Breast augmentation and uplift

Breast enlargement can be combined with breast uplift (mastopexy) or nipple uplift surgery (this procedure is also known as augmentation mastopexy, mastopexy augmentation or augmented mastopexy). Breast augmentation (breast implants) can slightly lift the nipples but for patients who have significant drooping of the nipples or excess skin a breast uplift (mastopexy) procedure is also necessary. For patients where there are only small amounts of nipple drooping the nipple position can be improved with a nipple lift procedure. The combination of breast augmentation and breast lift is most frequently requested by patients who have had children or who have lost significant amounts of weight.

To learn about the other procedures that Mr Morritt offers – please click here

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Click here to read more about breast uplift (mastopexy) – learn more

Surgical procedure – breast augmentation and uplift

Mr Morritt initially inserts the breast implants (his preference is to insert them in front of the muscle where possible as this reduces the chance of a subsequent ‘waterfall deformity’ developing with time). The breast skin is then tightened and nipple lifted with a breast uplift procedure. In some cases where there is relatively little excess skin a vertical scar (lollipop scar) will suffice. In cases where there are large amounts of excess skin an ‘anchor pattern’ scar will be necessary. In most cases a small amount of tissue from the lower part of the breast is removed as this gives a better shape to the breast. Sometimes Mr Morritt may significantly reduce the amount of breast tissue (breast reduction) before the implants are inserted (this is generally in patients who are starting with a lot of breast tissue before surgery. Mr Morritt does not use drains for the procedure. Patients stay in hospital overnight followed by a check up one week and six weeks after surgery. Mr Morritt does not recommend one stage breast enlargement and uplift for some complex cases as more predictable results with a better cosmetic outcome and lower risk of complications is achieved by performing the surgery in two stages. Examples of these complex breast implant and uplift cases are patients who are starting with larger than average breasts e.g. D cup or those with tight skin and firm/dense breast tissue.

Photos showing appearances before and after breast augmentation with uplift (augmentation mastopexy)

Summary of cases – for more details see individual case descriptions below:

Case 1. Photos showing appearances before and 6 weeks after combination of breast augmentation (breast enlargement) and breast uplift (mastopexy). This lady in her 30’s was unhappy with her deflated breasts (32B) after breastfeeding two children. The volume has been increased (32D) with round breast implants (275cc, high profile silicone implants in front of muscle) and a vertical scar breast uplift. Thanks to my patient for giving permission to show these images.

Case 2. Photos showing appearances before and 7 weeks after combination of breast augmentation (breast enlargement) and breast uplift (mastopexy). This lady in her 30’s who had completed her family after having 2 children wanted to increase the size of her bust by approximately 1 cup size. She requested increased fullness in the upper part of the breast but also for appearances to still look natural. Round 250cc moderate plus profile breast implants have been placed in front of the chest muscle and a vertical scar (lollipop scar) breast uplift has been performed.

Case 3. Before and after photos showing the outcome of combined breast enlargement and uplift (mastopexy) surgery. This mum in her 30s wanted to restore breast volume and nipple position which had been lost after breastfeeding her two children. She requested that the outcome of surgery looked fake if possible with increased fullness in the upper part of the breast. The appearances here are shown 6 weeks after breast augmentation and breast uplift which were performed in a single operation. Round 400cc high profile breast implants were inserted on top of the chest muscle (‘overs’) to augment the breast volume and projection. Her skin was tightened with an anchor pattern breast uplift. Thanks to my patient for giving permission to show these images.

Case 4 – Photos showing the appearances before and after combination of breast enlargement and uplift. This lady in her 30s wanted to replace the breast volume that she had lost after losing weight and also wanted her breasts to be more lifted. Insertion of breast implants and uplift surgery ((250cc round breast implants in front of the muscle) was performed in a single operation. Thanks to my patient for giving permission to show these images.

Case 5. Combination of breast augmentation and uplift in a one stage operation. This lady was unhappy with her breasts after significant weight loss (4 stone weight loss achieved though dieting and exercise). A 325cc high profile round implant was inserted in front of the chest muscle and the breast lifted. Her bra size increased from a B cup to a D cup. Appearances shown after 6 months. Thanks to my patient for giving permission to show these images.

Case 6. Photos showing the appearance of a combination of breast implants and breast uplift (appearances shown after 6 weeks). This mum of 2 was unhappy with the lack of breast volume and also with the shape of her breasts. She had less tissue in the lower part of the breast and the distance from the nipple to the crease under the breast was shorter than average which are features of mild tuberous breast deformity. Round breast implants (300cc moderate plus) were inserted in front of the muscle with a anchor pattern breast uplift taking her from 36A to 36D. Thanks to my patient for giving permission to show these images.

Patient testimonial – Mr Morritt talks with Dawn about her breast augmentation and uplift procedure

Risks of breast enlargement and uplift (augmentation mastopexy)

Scar

• scars following breast augmentation tend to heal well but will vary between patients and some patients (6.3%) may get poor scars (also called hypertrophic scars – red, thick, raised, painful)
• the scars fade with time and can take up to 18 months to fully settle
• The scars are never invisible but sometimes are difficult to see
• The scars tend to be located in the crease under the breast but for some patients the scars will be located on the skin of the breast or tummy
• Larger implants and teardrop implants require slightly wider scars for insertion

Significant bleeding

• results in a collection of blood in the breast that will make the breast appear swollen and may cause pain
• This blood has to be removed in the operating theatre
• Rare –  affects approximately 2-3% of patients
• More frequent when implants are placed under the chest muscle
• Patients are advised to avoid strenuous activity and lifting for 6 weeks following surgery to minimise the risk of this complication. Patients are also advised not to take NSAID’s (ibuprofen, aspirin etc) 2 weeks before or after surgery as these are associated with an increased risk of bleeding

Infection

• Infections are rare following this surgery (0.5%)
• Shallow infections (of the skin) can be treated with a course of antibiotics but deeper infections (of the implant itself) are more difficult to treat and sometimes it is necessary to remove the implant. If the implant is removed for infection then it is normal practice to wait 2-3 months for the infection to settle before inserting more implants

Asymmetry of breasts or nipples

• almost all women have different sized/shaped breasts
• Breast augmentation can sometimes make differences between breasts and nipples more noticeable or less noticeable
• There will always be differences in breast size, shape and nipple position following breast enlargement surgery

Wound breakdown

• this is very rare but requires removal of the breast implant if the implant gets exposed to the air

Significant capsule formation (capsular contracture)

• this causes the breast to harden, change shape (become rounder) and can become painful
• usually further surgery is necessary to correct this problem (capsulectomy)
• Significant capsular contracture (Baker 3 or 4) affects approx 20.4% of patients 13yrs after surgery

Visible/palpable implant/Rippling following breast enlargement

• This is more common in thin patients or patients with only a small amount of breast tissue
• Breast implants naturally ripple and this rippling can sometimes be seen as rippling of the breast skin

Permanence of result

• Breast appearance changes with normal ageing, pregnancy, breast feeding and weight change.
• The appearances created with breast enlargement and uplift surgery do not last forever

Need for more surgery in the future

• All patients having breast enlargement surgery are warned that they will need to have surgery on their breasts again at some point in the future and should budget for this
• This may be to replace implants that have ruptured or for capsular contracture
• Other patients decide to increase or decrease the size of their implants
• Some patients decide to have their breast implants removed.
• With time the breasts will gradually droop and a repeat uplift will be necessary

Long term effect of breast implants on surrounding tissues

• breast implants can cause permanent thinning of the breast skin and of the breast tissue
• breast implants can cause permanent indentation of the rib cage
• breast implants increase the weight of the breast and this can cause breast drooping with time
• silicone can leak from the implants into surrounding tissues or lymph nodes and this can be permanent

Lifespan of breast implants

• breast implants last different amounts of time in different people but at some stage will rupture
• breast implants last on average between 10 and 20 years
• Ruptured implants need to be removed or replaced which requires further surgery
• It is not always possible to remove all the silicone from the body (breast/chest tissue/lymph nodes) in the event that a breast implant ruptures. Sometimes the silicone cannot be seen with the naked eye during surgery to remove the implant and may only become apparent when a lady goes for a mammogram/scan

Breast implant rupture

• Breast implants can rupture
• This is rare within the first 10 years after surgery but becomes more likely as time goes on
• Trauma etc can cause rupture of breast implants

Breast implant gel bleed

• The silicone inside a breast implant can over time gradually leak through the shell of the implant even when the implant shell is intact
• Is less common with the current generation of breast implants than it was with older breast implants

Nipple and skin sensitivity alterations after breast enlargement

• reduced nipple sensitivity occurs frequently following surgery and is more frequent when larger implants are inserted
• may affect one or both sides
• generally improves with time
• Numbness may be permanent in 10% of patients
• Rarely, the nipples may become hypersensitive
• Very rarely, patients may get chronic pain after breast enlargement surgery

Breast animation for subpectoral breast implants (under the muscle)

• When breast implants are placed under the chest muscle it is normal for the breast to change shape to some degree when the muscle contracts
• Rarely this phenomenon can happen spontaneously when the patient is not actively tensing the chest muscle

BIA – ALCL (Breast implant associated – anaplastic large cell lymphoma)

• a very rare type of cancer which has been identified in some patients who have had breast implants
• Worldwide, approximately 800 cases have been reported (includes 20 disease-related deaths)
• The lifetime risk for BIA-ALCL ranges from 1:1,000 to 1:30,000 for those with textured implants (for Mentor implants the incidence is 1:24,000). To put this in perspective the lifetime risk of getting breast cancer for a women is 1:8.
• Typically presents 8-10yrs after breast augmentation with a visible, painless swelling of the breast due to seroma (fluid accumulation). Less frequently patients notice a lump in the breast (this is in the capsule surrounding the breast implant).

Breast implant sickness or illness (BII)

• Some patients with silicone breast implants can develop fatigue and general ache/pains
• In these patients usually no cause can be found to explain their symptoms after extensive investigations
• Removing the implants can sometimes improve the symptoms
• Extensive scientific studies have failed to prove the existence of this condition and it is not currently recognised as a disease by the World Health Organisation
• Many doctors think that these patients are actually suffering from fibromyalgia and it is simply a coincidence that the patients have breast implants

Breastfeeding after a ‘boob job’

• approximately 80% of women can still breastfeed after breast augmentation

Unhappiness with size or shape of breasts after breast augmentation

• Mr Morritt cannot promise that inserting breast implants will create a specific breast shape as the effects of breast implants vary between individual patients. In fact, two friends with identical size breast implants may get very different breast sizes and shape after a ‘boob job’
• Mr Morritt cannot give an exact indication of expected bra size following breast augmentation as bra sizes vary between different manufacturers. An approximate prediction is given about expected cup size.
• Breast implant size changes after surgery are sometimes possible but these incur an additional charge payable by the patient.

Stretch marks

• the breast skin can develop stretch marks after breast augmentation surgery. This is more common when people with small, tight breasts have larger than average sized breast implants

Breast implant scares

• Patients having breast implants are made aware that medical knowledge improves with time. In the future some breast implants will almost certainly be found to have an increased complication rate etc and may be recalled or removed from the market

Association of breast implants with autoimmune and connective tissue diseases

• early scientific reports in 1980’s suggested a link between silicone implants and connective tissue diseases e.g. scleroderma, rheumatoid arthritis, SLE etc
• all studies have concluded that there is no association between silicone breast implants and any connective tissue disease

Seroma

• tissue fluid accumulation immediately after surgery can happen and if significant may require drainage with a needle.
• It usually settles within a few weeks of surgery.
• Rarely, patients may suffer from long term fluid accumulation (chronic seroma) around breast implants and in this situation the implants usually need to be removed (0-1% of patients).

‘Double bubble’

• a bulge in the bottom of the breast
• this can happen after time if the implant slips below the natural breast crease. It is more common with smooth implants and/or larger implants
• sometimes it is necessary to lower the natural breast crease during surgery to accommodate implants. This is frequently done when the distance from the nipple to the breast crease is shorter than average e.g. tuberous breasts or tight lower pole.  Usually the crease will stretch to some degree and appearances will improve but for some patients this does not occur resulting in a ‘double bubble’ appearance.
• Correction may require revision surgery such as exchange of breast implants to smaller implants, fat injections (lipofilling) or skin tightening (uplift surgery).

‘Waterfall deformity’

• With time the breast tissue can droop over the implant while the implant stays in place
• More common when the implants are inserted under the chest muscle and when patients have more breast tissue

A ‘non-perfect’ result

• All surgery carries the risk that the outcome will not be ‘perfect’. Sometimes ‘non-perfect’ outcomes can be improved with revision surgery. In other cases if the risks involved with revision surgery outweigh the potential improvement or if revision surgery is unlikely to meet the patient’s expectations, a recommendation is made to accept a ‘non-perfect’ outcome and not undertake revision.

General risks of breast enlargement & uplift surgery

• chest infection, DVT, PE, Death, COVID-19

Need to convert to a two stage technique

• Rarely, during surgery situations happen where the risk of potential complications is increased with a single stage combined breast uplift and enlargement procedure. In this situation a decision is made intraoperatively (during surgery) to defer one of the procedures (the uplift or the enlargement) until a later date (usually at least 6-12 weeks later). This could happen if a circulation problem became apparent with the nipples after the uplift part of the operation had been performed etc.

Book your consultation with Mr Morritt for breast augmentation and uplift surgery (from £8275).