What to Expect at Your Augmentation Mastopexy Consultation

Why Augmentation Mastopexy Is Different

When patients come to see me wanting fuller, more lifted breasts, they often assume that implants alone will solve the problem. Sometimes that's true. But frequently, what they actually need is an augmentation mastopexy, which combines a breast uplift with implants.

This is one of the more technically demanding breast procedures. The surgeon is simultaneously lifting the breast (which involves tightening tissue) and adding volume with an implant (which involves stretching tissue). Getting the balance right requires careful planning and honest discussion about what's achievable.

This article walks you through what we'll discuss during your consultation.

Understanding Your Starting Point

The first thing I need to understand is your current breast anatomy. During the consultation, I'll take several measurements:

Sternal Notch to Nipple Distance

This measurement tells me how far your nipple has dropped. In a youthful breast, this distance is typically 19-21cm. If your measurement is 23cm or more, an uplift will likely be beneficial. The greater the distance, the more significant the lift required.

Nipple to Inframammary Fold Distance

This measures the length of your lower breast pole. If this is excessive (greater than 7-8cm in proportion to your breast), there's excess skin that needs to be removed. This excess skin won't disappear just by adding implants. It needs to be addressed surgically.

Breast Width

The width of your breast determines the maximum implant width I can use. An implant that's too wide will extend into your armpit or meet in the middle. The implant should fit within the natural footprint of your breast.

Pinch Thickness

This is how much tissue I can pinch between my fingers. It tells me how much natural coverage you have over the implant. If your pinch thickness is good (3-4cm), we have more options for implant placement. If it's thin, the implant may be more visible or palpable.

The Question of Natural Results

Most women who come for augmentation mastopexy tell me they want "natural" results. But "natural" means different things to different people.

When I ask patients to describe what they're hoping for, I often hear things like:

• "I want to wear a nice dress without a bra"
• "I don't want anyone to know I've had anything done"
• "I just want to feel filled out, not fake"
• "I want to be able to go to the beach with confidence"

These are all achievable goals. They describe a natural-looking result where the breast has a gentle slope from the collarbone to the nipple, not a rounded, obviously augmented appearance.

To achieve this, I typically recommend medium profile implants rather than high profile. High profile implants create more roundness in the upper part of the breast, which can look obviously augmented. Medium profile implants create a more natural contour.

Implant Profiles Explained

Breast implants come in different profiles, which refers to how far they project forward relative to their width:

Low Profile

The flattest option. These implants add width without much projection. Rarely used in augmentation mastopexy because most patients want some forward projection.

Medium Profile

The most natural-looking option for most patients. These create a gentle slope with moderate projection. The breast looks fuller but not obviously augmented.

High Profile

These project further forward for a given width. They create more roundness in the upper breast. Some patients want this look, but for most wanting natural results, high profile creates an obviously augmented appearance.

Extra High Profile

Maximum projection. Creates a very round, prominent look. This is rarely what patients wanting natural results are hoping for.

During your consultation, I'll show you implants of different profiles so you can see and feel the difference.

Above or Below the Muscle?

One of the decisions we need to make is whether to place your implant above the pectoral muscle (subglandular) or below it (submuscular).

Above the Muscle (Subglandular)

This is my preference when patients have adequate tissue coverage. The advantages are:

• More natural breast movement
• No animation deformity (breast distorting when you contract your chest muscles)
• The implant and breast drop together over time, maintaining a natural relationship

The disadvantage is that the implant may be more visible or palpable if you don't have enough tissue to cover it.

Below the Muscle (Submuscular)

This provides additional tissue coverage over the implant. I recommend this when patients have very little breast tissue (pinch thickness less than 2cm) or very thin skin.

The disadvantages include animation deformity and the breast and implant moving somewhat independently as time passes.

With the smooth implants I use, above the muscle is particularly advantageous because these implants can be displaced by muscle movement. Placing them above the muscle avoids this issue.

Breast Screening and Implants

If you're in your 40s or beyond, or if you have family history of breast cancer, we need to discuss breast screening.

Breast implants do affect mammograms. The implant sits in front of some breast tissue, making that tissue harder to see on X-ray. Radiographers know how to work around this, they take extra views, but it's not perfect.

For screening purposes, you may need:

• Extra mammogram views (Eklund technique)
• Ultrasound scans to supplement mammograms
• MRI scans for the most complete assessment

If you have a breast lump after augmentation, the investigation process might include more imaging than would be needed without implants. This isn't a reason not to have implants, but it's something you should know and factor into your decision.

I recommend that all patients with breast implants have regular breast health checks. This might be an annual ultrasound, which can also check the integrity of the implants themselves.

The Recovery Timeline

Augmentation mastopexy involves more recovery than implants alone because we're also tightening tissue and repositioning the nipple. Here's what to expect:

First Week

You'll wear a supportive surgical bra. Most pain is minimal due to local anaesthetic used during surgery. Stitches are hidden and dissolving.

Weeks 1-6

Continue wearing the surgical bra. Avoid heavy lifting or strenuous exercise. You can return to desk work within a few days, more physical work after 2 weeks. I'll see you for follow-up appointments during this time.

6 Weeks

At this point, most patients can return to all normal activities including exercise. The initial result is visible, though the breasts are still settling.

3-6 Months

The breasts continue to "drop and fluff", settling into their final position. The implant sits lower and softer. The final shape emerges.

6-12 Months

By six months, you're seeing essentially the final result. Subtle changes continue for up to a year as the last swelling resolves and tissues fully settle.

Setting Realistic Expectations

During the consultation, I'll show you photographs of patients who've had similar procedures. This gives you a realistic idea of what's achievable.

Some important points to understand:

• Asymmetry that exists before surgery will likely persist to some degree afterwards
• Scars are inevitable with mastopexy, they'll fade but never completely disappear
• Breasts will continue to change with age, weight fluctuations, and hormonal changes
• Implants don't last forever, you may need revision surgery at some point in your life

None of these points should dissuade you from having surgery if it's right for you. But having realistic expectations leads to happier patients.