Breast augmentation with a simultaneous lift
What does the procedure involve?
Breast augmentation with a simultaneous lift (augmentation mastopexy) is a surgical procedure that combines the insertion of breast implants with the correction of a sagging breast and nipple–areola complex. The aim of the operation is to increase breast volume, improve breast shape and projection, restore an appropriate nipple position and achieve harmonious body proportions.
The procedure is used mainly in patients who have both insufficient breast volume and sagging breasts (ptosis). These changes may result from pregnancy, breastfeeding, significant weight loss, ageing or individual anatomical predisposition.
Unlike breast augmentation with implants alone, augmentation mastopexy not only increases breast volume but also removes excess skin, reshapes the tissues and corrects the position of the nipple–areola complex. The choice of surgical technique depends on the degree of sagging, skin quality and elasticity, the amount of glandular tissue available and the expected aesthetic result.
Indications for the procedure
The most important indications for a combined breast augmentation and lift include:
sagging breasts together with insufficient breast volume;
loss of breast volume and firmness after pregnancy and breastfeeding;
loose skin and a change in breast shape after significant weight loss;
a lowered position of the nipple–areola complex;
breast asymmetry related to differences in volume, shape or degree of sagging;
unsatisfactory breast projection and loss of upper pole fullness;
the need to correct breast volume and position at the same time to achieve a proportionate shape.
Eligibility for the procedure needs an individual anatomical assessment, determination of the degree of ptosis and an analysis of tissue quality and of the possibility of a stable surgical result.
Contraindications to the procedure
Contraindications mainly include:
active infection or untreated inflammation;
uncontrolled chronic diseases that increase perioperative risk;
significant blood clotting disorders or poorly managed anticoagulant therapy;
active breast cancer that needs further diagnostic or therapeutic decisions;
pregnancy and breastfeeding;
significant healing disorders, including those associated with some systemic diseases;
unmanaged mental health disorders that affect the ability to make an informed decision or to assess possible results realistically.
Smoking and nicotine use increase the risk of impaired tissue blood supply, delayed healing and necrosis of the skin or the nipple–areola complex. For this reason, they need detailed assessment and appropriate preparation before surgery. The final assessment also takes into account individual risk factors, medications, previous breast operations and the results of diagnostic tests.
The procedure
The operation is performed under general anaesthesia. It includes the insertion of suitably selected breast implants and the reshaping of the tissues, with removal of excess skin and repositioning of the nipple–areola complex to the planned position.
Depending on the degree of ptosis, skin quality and breast structure, different mastopexy techniques are used, including periareolar, vertical or inverted T incisions. The choice of access and implant position — subglandular, subfascial or submuscular, depending on anatomical indications — is made individually.
Careful planning of the implant volume and the extent of skin resection is particularly important. An implant volume that is too large for the quality of the tissues can increase tension on the sutures, put strain on the lower pole of the breast and encourage recurrent sagging. For this reason, the aim of the operation is a result that lasts as long as possible while keeping the tissues safe.
In selected cases, because of the degree of ptosis, tissue quality or the risk of impaired blood supply, it may be better to perform the augmentation and the lift in two separate stages.
Possible complications
Breast augmentation with a simultaneous lift is a more complex procedure than augmentation with implants alone or mastopexy alone. It combines creating a space for the implant, reshaping the tissues and removing excess skin. As a result, it carries both the complications typical of implants and those associated with a breast lift.
Possible complications include:
haematoma and post-operative bleeding;
infection of the surgical wound or the area around the implant;
healing disorders, wound separation and delayed healing;
skin necrosis or partial or complete necrosis of the nipple–areola complex;
hypertrophic or abnormally remodelled scars;
temporary or permanent changes in nipple and breast skin sensation;
breast asymmetry, an unsatisfactory shape or an incorrect position of the nipple–areola complex;
persistent pain;
capsular contracture around the implant;
displacement, rotation or a visible outline of the implant;
rippling of the implant surface;
skin wrinkling, excessive tissue tension or breast contour irregularities;
recurrent sagging of the breast, known as bottoming out, or a renewed lowering of the nipple–areola complex;
the need for revision surgery or implant exchange;
complications related to general anaesthesia, thromboembolic complications and other rare systemic complications.
The risk of complications depends, among other things, on the initial breast anatomy, the degree of ptosis, skin quality, implant size, surgical technique, coexisting diseases and nicotine use. The risk of impaired blood supply to the nipple–areola complex and of healing problems is particularly important, because the procedure moves tissues while increasing their volume and tension at the same time.
Recovery
Immediately after the operation, swelling, bruising, a feeling of breast tightness and temporary pain may occur. Their intensity and duration depend on the extent of the operation and the individual response of the body.
During the post-operative period, it is recommended to wear a suitably fitted post-operative bra, follow wound care instructions and limit physical activity according to the doctor's recommendations. Avoid excessive strain on the arms, intensive exercise and activities that increase tissue tension until the wounds have healed adequately.
Regular follow-up visits make it possible to assess healing, implant position and the blood supply to the skin and nipple–areola complex, and to detect any complications early. The final breast shape settles gradually over the following months.
Results of the procedure and how long they last
The aim of augmentation mastopexy is fuller, lifted breasts with improved proportions, appropriate projection and a more harmonious shape. The procedure can improve upper pole fullness, correct the nipple position and reduce excess skin.
However, the result of the operation does not stay the same forever. How long it lasts depends on ageing, weight changes, pregnancy, skin properties, implant weight and individual predisposition to renewed sagging.
Breast implants are not lifetime devices and may require further procedures if complications, changes in their condition or other clinical indications occur. The patient should be informed about the need for continued follow-up and the possibility of future revision surgery.
Consultation and eligibility for the procedure
Assessment for a breast augmentation and lift includes a detailed medical history, a physical examination, an assessment of the degree of sagging, skin and tissue quality, and an analysis of the patient's expectations. Depending on age, medical history and clinical indications, the doctor may recommend appropriate breast imaging.
During the consultation, we discuss possible surgical techniques, the type and volume of the implant, expected scars, recovery and the individual risk of complications. The patient receives information about both the expected benefits and the limitations of the procedure, including the possibility of an unsatisfactory aesthetic result and the need for another surgical intervention.
