Sagging (the medical term is ptosis) of the breasts is a common problem. In his 1931 book “Deformities and Cosmetic Operations of the Female Breast” – the first and for a long time arguably the finest textbook/atlas of cosmetic breast surgery – the Austrian surgeon Hermann Biesenberger very clearly described why breasts sag. In youth, a connective tissue “suspensory apparatus” holds the breasts in an uplifted, youthful position. It may be best thought of as a lacy, three dimensional network. Weakness of the connective tissues and thus the “suspensory apparatus” results in sagging. Gravity, age, weight of the breasts, hormonal influences and a shift in the ratio of fatty to breast tissue (youthful breast are generally firm and contain less fat and more breast tissue) in combination or isolation eventually overwhelm the “suspensory apparatus”. This simple, clear and mechanistic explanation allows operative procedures to be designed to solve the problems of the sagging breasts.
For a long time classification systems focused on the position of the nipple areola complex, but it is really the position of the breast volume in relation to the inframammary fold and the position of the nipple areola complex in relation to the most projecting part of the breast volume which together give a classification system meaningful enough to deduce corrective strategies from.
At Trinidad Institute of Plastic Surgery we follow the paradigm that structure is beauty. Structure has to be created first. The skin is a secondary phenomenon. We just drape it over the newly created structure. Thus foremost we strive to create a conical, youthful breast mound above the inframammary fold.. Excess weight if present has to be taken off by small reductions at the lower and outer aspect and the remaining breast tissue has to be shifted into a more uplifted position and shaped into an ideal, youthful conical contour. The nipple areola complex needs then to be moved to the most projecting part of the ideal breast. Lastly, the redundant skin has to be reduced with minimal scarring. Longterm maintenance of results by means of skin reduction alone is not possible. Internal scars resulting from shaping maneuvers and breast tissue rearrangements together with long lasting sutures reinforce the “suspensory apparatus”.
This philosophy is reflected in most contemporary breast lifting procedures such as SPAIR (Hammond), round block (Benelli) or vertical (Lejour/Lassus) procedures.
Of note, only in the rare exception (e. g. isolated mild nipple areola complex malposition in relation to the inframammary fold) can one aspire to correct sagging breasts by placing an implant alone. As the breast volume is usually saggy in relation to the inframammry fold the implant cannot be placed correctly without adding another deformity (double bubble or excessively low fold).
Breast lifting (mastopexy) and augmentation with silicone or saline breast implants are really separate procedures and in fact work against each other with the lift trying to move the breast tissue “up and in”, the implant displacing it “down and out”. Striking a balance between these two antithetic concepts is a delicate undertaking as evidenced by the considerable number of reoperations after “augmentation mastopexy” (breast lift with simultaneous placement of a silicone or saline breast implant).
If there is some excess of breast tissue in the lower aspects of the breast we may move it to the central and upper aspects of the breast above the fold to provide more projection and upper pole fullness if desired by the patient. This “autoaugmentation” with the patient’s own tissue (autologous breast augmentation) avoids the placement of an implant.
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Posts (63)
1. A Cleft Pastiche
2. A Cure for Migraine Headaches: Botox, Nerve Decompression, Brow Lifting and Septoplasty
3. Abdominoplasty (Tummy Tuck)
4. Aesthetic Craniomaxillofacial Surgery of the Midface
5. Applied Aesthetics of the Female Breast
6. Autologous Breast Augmentation with Fat Grafting
7. Autologous Breast Augmentation with Micro Fat Grafting and External Expansion
8. Blepharoplasty – Eyelid Reshaping and Eyelid Tightening
9. Botox in Aesthetic Medicine
10. Breast Augmentation and Enhancement – Breast Implants
11. Breast Implants for Breast Augmentation and Enhancement: Teardrops, Gummy Bears, Furry Brazilians and the Baywatch
12. Breast Lift (Mastopexy)
13. Breast Reconstruction
14. Breast Reduction – Before and After
15. Breast Reduction – Reduction Mammaplasty
16. Breast Reduction – Techniques and Indications
17. Candidate Selection for Abdominal Wall Contouring
18. CEO Announcement: Aesthetic Medicine and Skin Therapy
19. CEO Announcement: New Plastic Surgery and Cosmetic Surgery Forum at Trinidad Institute of Plastic Surgery
20. CEO Announcement: Telemedicine and Virtual Consultations at Trinidad Institute of Plastic Surgery
21. Cleft Lip and Palate – Yardsticks for Perfection
22. Correcting Crooked Noses and Faces
23. Cosmetic and Plastic Surgery Abroad for the Medical Tourist
24. Craniofacial Surgery
25. Denise’s (Bridgetown/Barbados) Experience at Trinidad Institute of Plastic Surgery
26. Electrical Injuries – The “Great Masquerader” in Burn Surgery
27. Face Lift – Rhytidectomy – Rhytidoplasty
28. Fronto-orbital advancement for correction of craniosynostosis
29. Gunshot Injuries of the Hand
30. Healthgrades
31. Incisions for Breast Augmentation
32. Kayla’s (Georgetown/Guyana) Experience at Trinidad Institute of Plastic Surgery
33. Laser skin rejuvenation in dark skin types
34. Laser Tattoo Removal in Dark Skin Types
35. Lip Enhancement
36. Liposuction – Lipoplasty – Liposculpture
37. Malar Bags and Festoons
38. Maria’s (Port-of-Spain, Trinidad) Experience at Trinidad Institute of Plastic Surgery
39. Midface Lift
40. Mini Abdominoplasty
41. Optimal Implant Size for Breast Augmentations and Enhancements
42. Options in Breast Reconstruction
43. PIP Implants – Removal or Exchange after Breast Augmentation
44. Plastic Surgery – A Plastic Surgeon’s Perspective
45. Rhinoplasty – Nose Reshaping
46. Simone’s (Bridgetown, Barbados) Experience at Trinidad Institute of Plastic Surgery
47. Six Packs and the Male Abdominal Wall
48. Skin therapist Areana Emmanuel featured
49. Skin Therapy and Aesthetic Medicine Service Menu September 2010
50. Smoothing the Wrinkles
51. Specialist Treatment of Burn Injuries
52. Structural Abdominoplasty – Tummy Tuck
53. Tendon Problems in the Fingers and Hand – Trigger Finger, Trigger Thumb and de Quervain’s Disease
54. The Art of Reducing Excessive Sweating
55. The Culture of Aesthetic Surgery
56. Trinidad Institute of Plastic Surgery Featured in Caribbean Belle Magazine
57. Trinidad Institute of Plastic Surgery in Caribbean Beat Magazine
58. Verdine’s (Miami/FL) Experience at Trinidad Institute of Plastic Surgery
59. Vertical Breast Reduction and Breast Lifting with Short Scars
60. What is cosmetic surgery, what is reconstructive surgery, what is everything in between ?
61. What is the cost of … ? And why are there consultations ?
62. Worst Wrists
63. Writing for the gallery
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