Combined Breast Uplift with Implants - Where is the Compromise?

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Where is the compromise ?

It is so common for ladies to complain “I lost volume of my breasts” or “I have a lot of lax wrinkly skin over my breast” or “I noticed my breasts have dropped after having my kids” or more troublesome a combination of the above! Unfortunately, plastic surgeons hear these words so often especially with ladies who had children, have lost a significant amount of body weight or with advanced age.

 
Plastic surgeons always try to achieve the perfect cosmetic results for their patients. However, it is difficult to define “perfect result”. There is a consensus that restoring the breasts volume and shape with minimal well-hidden scarring is considered the best outcome for these patients. The problem arises when surgeons have more than one problem to address in the same breast at the same time. Most common problem is operating on patients who have lost their breast volume and keen on breast augmentation but they also have droopy breast and keen on breast uplift. In this situation, “Perfect Result” might not be achievable. Hence, surgeons ask the patient “where is the compromise?”.
 
Patients need to understand that there is a grading system to classify the degree of ptosis (level of the droopy breasts)
 
Grade of ptosis 
 
Normal: in a full round normal breast, the nipple is usually situated at a level which is just higher than the infra-mammary fold (junction between the breast and chest wall below the breast).
 
Mild ptosis: when the nipple is at the same level as the IMF
 
Moderate ptosis: when the nipple is just below the level of IMF
 
Significant ptosis: when the nipple is well-below the IMF
 
The surgical options available for these ladies depend on the degree of ptosis and how big the implants they are interested in. But more important, it depends on the compromise they accept.
 
Options:
 
Do nothing: it is a reasonable option for ladies who are not keen on any compromise but they accept what they naturally have.
 
Breast uplift alone: it results in a better higher breast position but it leaves scars on the front of the breasts and maintains nearly the same breasts size. 
 
Breast implants alone: it results in augmentation of the breasts volume through a well-hidden scar but it leaves the natural breast at a lower position to the implants (long breasts). 
BA and Mastopexy (single stage): it results in augmentation of the breasts volume and a better higher breast position but it leaves scars on the front of the breasts and carries higher surgical risks 
 
BA and Mastopexy (2-stage): it results in augmentation of the breasts volume and a better higher breast position but it leaves scars on the front of the breasts. It carries the same surgical risks as with the single stage but incidence of risks is less. However, this option includes 2 separate operations with 2 admissions to hospital and 2 episodes of general anaesthesia. 
 
In some patients with mild to moderate degree of breast ptosis, the are other options which may provide half-way measures e.g. less than perfect result with less obvious scarring. These options include
 
Nipple uplift alone: it results in a higher breast position but it leaves scars on the top half of the nipple. It maintains nearly the same breasts size.
 
Nipple uplift with implants: it results in augmentation of the breasts volume and a higher breast position but it leaves scars on the top half of the nipple.  
 
Breast implants with “teat-drop” shaped or specially designed implants: in certain narrow spectrum of patients with mild ptosis, an extra projection round implants or shaped implants can be used to augment the breast but also disguise the droopy nature of the breast. 
 
During consultation, Mr Shaaban would help patients by providing them with detailed information regarding the available options for them. However, it is entirely up to the patient to choose the option and to answer the important question “where is the compromise?!!!

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