If you have significant sagging, breast augmentation alone may not lift the nipple and areola enough The result is a breast that droops over the implant, known as a snoopy deformity. If the nipple only needs moving up under 2cm and there is not significant skin laxity a nipple lift may suffice. If laxity is more significant a breast lift may be required with your breast augmentation to avoid a snoopy deformity. It is possible to do both procedures in a single operation if you are conservative with both procedures. What is a breast augmentation with a lift? Actually, the two procedures essentially work against each other in a physical sense. The breast lift tightens the skin brassiere and the implant expands the breast volume and places stress on the scars of the breast lift. So, if you are looking for a conservative increase in volume and a conservative lift you can achieve good results in one operation with slightly higher but acceptable risks of complications, like wound breakdown. If however, you need a significant lift and choose to have a large implant for volumisation, your risk of wound complications may be too high. Doing the breast lift first and letting the wounds heal for two to three months before having a second operation to insert the implants may give a significantly lower risk of complications and better overall aesthetic results. Dr Raja will assess your individual situation, desires and risk factors. He will then explain the options, relative risks and benefits of each before coming to a decision with you on a plan for your chosen procedures. It is certainly easier for Dr Raja to perform both procedures together and see you through a single recovery period and time off work. What is the recovery like? The recovery for both procedures together rather than either one alone is not too dissimilar. There is a cost benefit to you too from a hospital and anaesthetist fees perspective and the Sculpted Clinic does offer packages of procedures performed together if Dr Raja deems it safe to do them in one sitting for that patient. The most important patient factor here is smoking and it is imperative that smoking be stopped for six weeks prior and after a breast lift procedure especially if with an implant. Smoking constricts blood vessels and decreases healing capacity. Breast lift scars have a significantly higher chance of breaking down in smokers due to the tension required to be put on the scar to achieve skin tightening and a rejuvenated youthful look. Smoking can also cause nipple and areolar death by constricting the blood vessels to these tissues. Other significant risk factors are diabetes, immunosuppression, excess weight and any serious medical condition. Breast lift scars (with augmentation) Scars required for a breast lift vary depending on the amount and direction of skin laxity. If a conservative lift only is required and vertical laxity is small a scar around the areola in the form of a nipple lift (periareolar mastopexy) may suffice. The breast implant may be placed through these incisions but often using a small scar in the fold below the breast gives better control of the pocket dissection and avoids going through the breast tissue itself. This in turn reduces risk of infection and capsular contracture. If laxity is more significant you may need a breast lift with your augmentation. If the additional laxity is moderate, a vertical scar maybe required extending from the areola scar to almost the fold below the breast. This is called a circumvertical mastopexy and a breast implant can easily be placed behind the breast or muscle with these scars. If skin laxity is more pronounced, you may require a full anchor scar involving scars around the areola, a vertical scar from the lowest point of the areolar scar to the fold below the breast and a scar in the curved horizontal fold below the breast. 3D-imaging with Vectra cannot predict nipple or breast lift capacity of an implant in a patient with breast droop or sag. FAQs How long does a nipple lift procedure take? A nipple lift on its own can take up to an hour to perform. Depending on your anaesthetic there may be one to two hours in recovery before you can go home. You will read about this procedure being done in lunch breaks and you can go back to work that afternoon. The local anaesthetic can last up to 12-16 hours and you should be fairly comfortable when you leave that day. As that local anaesthetic wears off you will need some painkillers and rest. When can I exercise/swim/surf after a nipple lift procedure? You can commence low level leg aerobic exercises and cycling machines at low stress in two to three days and guided by your pain. The aim is not to raise your blood pressure too much (that can cause bleeding) or pull hard on the good work. Significant aerobic exercise and low-level exercises involving the chest should be avoided for two to three weeks to allow your wounds to heal. No weight training/ high-level aerobic exercise involving the chest should be done for six weeks. No swimming until the wounds are sealed, as water may seep into your wounds and cause infections. This usually takes two to three weeks and you can ask about it at your follow-up appointments at week one and two. Same goes for sitting in a bath. Surfing is high-level aerobic exercise involving the chest, so six weeks is appropriate. Dr Raja Sawhney will individualise your exercise plan to suit your procedure, your predicted response to that procedure and your usual exercise regime and fitness aims. What should I do after a nipple lift procedure? It is time to take it easy for the first few days after the procedure. You can shower the next day and the tape can get wet. You can pat the area with a towel but don’t rub it, the tape will dry quickly, and you can get dressed. If you have minor bleeding spots these will settle with light pressure with a pad or gauze for five minutes. You can put some gauze or a pad in your bra to protect your bra and clothes from minor bleeding. What is the cost of a nipple lift? It is important for you and Dr Raja Sawhney to know whether you are a good candidate for this procedure before considering costs. When you have your first consultation you can speak to his practice staff who can give you an accurate quote. Also, this procedure is mostly done in conjunction with breast augmentation where some of the costs may be absorbed by the costs of that procedure. What anaesthetic/pain relief is required for a nipple lift? A nipple lift can be performed under local anaesthetic, but this is a very sensitive area, so sedation is advised. You may choose to have a short general anaesthetic. You must have an empty stomach before any sedation or general anaesthetic can be given and this requires not drinking or eating anything for six hours prior to your procedure. If you have foodstuff in your stomach and you vomit in reaction to the anaesthetic or procedure, you can inhale this vomit into your lungs and become very sick, even ending up in ICU on a ventilator. Your anaesthetist will clarify that you have fasted appropriately prior to your procedure. After any sedation or general anaesthesia, you will need to stay in recovery for two hours before going home and need to be accompanied by a mature adult when leaving. An adult should be with you after any significant procedure for the first 24 hours. You may have effects from the anaesthetic or the procedure that may mean you need adult help. The local anaesthetic will keep you comfortable until that evening or the next morning, depending on what time of day your procedure is done. We recommend you take some basic pain relief before going to bed for a better chance of a good night’s sleep. You will be given pain killers to take for the subsequent few days and by a week you should usually only need intermittent, basic over the counter painkillers. For a confidential and comprehensive appointment with Dr Raja Sawhney, click here. Before and after images Magnifying Glass Patient 1 Magnifying Glass Patient 2 Don’t forget to share this via Twitter, Google+, Pinterest and LinkedIn.