Breast Surgery: The Path to a Natural Result Begins with a Personal Consultation

A breast lift is suitable for patients who have sufficient natural breast volume but are concerned about a loss of firmness, sagging, or low-positioned areolae and nipples. The aim is not to enlarge the breasts substantially, but to reshape them, remove excess skin and move the areola and nipple into a more natural position.

The extent of the lift depends on the degree of sagging and the quality of the skin. With mild sagging, a periareolar breast lift, performed through an incision around the areola, may be sufficient. This technique can also reduce the size of an overly large areola. When the skin is more significantly stretched, a more extensive lift is required, resulting in an anchor-shaped or inverted-T scar around the areola, vertically downwards and along the inframammary fold.

When the breasts lack volume and have also lost firmness or are sagging, a combination of an implant and a breast lift may be appropriate. The implant restores the desired volume, while the lift removes excess skin, reshapes the breast and moves the areola and nipple into a more natural position.

This procedure is more demanding than breast augmentation alone because it increases volume and removes excess skin during the same operation. The two steps must be precisely balanced. An implant that is too large could increase tension on the scars and place excessive strain on tissues that are already lax.

“When breast augmentation is combined with a lift, the implant size must be selected with two opposing factors in mind. On the one hand, the implant must not be too large, as this would increase tension in the skin and scars. On the other hand, we must take into account that, during the lift, a smaller or larger amount of skin and fatty tissue may also be removed from the lower pole and the inframammary fold,” explains plastic surgeon MUDr. Vatľak.

The implant must therefore not only provide the desired volume but may also need to replace volume removed during the breast lift. Its size is always determined individually according to the extent of the procedure, the thickness of the tissues and the desired result.

Breast augmentation alone is primarily suitable for patients who lack volume but do not have significant breast sagging.

A breast lift is suitable when breast volume is sufficient but the breasts have lost firmness, are sagging or have low-positioned areolae.

Breast augmentation combined with a lift is suitable when the breasts lack volume and have also lost firmness or are sagging.

“In most appropriately selected patients, breast augmentation and a lift can be performed during a single operation. In some cases, however, it may be safer to divide the treatment into two stages. The decision depends on the degree of sagging, skin quality, the desired implant size and the overall size of the breasts,” explains MUDr. Vatľak.

In breasts with a favourable initial shape, a correctly selected implant can produce a very attractive and natural-looking result. The situation becomes more complex when there is marked asymmetry, an irregular shape or a congenital breast difference. In these cases, inserting an implant alone may not be sufficient and could sometimes make the original irregularity more noticeable.

A typical example is tuberous, or tubular, breasts. In this condition, the lower pole of the breast is often underdeveloped, the breast base may be narrower, and the areola may be enlarged or protruding. Although an implant can add volume, it may not correct the underlying shape abnormality. Breast augmentation therefore often needs to be combined with a periareolar lift and sometimes with internal reshaping of the breast tissue. During this step, the patient’s own breast tissue is released, reshaped and moved to the areas where volume is lacking, most often into the lower quadrants of the breast. The aim is not simply to enlarge the breasts, but to create a more natural shape and a smoother lower pole.

Asymmetry and the limits of the result

A certain degree of asymmetry in the breasts and areolae is natural and is present in most women. During a breast lift, the areola can be moved upwards relatively effectively. Moving it sideways, either inwards or outwards, is technically more limited.

For example, if one areola points more towards the outside, its position can be adjusted partially towards the centre of the chest, but complete symmetry may not always be achievable. The final position of the areolae may therefore remain slightly asymmetrical even after a correctly performed operation.

“It is important to discuss these limitations before surgery. The aim is to reduce asymmetry as much as possible, not to promise mirror-image symmetry, which practically does not exist in the human body,” says MUDr. Vatľak.

Large areolae and residual pigmentation

With very wide areolae, the original pigmentation may extend beyond the area planned for the breast lift. A small area of residual pigmented skin may therefore remain after surgery, most often at the lower part of the areola and the upper end of the vertical scar.

This is generally not a serious problem, but rather a detail related to the original size of the areola and the limits of a safe surgical design. If the pigmentation remains bothersome after healing, it can be adjusted later with a minor secondary correction.

The long-term result of breast surgery is influenced not only by the surgical technique and implant size, but also by the quality of the skin and connective tissues. In very thin, lax or heavily stretch-marked skin, the early postoperative result may be very attractive, but the tissues can gradually loosen again over time.

“The breasts usually do not return to their original condition, but some descent of the lower pole or a renewed excess of skin may occur. In certain cases, a minor correction may therefore be appropriate later, removing some of the loosened skin along the vertical scar and the inframammary fold. Such a secondary procedure does not necessarily mean that the first operation was performed incorrectly. It may be the result of less favourable properties of the original tissues, which surgery cannot completely change. This is why it is important to assess the condition of the skin and breast tissue as accurately as possible before surgery and to discuss openly with the patient not only the expected result, but also its limitations and long-term development,” explains plastic surgeon MUDr. Vatľak.

During the consultation, we discuss the advantages, disadvantages and limitations of the individual methods. The decision-making process also includes the size and shape of the implant, implant placement, the type of breast lift, the position of the scars and a realistic assessment of what can be achieved in view of the patient’s anatomy. In some cases, breast augmentation alone is appropriate; in others, a breast lift or a combination of the two procedures is the better option. The correct approach is based on body proportions, tissue quality, the original shape of the breasts and a shared understanding between the patient and the plastic surgeon.

“An in-person consultation helps determine which option best matches the patient’s wishes and anatomical possibilities. The result should not simply be larger or more lifted breasts, but above all a natural shape that is in harmony with the entire body. A good result does not come from choosing an implant alone, but from correctly addressing the breast’s entire original shape,” concludes MUDr. Vatľak.