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Combining breast augmentation with a breast lift is often the best procedure for those who have deflated and sagging breasts. If the nipple is at or above the breast fold, then usually an augmentation alone will fill and lift the breast, however if the nipple is below the fold, then frequently a breast lift is required as well to provide an ideal shape. If a small augmentation is needed, then a silicon gel implant is often an ideal solution to provide the most natural appearance. On the other hand, many women seeking breast augmentation want more than a small augmentation, and this can sometimes lead to problems when the two procedures are combined.

A mastopexy involves an incision around the areola, and a vertical incision if the lower breast skin needs tightening as well. Placing a medium or large implant at the same time as the mastopexy procedure can result in excessive tension on the wounds as they heal, resulting in delayed healing at times, poor scars, and even loss of nipple skin occasionally.

To decrease the initial tension on the incisions I now use the Mentor Spectrum Adjustable implant with all combined mastopexy augmentation using saline implants. If the patient chooses to have silicon gel implants, and agrees to participate in the appropriate gel implant study protocols, then I will use gel implants, but only up to 250cc. The Spectrum implant has a valve, which can be connected to the implant through a thin tube, and the valve can be left outside the skin for 7-10 days, allowing the implant to be filled and adjusted after the procedure.

The procedure involves placing the implant in the usual fashion, usually submuscular, and completing the mastopexy. At the end of the procedure the saline is removed so that only 150cc is left in the implant. At the one-week postoperative visit, the implants are inflated to the desired final fill volume, and then the fill tubes are removed with a gentle tug. Occasionally, if there is a question about symmetry, or with very large implants, we may take a few days to inflate the implants.

I have found this approach to have many advantages, the most significant of which is a tension free wound, which results in better healing, and much better scars. Even just one week of tension free healing, allowing swelling to subside before inflating the implants, seems to have made a great improvement in the quality of the scars. This has been my experience with circumareolar and vertical scar mastopexy procedures. In addition, I have found this technique valuable in obtaining better symmetry as well, as the implants are adjusted after much of the surgical swelling has subsided.

Attached photo set shows circumareolar lift with Spectrum implants for severe asymmetry and tubular deformity. Spectrum implants – inflated to 395 cc on left and 370cc on right with lowering of folds, 6 months post-op.

Disadvantages Once that port is removed, (which requires another minor surgery) the implant cannot be deflated and re-inflated as can the standard smooth round. This would be necessary if a capsule contracture were to occur, or the pocket needed to be repaired due to stretching of mal-position of the implant due to problems with the  pocket, e.g., the implants settling in too low, etc. They would have to be removed intact, which requires a longer incision and scar, and risks injuring the implant. Also, every time the implant port is accessed, i.e., with a needle or to be removed, there is a risk, albeit small, of introducing an infection. The doctor should probably cover you with antibiotics for a couple of days each time this is done.

Spectrum Adjustable Implants - Specs - Sizes

Spectrum Smooth Round

The volume of Spectrum™ breast implants may be adjustable after surgery. This means you can reduce or enlarge the implants during a simple office procedure for up to six months after your surgery.

Siltex (textured) Round Spectrum

Siltex (textured) Contour (Anatomical) Profile Spectrum

Please Note: Individual implant dimensions may vary slightly in products of this type. Not all units will conform exactly to the dimensions noted above.