What are Your Options?

By: Mr Philip Turton
Created on 25th March 2010

Specialist breast surgeon Mr Philip Turton discusses what options are available when contemplating breast surgery

Uplifting results
Some women just have very marked breast droop but the breast size is normal or small. These patients may benefit from a mastopexy or uplift. A full ‘wise pattern' mastopexy includes an anchor shaped incision, removal of the loose skin, relocation of the main breast tissue higher on the chest wall, with repositioning of the nipple so that it is in a more youthful position.

The fuller picture
Breast augmentation remains the most popular cosmetic surgery procedure for women but an experienced breast surgeon can mean the difference between a good result and a fantastic result. The consultation is an incredibly important part of getting the best outcome for you.

I believe in having incredibly detailed consultations to assess the patient's situation, medical history, suitability for breast enlargement, and to perform the biodimensional assessment. You will have a full breast exam, and comprehensive measurements made of your frame, existing breast size, etc. The implants will also be discussed.

I advise strongly against a very large augmentation that takes your breast size excessively out of proportion to your frame. Most of my patients desire to be a C to D cup, although cup size can not be explicitly guaranteed, but if a patient asks for a size that is much larger than their assessment suggests then I make them aware of the possible complications, such as breast tissue sag, palpability, less natural appearance, numbness, backache and future malposition.

Asking for a natural shape augmentation is common and I find that the anatomical implants and the new round implants produce the most natural shape of breast enhancement. Not many of my patients request a prominent rounded appearance in the upper bust, but this can be readily achieved if desired.

Breast augmentation may make you feel more confident but will not change things if you are dissatisfied with your lifestyle. Surgery in itself will not change a life situation, but the confidence which results from it can indeed empower you to make the required changes, allowing you to live and enjoy your life, to the full.

More than a handful
Breast reduction surgery has become very common in the last ten years as women realise that they do not have to put up with having breasts which they perceive as overly large. Women requesting breast reduction surgery now vary in age from their 20s to their 70s.

For most breast reductions there will be a scar around the new areola margin, vertically down to the crease of the breast and along the under-crease of the breast (an anchor shape scar and sometimes called the ‘wise pattern'). The scar in the undercrease of the breast contributes a great deal to the reshaping if you have large breasts or breast droop and, because of its position, is not normally that conspicuous.

Most women request a reduction to a C or D cup. This is often achieved, but above all the specialist surgeon will want to protect the blood supply to the nipple and areola throughout the operation. This means that resection of the breast tissue cannot be performed in isolation to the protection of the blood supply. It is quite usual to need to maintain the blood supply by preserving more breast tissue under the nipple in people with very large breasts. This may mean being reduced to a DD instead of a D, for example.

Perfect balance
Some patients who are considering cosmetic breast surgery have very marked differences (asymmetry) between their two breasts which they are already aware of. Other patients are unaware of more subtle differences that exist and unless their surgeon is experienced at recognising this, those differences can be missed and if these are not identified prior to surgery, it is possible that they will be more obvious to patients after surgery.

Where there is an obvious difference in breast size but nipple height is similar, the options include using different size breast implants. If one breast is significantly larger than the other and there is also breast droop present, then a combination of partial breast reduction and partial breast uplift is often a very good option.

A fairly common situation after pregnancy or breast feeding is for one nipple to appear lower. This can also occur as a developmental problem during adolescence that gradually gets worse. Patients will normally always identify the less drooping breast as the one that they want to match. If the good breast has a nice size and shape, the preferred option is for a breast mastopexy (uplift and minor reduction) on the other side.

The bigger the difference between the two breasts the more careful one has to be. It is not always possible to correct major differences in one go. Tuberous breast problems are a good example of this where one breast has developed into a sausage-shaped projection in the most severe form, or the crease under the breast is much higher than it should be.

For the more severe cases of tuberous breast correction, I will plan a series of operations that usually include elements derived from breast augmentation, areola reduction techniques as well as corrections to nipple height.

In conclusion

There are many different options available in breast surgery and it is the job of an experienced cosmetic surgeon to determine which procedure, or combination of procedures, will produce the best result and fulfil a patient's expectations. Most of my patients have a good idea of what they want to look like after surgery and it is my goal to get them there.