What’s the difference between a breast augmentation mammoplasty and breast augmentation mastopexy, or are they both the same thing (BAM)? I’ve been told I might need the mastopexy version with my implants.
A mastopexy is another word for a breast ‘lift’. A breast augmentation mastopexy is a combined breast enlargement and lifting procedure; it involves the placement of an implant to increase breast size and fill out the skin, while excess skin is removed and the nipple is lifted to sit higher on the new breast shape. Incisions are made around the nipple, with a single vertical incision down the middle of the lower breast, and in the inframammary fold.
A breast augmentation mammoplasty, on the other hand, is commonly referred to as a ‘BAM’ involves the placement of an implant, normally using a single incision in the inframammary fold of each breast.
Mastopexies can be performed on their own to lift a breast, or in combination with an augmentation to lift and enlarge.
There are a few reasons why your surgeon may recommend a mastopexy with your augmentation. For some women, the position of their nipple and areola complex sits lower on their chest.
This can be due to weight loss, genetics, breastfeeding or the natural ageing process.
If the nipple and areola sits below the inframammary fold (see right), this is classified as ‘nipple ptosis’. There are various grades of ptosis.
When seeking breast augmentation, it is often the case that an implant alone will not move the nipple upward enough so that it’s centered on the implant, forming a more pleasing shape. A mastopexy may be recommended as part of your surgical plan. Mastopexy removes skin, lifts the nipple and reshapes the breast; there are various techniques for mastopexy and it’s important to ask your surgeon to explain and show you a picture of their recommended approach, and scar placement, so you know what to expect. My typical incision placement is shown in the first set of before and after images below.
Patients often wish to avoid a mastopexy for understandable reasons, and shop around for surgeons to find one willing to do the augmentation without a lift. However, if your specialist plastic surgeon has advised you that a lift is indicated to achieve a good result, it’s because they’ve seen enough to know that both you, and your surgeon, will eventually be disappointed with the outcome of an augmentation alone. While your scars will always be visible, if you are concerned about scarring after a mastopexy, ask your surgeon to create a scar reduction plan for you to commence straight after your surgery. Our mastopexy patients receive a scar reduction treatment plan included as part of their surgery with us, however many indicate that they don’t even feel the need to utilise the full program, as they’re satisfied with how their scars have matured and faded with just the use of topical scar reduction products, massage and time.
A final note about ‘borderline’ or ‘pseudoptosis’ - whereby the nipples/areola is sitting lower on the breast, but not entirely below the inframammary fold. After discussing the pros and cons, your surgeon may be able to use a well-chosen implant and pocket placement to utilise the augmentation for a slight lift of the nipple/areola, instead of performing a mastopexy. In these cases, it’s important for the patient to understand that they may require a mastopexy further down the track if the ageing process or weight fluctuations cause more sagging.
These photos show a patient who had clinical ptosis and wanted a fuller breast with a higher-sitting nipple/area complex. She underwent a breast augmentation mastopexy as a combined procedure, with a typical ‘lollypop’ scar. Photos show results at 6 weeks post surgery.