Breast shape, consistency, size and position changes are have an important aesthetic impact and are very frequent because they result from life events like: Normal aging process; Gaining or loosing body weight; Pregnancy, breastfeeding, and female hormonal cycles. Breast size is also influenced by genetic factors present in families, which often determine, from an early age, breast underdevelopment (hypoplasia) or an exaggerated breast size (hypertrophy) for a woman body structure and does not tend to change significantly throughout life. An undesirable breast can interfere with the so sought self-image and self-esteem, and affects the quality of life and well-being : The breast is the organ of femininity and its inappropriate shape or size interferes with intimate life and couple life; Often, woman impose restrictions herself and on her social life, especially during the summer months; Dressing style and life habits are modified by the presence an unwanted alteration that is difficult to hide. Aesthetic breast surgery For the correction of aesthetic changes in the breast, two types of breast plastic surgery interventions can be indicated, alone or in combination: Mastopexy or breast lift; Augmentation mammaplasty with breast implants. However, before a possible surgical indication, a careful medical evaluation is mandatory , to determine specific problems that need to be treated. The type of treatment for aesthetic breast alterations depends on each case particularities. It may even happen that mastopexy and augmentation mammaplasty are not the most appropriate procedures, are contraindicated or should only be performed in the context of other medical or surgical treatments. Rarely, in very mild cases, a non-surgical filling treatment with hyaluronic acid (filler) may be indicated. Do mastopexy and breast augmentation correct the same thing? Mastopexy and augmentation mammaplasty: They are used for different purposes; The corrections they allow are different; However, they have a complementary potential . Thus, in specific cases, mastopexy and augmentation mammaplasty can be used simultaneously to obtain the best possible aesthetic result, restoring lost harmony, breast shape and body contour, allowing to achieve a silhouette closer to the desired one. Both mastopexy and augmentation mammaplasty with implants are surgeries that should only be performed in an operating room , preferably in the safety of a hospital environment and always by plastic surgeons ( plastic, reconstructive and aesthetic surgery is a medical specialty). Mastopexy Mastopexy corrects sagging or excess skin and restores the ideal shape and positioning of the breast , giving the woman back a breast: Firmer, with greater filling of its upper part; Well positioned above the crease of the breast, creating a desired “ push-up ” effect for the necklines of dresses and bathing suits. It can be done with a variable extension: From a peri-areolar mastopexy (excision of the skin around the areola), repositioning the nipple and areola higher up without significantly changing the shape of the breast; To a “complete” mastopexy , with extensive removal of skin and complete remodeling of the breast, allowing to restore the shape and positioning of the entire breast. Mastopexy leaves more or less important scars depending on the extent of the intervention and the amount of skin removed, as well as the degree of breast sagging to be corrected. Scars can be placed only around the areola, being hidden by the darker color transition of the skin of the areola. They may include a vertical branch from the areola to the furrow that is almost always imperceptible after a few months. In more severe cases, inverted T scars are additionally required that are disguised in the inframammary fold. These scars never disappear but tend to fade over time during the 6-12 months after the procedures, as long as there are no scarring problems. In this case, a strict follow-up and additional specific treatments may be necessary. Augmentation mammoplasty Breast augmentation plasty with silicone implants allows to: Restore lost breast volume ; Increase the size of a breast that has always been small; Correct the loss of breast consistency and sagging . There are different types of breast implants, concerning shape and coating. Implants can be introduced through different skin incisions (surgical approaches) and placed in different positions in relation to the pectoral muscle (in front of or behind the muscle or even partially behind). Augmentation mammaplasty: Leaves almost imperceptible scars in the axillary folds, in the inframammary fold or in the color transition of the skin of the areola; The scar location depends on the patient and surgeon choices, after deciding on the most appropriate position for the implant; The size of the breast implant to be used is limited by the base of the patient breast (and indirectly by the width of her chest) and the volume can vary according to the desired breast projection and size increase. As an alternative to silicone implants, the patient own fat can be used , which, after being aspirated from areas of the body with excessive volume, is infiltrated as a graft ( lipofilling ) in the breast region. Adipose graft should be considered case by case. It has some advantages but also disadvantages compared to silicone implants. Practical information about mastopexy and breast augmentation A presential clinical exam in a preoperative plastic surgery consultation is essential; Follow-up consultations may also be carried out in videoconsultation, depending on the case and the time of evolution; Medicines or natural products that are not known to the surgeon should not be taken in the 10 days prior to the surgery; The preoperative tests to be carried out depend on age, any present diseases and the type of anesthesia. In many cases, a preoperative anesthesia consultation is also performed; Approximate duration of mastopexy surgery: 1 to 2 hours; Approximate duration of augmentation mammaplasty with implants: 45 minutes to 1 hour; Type of anesthesia: more often general anesthesia, eventually local anesthesia (with or without sedation), depending on the specific procedure indicated and the patient particularities; Need for hospitalization: mastopexy and augmentation mammoplasty can be performed on an outpatient basis or with a one night stay at the hospital; Recovery: depending on professional activity and lifestyle, it may vary, on average, from 1 to 3 weeks. Physical exercise with load should only be resumed after 1 to 2 months, according to the surgeon indications and depending on the specific procedure; After both procedures, it is recommended to wear an adequate bra for 3 to 4 weeks; These surgeries do not normally interfere with breastfeeding or with breast cancer detection and follow-up methods. How to decide which surgery is appropriate? Only knowing each specific case, with an assessment of the woman complaints and desires and after a complete clinical exam carried out in person, will it be possible for the surgeon to define the most correct surgical procedures . There is no ideal surgery to all women, but a more favorable surgical option to achieve concrete goals and desired results in each case . As in all elective surgical procedures, and particularly in aesthetic procedures, safety is a priority, and it is up to the surgeon to: To consider with the woman the advantages and disadvantages of the techniques that, alone or together, may be indicated for her case; Inform and clarify about the possible and predictable results of the interventions, in a realistic way, and advice regarding the expectations; Consider contraindications or more frequent complications inherent to surgical and anesthetic procedures. The virtual simulation of results using software for manipulating the patient image is not reliable, nor does guarantee the final result to be obtained with the surgical procedures. This simulation does not consider breast consistency or skin flaccidity, which vary greatly from person to person and is crucial for the final result obtained. The choice of breast implant size can be done with the surgeon, using devices (identical to the prostheses to be used in surgery) of different volumes placed in the surgical bra and evaluating the impact they have on the change in size and projection of the breast. Attempting to meet unsuitable expectations with inappropriate procedures can jeopardize clinical safety or cause irreparable frustration. Author : Alberto Rocha Pereira Meet the reconstructive and aesthetic plastica surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
