Mastopexy / Augmentation

Appropriate candidates for a mastopexy/augmentation are non-smoking women in good general health with sagging breasts due to past pregnancies, genetics, aging, or massive weight loss. Patients who desire an increase in size of the breast, or to achieve a significant rounding of the upper aspect of the breast should consider a this procedure. In this procedure, a breast implant is inserted in addition to lifting the breast in order to achieve the desired result.

Patients are seen in consultation and their goals are discussed. Dr. Casso suggests deferring surgery, if possible, until patients have decided on not having more children, as future pregnancies typically result in further enlargement and subsequent shrinking of the breasts, and recurrent sagging. Patients who are losing weight are also advised to defer surgery until their weight is stable, for the same reasons.

Women who smoke are advised to avoid any contact with nicotine for several weeks prior to considering breast lift surgery, in order to minimize risks of complications.

In this procedure, Dr. Casso strives to make maximum use of the patient’s own tissue to provide fullness in the right places, and, if necessary, to remove areas of laxity extending from the breast towards the underarm area. A breast implant is inserted into a pocket created under the breast tissue and the pectoralis major muscle. By placing the implant under the muscle, the implant is camouflaged not only by breast tissue, but also by muscle. This helps the breast look and feel more natural. Also, formation of significant scar tissue (capsular contracture) is less with this technique.

Dr. Casso discusses the planned incisions in the consultation, so as to result in scars which may be concealed in the patient’s clothing.

Patients have an option for a saline implant or a silicone gel implant. In the opinion of Dr. Casso, both devices are good products and have a strong record of safety. There are pros and cons, however, associated with each device.

Patients who are particularly thin, and who have very scant breast tissue often do best with silicone gel implants. In these patients, despite the fact that the implant may be placed under breast tissue and pectoralis major muscle, there are some areas (particularly the lower outer aspect of the breast), where there is no significant muscle available for implant concealment. In these thin patients, some visible rippling, or waviness may be apparent if saline implants are used. While it is possible that this may also occur with silicone gel implants, the tendency for this is less.

On the other hand, patients with a more normal body weight, or with at least a moderate amount of breast tissue, particularly in the lower outer aspect of the breast, visible wrinkling with a saline implant is uncommon.

There are some advantages of saline implants for patients. Firstly, after the saline implant is inserted and filled, small adjustments in the volume of the implant can be made. This is particularly helpful for women who have breasts which are slightly asymmetrical in size.

Secondly, breast implant manufacturers and the FDA recommend an MRI of the breast three years after insertion of silicone gel implants, and every two years thereafter to rule out the possibility of rupture. This is not required of patients with saline implants, as a rupture is readily apparent when the body absorbs the harmless saline (salt water) within a couple of days. While rupture is uncommon, a surgical procedure is required in the event of such an implant leak to replace the ruptured device.

Thirdly, saline implants are a bit less expensive.

The mastopexy/augmentation procedure is performed by Dr. Casso under general anesthesia at Houston Methodist St. John Hospital. While this procedure is sometimes performed under local anesthesia in outpatient facilities and doctors’ offices, Dr. Casso recommends general anesthesia at Houston Methodist St. John Hospital, which provides the patient with a comfortable surgical experience, and close, expert nursing attention, treatment of postoperative nausea, if present, and immediate medical attention in the event of any unforeseen emergency. The option for surgery in a full-service, state-of-the-art facility such as Houston Methodist St. John provides patients with a measure of safety and security which is unmatched.

Although design of incisions varies, incisions are usually made around the nipple-areolar complex, extending down to the crease under the breast, and within the crease. The nipple-areola complex is usually made smaller and repositioned higher on the breast and excess skin is removed on the undersurface of the breast. Usually, complete removal of the nipple is not needed, as it may be kept attached to underlying breast tissue while repositioned higher. This allows most women to retain sensation. The breast is also reshaped for a more pleasing contour. A breast implant if inserted under the pectoralis major muscle for augmentation or reshaping purposes.

The mastopexy-augmentation procedure normally takes about three and a half hours.

After the procedure, bulky dressings are placed over the incision lines. Patients are typically discharged in the afternoon after surgery. Initial discomfort is alleviated with oral medication. Patients are generally seen at Dr. Casso’s office the day after surgery. Patients may shower beginning about three days after surgery. Sutures are completely removed within 10 days in most cases. A light cami bra will be provided and may be worn beginning the day after surgery and light activity may be resumed in seven to 10 days. Vigorous exercise is discouraged for about six weeks.

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