stays attached to the deeper tissues, and it is not removed and replaced. The nipple is repositioned to the most projecting part of the breast, and the areola diameter is reduced.

Implant selection for a breast augmentation + lift is different from implant selection for an augmentation alone. The most significant contributing factor is the amount of excess skin and the elasticity of your tissues. Selecting an implant that is too large may impair your body’s ability to heal, resulting in wound breakdown.  This, among other factors, determines the best implant for you. First, we will discuss your ideal look, meaning we will talk about whether you want an athletic, more natural look or a round, shelf look with more cleavage. A higher-profile implant usually creates more roundness and cleavage. Inspiration photos can be helpful in understanding your goals more clearly.

Dr. MaDan will take breast measurements and assess your natural breast tissue. One of the most important measurements is your breast width, which indicates the maximum base width of an implant that can fit on the chest wall. This ensures your implants won’t interfere with your hobbies and daily activities—no one wants an implant in their armpit. We will use our shaped sizers to try out different volumes to give you an idea of the look in clothing. We will also use our 3D software to simulate what that size may look like on you. We review before and after photos to visualize the differences between implant profiles and volumes.

The extent of nipple repositioning and excess skin are important factors that influence the final implant selection. During your consultation, Dr. MaDan can help you determine what is realistic and anatomically possible. The opposing forces of a lift and implants may limit the recommended volume/size of your implants. Depending on your desires, a two-stage procedure may be recommended. With secondary breast procedures, like implant exchange, patients are often able to increase size as the soft tissue has already expanded and stretched.

We use multiple methods to help you choose your desired volume. We use a sizing insert system that shows you what your desired volume looks like in clothing. Our 3D software simulates what your desired volume will look like on you. Another method is reviewing before and after photos of patients with a similar build and starting volume as yourself. Physical characteristics, such as breast width and soft tissue envelope, may influence or limit possible volume. Typically, Dr. MaDan will bring a range of implant volumes for your surgery, allowing her some flexibility in the operating room. 

It is important to understand that breast implants are not considered lifetime devices. This means you will require future surgery for implant exchange or removal, depending on your goals at that time. It is easier to exchange implants for a larger size than downsizing as soft tissues expand to accommodate the larger implant. However, tissues may not bounce back or tighten up if smaller implants are placed. Sometimes, downsizing implants requires a secondary or repeat breast lift at the same time to remove the excess skin that previously stretched with larger implants.

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Silicone implants will feel the most supple and similar to natural breast tissue. The silicone gel is form-stable while still feeling soft, which minimizes the risks of unnatural-looking rippling and wrinkling. Saline implants may feel harder and less natural, depending on the fill volume. Due to the property differences between silicone and saline, saline implants have less height retention in the upper pole in an upright, standing position. The cohesive silicone gel found in a “gummy bear” implant maintains its shape in the upper pole, giving you more shape and upper pole fullness in all positions.

Maximum cleavage can be achieved with the most cohesive gel and a higher profile implant like full/high or extra full/extra high. When placing implants in the sub pec—behind the pectoral muscle—position, Dr. MaDan is limited by a patient’s anatomy to a certain degree. Some women naturally have a wider space at the midline between the breasts. Releasing too much of the pec muscle from the sternum can create a complication called symmastia. Generally, the breast footprint, where the breast is located on the chest wall, cannot be changed.

The implant placement creates a lifting effect due to the implant’s volume and projection (height), but the breast lift repositions the nipple and tightens the lower pole of the breast by removing excess skin. It is essential to follow recovery recommendations, such as wearing a supportive bra at all times, to ensure tissue and implant stability as the healing process occurs. Factors like noncompliance and genetics can contribute to excess lower pole tissue stretch or “bottoming out.”

The Keller Funnel is a useful tool that increases safety during augmentation procedures. It resembles a pastry bag with the implant as the icing. With the implant in the Keller Funnel, squeezing the open end of the funnel will propel the implant forward. With the Keller Funnel, Dr. MaDan can insert large implants through small, 4 cm incisions. The Keller Funnel also minimizes the risk of contamination because no one, not even Dr. MaDan, touches the implant with their hands. In essence, the implant goes from its sterile container into the funnel, then into the breast pocket. The implant is placed first, ensuring the greatest field of sterility before manipulating the breast tissue and skin. Strong, absorbable sutures are then used to close off the implant in its pocket before performing the lift.

The no-touch technique is a method of handling the implant to optimize safety and minimize risk during the procedure. The Keller Funnel ensures the implant does not come into contact with the skin or other contaminants. Additional measures Dr. MaDan employs to maximize safety are the use of nipple shields and antiseptic solutions. The breast is not considered a sterile organ as the nipple, which allows breastfeeding, is open and may allow bacterial contamination. Nipple shields are an occlusive dressing applied during the procedure to decrease the risk of bacterial contamination of the implant. All these steps are performed as part of the ”no-touch” technique to reduce complications.

GalaFLEX or Durasorb are brand names of an internal soft tissue scaffold made of absorbable, strong, synthetic suture material. While this mesh is usually indicated for breast revision procedures, it can be placed for extra support during a lift if needed. The scaffold is absorbed over many months. This mesh can also be used to correct double bubble deformity—the disruption of the inframammary crease from a prior procedure.

Yes, breast surgery is performed in an accredited surgical center under general anesthesia provided by an anesthesiologist. Typically, an IV is placed while you are in the pre-op holding room. You are given IV medications for relaxation and induction of anesthesia. After you are asleep, an airway (LMA- laryngeal mask airway or ETT- endotracheal tube) device is placed to assist your breathing during the surgery. When you are awakened from anesthesia, the breathing tube is removed. Some patients may experience a sore throat afterward. This is temporary and usually resolves quickly. It is important to inform your plastic surgeon and the anesthesiologist of any adverse effects of prior anesthesia (including nausea) or family history of anesthesia problems. Anyone taking GLP-1 medications like Semaglutide or Tirzepatide should pause their injections for a minimum of 1 week before surgery to minimize the risk of aspiration. It is acceptable to resume those medications after surgery.

Yes, the minimum requirement is having someone drive you home from surgery and stay with you for the first 24 hours after anesthesia. Depending on your home situation, you may find assistance beneficial, especially if you have young children, pets, or lifting requirements. You can drive 24 hours after stopping all narcotic pain medications.

Yes, you will be placed in a supportive bra following surgery. You should wear this bra at all times except when showering. This bra will support and protect the tissues throughout recovery and stabilize the implant. You will not be allowed to wear underwire bras for a minimum of 6 weeks following the procedure. In approximately 3 months, you’ll see your final shape and implant position. At that time, it will be beneficial to be remeasured for your new bra size.

The recovery process is different for everyone. Generally, you may feel sore and tight after surgery. Swelling peaks 72 hours after your procedure. Cool compresses and anti-inflammatory medications can help your recovery. The biggest risk associated with breast augmentation with lift surgery is bleeding. While the risk is extremely low, approximately 4%, we want to optimize your safety and minimize the post-operative risks.

Do not exercise or do intense activities for 2 weeks following your procedure. After 2 weeks, light activity is acceptable. Light activities are walking, stationary bike, slow Stairmaster—nothing high impact or causing excess bouncing like running or jumping. You will have a weight restriction of 10 pounds for the first 4 weeks following breast augmentation with lift surgery. Upper body exercises should be minimized for at least 6 weeks.

Dr. MaDan recommends waiting to resume strenuous CrossFit-like exercises, bodybuilding, or heavy weightlifting with a barbell (heavy, intense, repetitive upper body exercises) for at least 3 months to minimize the risk of implant malposition.

Time off work depends on your occupation and desired speed to return to work. When you no longer need narcotic pain medication and can abide by all restrictions, it is acceptable to return to work. Dr. MaDan can provide documentation outlining your specific restrictions. Typically, Dr. MaDan recommends a weight restriction of 10 pounds or less for the first month, then 30 pounds or less for weeks 4 through 6.

Yes. Routine mammograms for breast cancer surveillance should be performed annually starting at age 40. High-risk screenings should begin at age 35. Inform your mammogram technician of your implants, as certain views are needed to displace the implant to allow complete screening of the breast tissue.

No, drainage tubes are not indicated following a breast augmentation with lift.

No. Dr. MaDan performs a meticulous multi-layer closure to ensure the implant is protected. All sutures are absorbable and do not require removal. After surgery, Dr. MaDan covers the incisions with steri-strips that will remain in place until your first post-operative appointment. Once the steri-strips are removed, Dr. MaDan will start you on her medical-grade scar therapy regimen to ensure your scar becomes almost invisible.

Permanent sensory changes following breast augmentation with lift are uncommon. However, temporary changes are common. Most of Dr. MaDan’s primary breast augmentation with lift patients experience more sensitivity during recovery. After things have healed and settled, nipple sensation typically returns to normal. However, the incision and resulting scar will remain numb, like any other scar.

Yes. Breast implants are not considered a lifetime device regardless of material—silicone or saline. Generally, 10 years is the recommended time frame for implant exchange or replacement. At 10 years, the rupture rate is quite low. Implants left in place for many years, or even decades, can develop a calcified capsule or shell that can become hard and painful. If calcification occurs, the entire capsule is usually removed with the implant. Total capsulectomy surgery is more invasive and is a higher risk than an implant exchange alone.

Major complications following a breast augmentation and lift are rare. The most common major complication following breast augmentation with implants is bleeding. The risk of bleeding is highest within the first two weeks of recovery. Activities that raise your heart rate or blood pressure should be avoided to keep this risk at a minimum. Dr. MaDan will never leave the operating room if something is bleeding; however, non-compliance with restrictions, such as exercising or overexertion, can cause a blood vessel to open and start bleeding. Although this complication is rare, bleeding can be a life-threatening complication that should be managed emergently. More common, minor complications like delayed healing at the T-point are managed with wound care and close follow-up with Dr. MaDan. Other less common risks are infection, wound breakdown, fluid collection, implant malposition, capsular contracture, permanent sensory changes, partial or complete nipple loss, BIA-ALCL, BIA-SCC, and breast implant illness.

Yes, any surgical incision will leave a scar. The common incision patterns for a breast lift include the Wise or anchor pattern and lollipop.  The anchor pattern incisions allow the reduction of excess skin in the horizontal and vertical vectors. The lollipop incision reduces excess skin in the horizontal vector only. Initially, the scar may appear red but will fade and soften over time. Dr. MaDan will provide you with her medical-grade scar therapy regimen to help the scar fade and achieve the best possible appearance.

Yes, implants can break or rupture. Shell failure is the most common reason for implant rupture. This can occur if the implant folds upon itself and is subjected to repeated friction and shearing forces. This is most likely to occur with an underfilled saline implant. The repeated shearing forces of the shell folding on itself cause shell failure. Saline implant rupture is usually obvious. These implants are filled with IV fluid or saltwater that is absorbed by your body upon rupture and can create a noticeable volume difference called deflation. 

The highly cohesive, fifth-generation “gummy bear” silicone implants may not show any outward signs or symptoms of implant rupture or shell failure. It’s called a silent rupture. Currently, MRIs are the gold standard for rupture surveillance of silicone implants. However, high-resolution ultrasound, like our Clarius L15, can be used in the office to evaluate your breast implants. Although the Clarius L15 is not the “gold standard,” it can be quite useful in obtaining information regarding your implant status before considering an MRI.

No. After surgery, your chest will feel tight. You may notice pressure from the implants with each breath you take. These symptoms are common and serve as your body’s reminder that you just underwent a major surgery. Be kind to your body and allow ample time for healing. Swelling and muscle spasms will subside, and the pectoral muscles will relax and stretch, allowing the implants to soften and settle. Although your chest may feel tight and sore, you should be able to perform activities like brushing your teeth and washing your hair without causing surgical complications. It’s important to use your normal arm mobility as shoulder stiffness can occur.