Mastopexy with or without implants?

Mastopexy is much more than a procedure; it’s a wellness choice for those who want to regain the shape of their breasts.
Often confused with other procedures, such as breast augmentation or reduction, mastopexy’s main goal is to address breast ptosis, meaning the drooping of the nipple-areola complex and the entire mammary gland, which can occur after pregnancies, significant weight loss, or as a result of aging and gravity.

«It’s a more complex procedure than either a reduction or an augmentation. There can be different variables depending on the patient: such as skin quality and the quality of the mammary gland, while also taking into account the patient’s wishes – explains Antonio Russo, specialist in reconstructive and aesthetic plastic surgery at the Reconstructive and Aesthetic Plastic Surgery Unit of Ospedale Maggiore in Novara -. The conditio sine qua non for performing a mastopexy without implants is the presence of a sufficiently represented mammary gland».

Mastopexy techniques to lift the mammary gland

The descent of the mammary gland can be more or less severe, and therefore different techniques and approaches can be used to lift the gland, that is, to perform a mastopexy.

Mastopexy can be performed using various techniques, «such as periareolar techniques, vertical techniques, or incisions that include the inframammary fold. It can also involve the use of a breast implant».
The essential difference between mastopexy with or without implants depends on the amount of remaining breast tissue.
If the mammary gland is sufficiently present, it’s possible to lift it using plastic surgery techniques without the use of implants.

«In some cases, we reduce the amount of skin, and we can also add autologous fat tissue, more commonly known as lipofilling», Russo continues.
To determine the appropriate procedure, the patient’s anatomical features are carefully assessed: from the skin quality and presence of excessive laxity, to the amount of fat tissue and the quality of the mammary gland itself.

On the contrary, the use of an implant becomes necessary to restore volume and give the breast a harmonious shape.

What to know for an informed choice

Like any surgical procedure, mastopexy also carries risks, which vary depending on the technique used.

«When implants are involved, the risks are those typical of any breast implant: capsular contracture, possible infection, or a deformity known as waterfall deformity, where the gland droops over the implant. These issues can stem from capsule contracture or incorrect surgical planning».

Even without implants, these specific risks are absent, but other potential complications remain, Russo continues, «such as issues with blood supply to the nipple-areola complex, recurrence of gland sagging, which can lead to patient dissatisfaction, and the presence of scars, which are obviously part of both surgical procedures».

Managing scars after surgery

Post-operative recovery from mastopexy depends on various factors: the surgical technique used, the presence or absence of implants, and the patient’s physical characteristics and activity levels.

«I normally advise avoiding intense physical activity and work for about three to four weeks. During this time, the patient should wear a support bra day and night to stabilize the breast. Afterward, the bra should continue to be worn during any physical exertion for around two months».

A key point is scar management, which is an inevitable result of mastopexy. Scars can appear around the areola, along the vertical axis of the breast, and often along the inframammary fold in what’s known as an “inverted T” pattern. The location and extent of the scarring depend both on the technique used and the patient’s anatomy.

Implants or no implants?

The decision to use a breast implant during mastopexy is dictated by the mammary gland. The surgeon explains:

«If there is a sufficiently represented mammary gland that is ptotic, that is, drooping, it is possible to perform a mastopexy without a breast implant».
However, if the gland volume is insufficient to carry out a proper lift of the gland itself, the use of an implant becomes necessary.
«Of course, everything must also align with the patient’s wishes, because if she desires a higher breast with a more prominent upper pole, then sometimes an implant is necessary».

The doctor also notes: «An implant can provide greater long-term stability, because the volume is maintained by the implant, and the reshaped skin around it tends to hold its shape better over time compared to mastopexy without implants».

Type of implant depends on patient anatomy and preference

«We generally use round or ergonomic implants because when there’s ptosis, the upper pole of the breast is where the volume is most lacking. A round or ergonomic implant allows for greater filling of that upper area».