Combining breast augmentation with a breast lift is often the best procedure for those who have deflated and sagging breasts. If the nipple is at or above the breast fold, then usually an augmentation alone will fill and lift the breast, however if the nipple is below the fold, then frequently a breast lift is required as well to provide an ideal shape. If a small augmentation is needed, then a silicon gel implant is often an ideal solution to provide the most natural appearance. On the other hand, many women seeking breast augmentation want more than a small augmentation, and this can sometimes lead to problems when the two procedures are combined.

A mastopexy involves an incision around the areola, and a vertical incision if the lower breast skin needs tightening as well. Placing a medium or large implant at the same time as the mastopexy procedure can result in excessive tension on the wounds as they heal, resulting in delayed healing at times, poor scars, and even loss of nipple skin occasionally.

To decrease the initial tension on the incisions I now use the Mentor Spectrum Adjustable implant with all combined mastopexy augmentation using saline implants. If the patient chooses to have silicon gel implants, and agrees to participate in the appropriate gel implant study protocols, then I will use gel implants, but only up to 250cc. The Spectrum implant has a valve, which can be connected to the implant through a thin tube, and the valve can be left outside the skin for 7-10 days, allowing the implant to be filled and adjusted after the procedure.

The procedure involves placing the implant in the usual fashion, usually submuscular, and completing the mastopexy. At the end of the procedure the saline is removed so that only 150cc is left in the implant. At the one-week postoperative visit, the implants are inflated to the desired final fill volume, and then the fill tubes are removed with a gentle tug. Occasionally, if there is a question about symmetry, or with very large implants, we may take a few days to inflate the implants.

I have found this approach to have many advantages, the most significant of which is a tension free wound, which results in better healing, and much better scars. Even just one week of tension free healing, allowing swelling to subside before inflating the implants, seems to have made a great improvement in the quality of the scars. This has been my experience with circumareolar and vertical scar mastopexy procedures. In addition, I have found this technique valuable in obtaining better symmetry as well, as the implants are adjusted after much of the surgical swelling has subsided.