Sagging (the medical term is ptosis) of the breasts is a common problem in our Caribbean plastic surgery clinic at Trinidad Institute of Plastic Surgery and treated definitively by breast lift surgery. There is no known method to man not involving surgery (no pill, exercise, magic roller, laser etc.) even remotely useful to do a breast lift.
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 and how breast lift corrects sagging breasts. 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 of breast lift 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 for breast lift.
At our Caribbean plastic surgery clinic 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 during breast lift 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 lift and breast augmentation with silicone or saline breast implants, so called augmentation mastopexy, 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 breast lift with breast implants placed at the same time.
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.
Trinidad Institute of Plastic Surgery – the superior choice for breast lift in the Caribbean, Antigua and Barbuda, The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Montserrat, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, Bermuda, British Virgin Islands, Cayman Islands, Turks and Caicos Islands, Miami, New York, Toronto, London