We often see patients complaining of sagging breasts, flaccid, and sometimes with loss of volume, especially after pregnancy. Almost always, we get the same important question:
– “Can I fix my breasts only with a silicone prosthesis or do I have to lift the breasts through skin removal, with consequent more extensive scars (which is what we call a mastopexy)?”
To answer this question – which is complex – we have to individually evaluate each case and, especially, appreciate and take into account what bothers the patient, if it is flaccidity, the position of the breasts, volume, etc. However, I will say a few general “rules” we take into account to associate the breast adjustment surgery (mastopexy) with or without prosthesis or only the implant of silicone prosthesis.
When only perform the silicone implant?
If your desire is only breast augmentation, silicone prosthesis is the ideal choice when:
- The slope (fall) of the breast is light;
- The areolas are still in the center of the breasts and are not pointing down;
- There is little excess skin below the areola when looking at the breasts from the front and in straight line;
- If you really want to increase the breasts, or accept this increasing.
When performing mastopexy with or without prostheses?
The mastopexy is advisable in skin adjustment and repositioning of the breasts with or without prosthesis when:
- The fall (downward slope) is moderate or severe (significant);
- The areolas are in the projection of the inframammary furrow or lower;
- You cannot see skin under the areolas when looking to the breasts from the front;
- The patient already has good breast tissue and does not want bigger;
- The areolas are very large and/or wide and the patient would like to reduce them;
- The complaint is large breasts, pendulous and/or loose.
The biggest reason of doubt to submit yourself to a surgery to lift or adjust the skin is the consequent presence of more extensive scars, which actually has a very high weight in the indication of this surgery. In this case, we use prosthesis with breast skin adjustment when:
- Patient wants bigger and less loose and sagging breasts;
- Patient would like to gain or maintain the upper projection and rounded outline of the breasts;
- Breasts with little breast tissue and spread down, what some patients call “spread egg”.
For any of these possibilities what I suggest is that in doubt, it is always better to be more conservative in the choice of conduct than to be bolder. The conversation with the plastic surgeon on the day of appointment will help you with this decision.
