During my consultations, I answer tons of questions. Most of the patient inquiries revolve around surgery. Most plastic surgery patients like to know and to see exactly what happens while they are under anesthesia. I know many of you have the same exact questions about plastic surgery, so this blog is for you. As you can see from the title, today I will explain and show you what happens during a breast augmentation and lift procedure.
First, there are several different ways to lift the breast. You may have heard of the crescent mastopexy, doughnut (360 periareolar, Benelli) mastopexy, lollipop mastopexy and full anchor (Wise) mastopexy procedures. Today’s blog is based on Episode 8 of my YouTube web series, “Transformation Tuesday with Dr. Katzen“. In that episode, the patient was a B cup with saggy breasts, and her goal breast size was a DDD. During her breast surgery, I was able to achieve her desired breast size by augmenting her breasts using silicone implants. Also, I was able to lift her breasts using a crescent mastopexy method. Below are the five simple steps I followed to make and create the desired transformation.
Disclaimer: I’ll use uncensored images for the remainder of the blog.
Step 1 – The Incision
I begin the breast augmentation with an incision. I choose this incision very carefully. There are four ways to access the breast for breast augmentation: around the areola, in the breast fold (infra-mammary), through the armpit (trans-axillary), and through the belly button (trans-umbilical). If a breast lift needs to be performed, an incision is created around the top half of the areola to lift the breast. So, if you need a breast lift, the incision must go around the top of the areola. The incision is not made in the crease located under your breast because I will not be able to LIFT your breast from the bottom crease. Make sense? I cut around the top half of the areola because this frees the areola and allows me to pull it to the higher position; therefore, lifting the breast.
Once I have decided where I want to place the incision, I inject a local anesthetic called lidocaine with epinephrine. Lidocaine numbs the area. Epinephrine minimizes bleeding. Then, I make my incision with a scalpel.
Step 2 – The Dissection
Next, I need to create a new home for the breast implant. After the incision is made around the top half of the areola, I dissect through the skin, through the breast tissue, and down to pectoralis major muscle.
There are several options where you can place your breast implants. These options depend on your breast augmentation goals. If you want a more natural look, I will position the implant under the breast muscle (pectoralis muscle). If you would like a more “noticeable” look, I will place your breast implant in a “dual plane” or halfway under the muscle and halfway under the breast tissue. If you want the most cleavage possible, I will place the implants under the breast tissue and on top of the muscle.
During my dissection to the breast muscle, I make sure to dissect through the breast tissue carefully. I minimize bleeding and avoid the very important nerve to the nipple. Also, while I am making my breast implant pocket, I ensure that the pocket I created is not too big or too small. Also, I am careful to avoid the breast implants touching in the middle. I ensure that the pocket for the left breast and the pocket for the right breast are not too close. Creating breast implant pockets that are too close to one another will create a “uni-breast.” The dreaded “uni-boob” must be avoided. I make certain that my breast implant pockets are at least 2cm apart.
Step 3 – The Temporary Balloon (Tissue Expanders)
To get an idea of what the final breast implant result will look like, I insert temporary implants or balloons. These balloons are very similar to saline breast implants. I use the breast expander as a temporary placeholder for the breast implant. The breast expander is very much like a balloon, but in the exact shape of your breast implant.
I insert the deflated breast expander into the breast pocket I created. Then, I inflate the breast expander to match your desired volume. Inflating the breast expander allows me to see what your breasts will look like before I place your permanent breast implants.
With the breast sizer in place, I will make the final decision on which breast implant size to choose. Choosing the best breast implant size, shape, and position is based on a patient’s desired breast volume, breast shape, and breast skin capacity, to name just a few factors.
Both breast tissue expanders are inserted and inflated in the implant pockets. This maneuver helps in the dissection and minimizes the chances of over-dissecting the breast implant pocket. Once I achieve the correct breast size and shape, I remove the temporary breast expanders. Then, the permanent breast implants are placed.
Step 4 – Insertion
Now that I have both breast implants in place, I elevate you in a sitting position on the operating room table. I step back, and for the first time, I can get a look at your new, full breasts. Now, it is on to the breast lift portion of the procedure. My goal is to position the nipple at the dome of the breast.
Step 5- The Crescent Lift
To make sure I lift each breast to the same position, I use a “tick-tock technique.” I use a temporary suture to measure the distance from the top of the sternum to the top of the areola. Then, I swing the thread (like a grandfather clock) to the other breast to mark where the top of that areola should begin. Equal measurements ensure that the distance from the top of the sternum to each nipple areola complex is the same.
Plastic surgeons call it a “crescent breast lift” because the skin that is excised is in the shape of a crescent. If your areola were a clock, the incision would begin at 9:00, follow the areola upward to 12:00, and back down to 3:00.
Sewing you up is the last step. I place strong, dissolvable sutures. Since these sutures are dissolvable, the sutures do not need to be removed.
So, that’s it! Those are the five steps I follow for silicone breast augmentation and a breast lift with a crescent lift method. The procedure takes around two to three hours. You can return to work after five to seven days. Full recovery takes around two to three weeks. I ask that you try not to use your chest muscles for about one month.
If you have saggy breasts, maybe after weight loss or after having children, and you are looking for a fix, please give me, Dr. Katzen, a call at (310) 869-7770. Consultations are FREE!